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Outcomes of ileal pouch-anal anastomosis without primary diverting loop ileostomy if postoperative sepsis develops

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Abstract

Background

The aim of the present study was to assess the short-term and long-term consequences of diverting loop ileostomy (DLI) omission in ileal pouch-anal anastomosis (IPAA) surgery complicated by postoperative pelvic sepsis.

Methods

This was a retrospective review of a prospectively maintained database. Of 4031 patients who underwent IPAA in 1983–2014, 357 developed IPAA-related pelvic sepsis with or without anastomotic dehiscence. Patients with Crohn’s disease or cancer were excluded. The patient cohort was divided into two groups, depending on the presence or absence of DLI. Patient characteristics, short-term and long-term outcomes were compared. Long-term pouch survival was estimated with the Kaplan–Meier method. Quality of life (QOL) in the groups was compared at the latest follow-up.

Results

Three hundred and twenty-six patients developing pelvic sepsis had diversion at the time of IPAA (D group) and in 31 who developed pelvic sepsis DLI had been omitted (O group). The length of hospital stay was significantly longer in the O group 11.5 (3–33) days versus 8 (2–59) days in the D group (p = 0.006). Forty-eight percent of patients from the O group with anastomotic leak underwent reoperation and had a DLI formed at this second procedure versus 12% in the D group requiring reoperation (p < 0.0001). In long-term follow-up, there was no difference in pouch survival between the groups: 99 versus 97% after 5 years and 88 versus 87% after 10 years, in the O group and D group, respectively (p = 0.40). There was no difference in QOL observed between the groups.

Conclusions

Omission of DLI in selected patients who had IPAA surgery did not increase pouch failure or adversely affect QOL in the long term, if pelvic sepsis occurred.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue/A30, Cleveland, OH, 44195, USA

    O. A. Lavryk, T. L. Hull, L. C. Duraes, L. Stocchi, J. H. Ashburn, D. Liska, E. Gorgun & H. Kessler

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  1. O. A. Lavryk
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  2. T. L. Hull
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  3. L. C. Duraes
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  4. L. Stocchi
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  5. J. H. Ashburn
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  6. D. Liska
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  7. E. Gorgun
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  8. H. Kessler
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Corresponding author

Correspondence to H. Kessler.

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The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by an institutional review board committee and meet all necessary governmental criteria.

Informed consent

Informed consent was waived due to retrospective nature of the study.

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Lavryk, O.A., Hull, T.L., Duraes, L.C. et al. Outcomes of ileal pouch-anal anastomosis without primary diverting loop ileostomy if postoperative sepsis develops. Tech Coloproctol 22, 37–44 (2018). https://doi.org/10.1007/s10151-017-1737-2

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  • DOI: https://doi.org/10.1007/s10151-017-1737-2

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