Impact of defunctioning loop ileostomy on outcome after restorative proctocolectomy for ulcerative colitis

  • Rudolf Mennigen
  • Norbert Senninger
  • Matthias Bruwer
  • Emile Rijcken
Original Article
First Online:
Accepted:

Abstract

Purpose

This study analyzes the impact of a temporary loop ileostomy on postoperative outcome after restorative proctocolectomy for ulcerative colitis in terms of complications and reoperations including ileostomy closure.

Methods

The records of 122 consecutive patients undergoing restorative proctocolectomy for ulcerative colitis during a 12-year period were reviewed. In 89 patients, a defunctioning ileostomy was created, while 33 patients had no ileostomy. Statistics were done with Chi-square test and Mann–Whitney U test, p < 0.05 considered significant.

Results

Both study groups were comparable concerning age, colitis activity, previous diseases, previous surgery, use of steroids, and immunosuppressives. Pouch-related septic complications (anastomotic dehiscence, pouch leakage, pelvic abscess) were significantly lower in the ileostomy group (5.6% vs. 18.2%, p = 0.031), resulting in a lower rate of emergency laparotomies following restorative proctocolectomy (4.5% vs. 30.3%, p < 0.001). Including all complications associated with scheduled closure of ileostomy, the cumulative frequency of emergency laparotomies was significantly lower in the ileostomy group (13.5% vs. 30.3%, p = 0.032). The cumulative duration of hospitalization, including all hospital stays for complications or closure of the ileostomy, was significantly longer in the ileostomy group [median 22 days (11–92) vs. 14 days (9–109), p < 0.001]. During long-term follow-up, a stricture at the pouch-anal anastomosis was more common in the ileostomy group (24.7% vs. 6.1%, p = 0.021), whereas only one stricture necessitated surgical therapy.

Conclusions

Creation of a defunctioning loop ileostomy reduces pouch-related septic complications and the frequency of emergency second laparotomies after restorative proctocolectomy for ulcerative colitis.

Keywords

Ileostomy Restorative proctocolectomy Complications Ulcerative colitis 
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Notes

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Rudolf Mennigen
    • 1
  • Norbert Senninger
    • 1
  • Matthias Bruwer
    • 1
  • Emile Rijcken
    • 1
  1. 1.Department of General and Visceral SurgeryUniversity Hospital MuensterMuensterGermany

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