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

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International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of General and Visceral Surgery, University Hospital Muenster, Waldeyerstr. 1, 48149, Muenster, Germany

    Rudolf Mennigen, Norbert Senninger, Matthias Bruwer & Emile Rijcken

Authors
  1. Rudolf Mennigen
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  2. Norbert Senninger
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  3. Matthias Bruwer
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  4. Emile Rijcken
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Corresponding author

Correspondence to Rudolf Mennigen.

Additional information

This manuscript has, in part, been presented as oral presentation at the 127th Annual Meeting of the “Deutsche Gesellschaft für Chirurgie” (German Society for Surgery) on 20–23 April 2010, at Berlin, Germany.

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Mennigen, R., Senninger, N., Bruwer, M. et al. Impact of defunctioning loop ileostomy on outcome after restorative proctocolectomy for ulcerative colitis. Int J Colorectal Dis 26, 627–633 (2011). https://doi.org/10.1007/s00384-011-1151-6

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  • DOI: https://doi.org/10.1007/s00384-011-1151-6

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