Skip to main content
SpringerLink
Log in

Feasibility of early closure of loop ileostomies

a pilot study

  • Published:
Diseases of the Colon & Rectum

Purpose

A loop ileostomy is constructed to protect a distal anastomosis, and closure is usually performed not earlier than after two to three months. Earlier closure might reduce stoma-related morbidity, improve quality of life, and still effectively protect the distal anastomosis. This pilot study was designed to investigate the feasibility of early closure of loop ileostomies, i.e., during the same hospital admission as the initial operation. METHODS: Twenty-seven consecutive patients with a protective loop ileostomy were included. If patient’s recovery was uneventful, water-soluble contrast enema examination was performed, preferably after seven to eight days. If no radiologie signs of leakage were detected, the ileostomy was closed during the same hospital admission. RESULTS: Twenty-seven patients (8 females; mean age, 60 years) were analyzed. Eighteen patients had early ileostomy closure on average 11 (range, 7-21) days after the initial procedure. In nine patients the procedure was postponed because of leakage of the anastomosis (n = 3), delayed recovery (n = 1), small bowel obstruction (n = 1), gastroparesis (n = 1), logistic reasons (n = 2), or irradical cancer resection followed by radiotherapy (n = 1). There was no mortality and four mild complications occurred after early closure: superficial wound infection (n = 2), intravenous-catheter sepsis (n = 1), small bowel obstruction (n = 1). CONCLUSION: Closure of a loop ileostomy early after the initial operation was feasible in 18 of 27 patients and was associated with low morbidity and no mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rolandelli RH, Roslyn JJ. Colon and rectum. In: Townsend CM, ed. Sabiston textbook of surgery. Philadelphia: WB Saunders, 2001:929–73.

    Google Scholar 

  2. Williams NS, Nasmyth DG, Jones D, Smith AH. Defunctioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy. Br J Surg 1986, 73:566–70.

    Article  PubMed  CAS  Google Scholar 

  3. Rullier E, Le Toux N, Laurent C, Garrelon JL, Parneix M, Saric J. Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery. World J Surg 2001;25:274–7.

    Article  PubMed  CAS  Google Scholar 

  4. Edwards DP, Leppington-Clarke A, Sexton R, Heald RJ, Moran BJ. Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial. Br J Surg 2001; 88:360–3.

    Article  PubMed  CAS  Google Scholar 

  5. Shellito PC. Complications of abdominal stoma surgery. Dis Colon Rectum 1998;4l:1562–72.

    Article  Google Scholar 

  6. Winslet MC, Barsoum G, Pringle W, Fox K, Keighley MR. Loop ileostomy after ileal pouch-anal anastomosis: is it necessary? Dis Colon Rectum 1991;34:267–70.

    Article  PubMed  CAS  Google Scholar 

  7. Keighley MR, Williams NS. Ileostomy. In: Keigley MR, Williams NS, eds. Surgery of the anus, rectum and colon. Philadelphia: WB Saunders, 1993:139–99.

    Google Scholar 

  8. Senapati A, Nicholls RJ, Ritchie JK, Tibbs CJ, Hawley PR. Temporary loop ileostomy for restorative proctocolectomy. Br J Surg 1993;80:628–30.

    Article  PubMed  CAS  Google Scholar 

  9. Phang PT, Hain JM, Perez-Ramirez JJ, Madoff RD, Gemlo BT. Techniques and complications of ileostomy takedown. Am J Surg 1999; 177:463–6.

    Article  PubMed  CAS  Google Scholar 

  10. Adang EM, Engel GL, Rutten FF, Geerdes BP, Baeten CG. Cost-effectiveness of dynamic graciloplasty in patients with fecal incontinence. Dis Colon Rectum 1998; 41:725–34.

    Article  PubMed  CAS  Google Scholar 

  11. Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG. Quality of life with a temporary stoma: ileostomy vs. colostomy. Dis Colon Rectum 2000;43:650–5.

    Article  PubMed  CAS  Google Scholar 

  12. Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG. Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy. Br J Surg 1998;85:76–9.

    Article  PubMed  CAS  Google Scholar 

  13. O’Leary DP, Fide CJ, Foy C, Lucarotti ME. Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma. Br J Surg 2001;88:12l6–20.

    Article  Google Scholar 

  14. O’Toole GC, Hyland JM, Grant DC, Barry MK. Defunctioning loop ileostomy: a prospective audit. J Am Coll Surg 1999;188:6–9.

    Article  PubMed  CAS  Google Scholar 

  15. Poon RT, Chu KW, Ho JW, Chan CW, Law WL, Wong J. Prospective evaluation of selective defunctioning stoma for low anterior resection with total mesorectal excision. World J Surg 1999;23:463–8.

    Article  PubMed  CAS  Google Scholar 

  16. Marusch F, Koch A, Schmidt U,et al. Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum 2002;45:1164–71.

    Article  PubMed  Google Scholar 

  17. Golub R, Golub RW, Cantu R Jr, Stein HD. A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am Coll Surg 1997;184:364–72.

    PubMed  CAS  Google Scholar 

  18. Karanjia ND, Corder AP, Beam P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 1994; 81:1224–6.

    Article  PubMed  CAS  Google Scholar 

  19. Fielding LP, Stewart-Brown S, Hittinger R, Blesovsky L. Covering stoma for elective anterior resection of the rectum: an outmoded operation? Am J Surg 1984; 147:524–30.

    Article  PubMed  CAS  Google Scholar 

  20. Machado M, Hallböök O, Goldman S, Nyström P-O, Jarhult J, Sjödahl R. Defunctioning stoma in low anterior resection with colonie pouch for rectal cancer: a comparison between two hospitals with a different policy. Dis Colon Rectum 2002;45:940–5.

    Article  PubMed  Google Scholar 

  21. Luna-Perez P, Rodriguez-Ramirez S, Hernandez- Pacheco F, Gutierrez DL, Fernandez R, Labastida S. Anal sphincter preservation in locally advanced low rectal adenocarcinoma after preoperative chemoradiation therapy and coloanal anastomosis. J Surg Oncol 2003; 82:3–9.

    Article  PubMed  Google Scholar 

  22. Kim NK, Lim DJ, Yun SH, Sohn SK, Min JS. Ultralow anterior resection and coloanal anastomosis for distal rectal cancer: functional and oncological results. Int J Colorectal Dis 2001;l6:234–7.

    Article  Google Scholar 

  23. Cavaliere F, Pemberton JH, Cosimelli M, Fazio VW, Beart RW Jr. Coloanal anastomosis for rectal cancer: long-term results at the Mayo and Cleveland Clinics. Dis Colon Rectum 1995;38:807–12.

    Article  PubMed  CAS  Google Scholar 

  24. Irving M, O’Dwyer S. Surgical management of anastomotic and intra-abdominal sepsis. In: Fielding LP, Goldberg SM, eds. Surgery of the colon, rectum and anus. London: Chapman & Hall Medical, 1996:93–104.

    Google Scholar 

  25. Nag D, Rogers CE, Nolan DJ. Early abdominal complications of intestinal surgery: the radiologist’s role in management. Br J Hosp Med 1989;42:214–22.

    PubMed  CAS  Google Scholar 

  26. Hallböök O, Sjödahl R. Anastomotic leakage and functional outcome after anterior resection of the rectum. Br J Surg 1996;83:60–2.

    Article  PubMed  Google Scholar 

  27. Karanjia ND, Corder AP, Holdsworth PJ, Heald RJ. Risk of peritonitis and fatal septicaemia and the need to defunction the low anastomosis. Br J Surg 1991;78:196–8.

    Article  PubMed  CAS  Google Scholar 

  28. Nesbakken A, Nygaard K, Lunde OC. Outcome and late functional results after anastomotic leakage following mesorectal excision for rectal cancer. Br J Surg 2001;88:400–4.

    Article  PubMed  CAS  Google Scholar 

  29. Everett WG. Suture materials in general surgery. Prog Surg 1970;8:14–37.

    PubMed  CAS  Google Scholar 

  30. Skakun GB, Reznick RK, Bailey HR, Smith KW, Max E. The single-layer continuous polypropylene colon anastomosis: a prospective assessment using water-soluble contrast enemas. Dis Colon Rectum 1988;31:l63–8.

    Article  Google Scholar 

  31. Goligher JC, Morris C, McAdam WA, De Dombai FT, Johnston D. A controlled trial of inverting versus everting intestinal suture in clinical large-bowel surgery. Br J Surg 1970;57:817–22.

    Article  PubMed  CAS  Google Scholar 

  32. Shorthouse AJ, Bartram CI, Eyers AA, Thomson JP. The water-soluble contrast enema after rectal anastomosis. Br J Surg 1982;69:7l4–7.

    Article  Google Scholar 

  33. Haynes IG, Goldman M, Silverman SH, Alexander- Williams J, Keighley MR. Water-soluble contrast enema after colonie anastomosis. Lancet 1986;l:675–6.

    Article  Google Scholar 

  34. Fielding LP, Stewart-Brown S, Blesovsky L, Kearney G. Anastomotic integrity after operations for large-bowel cancer: a multicentre study. BMJ 1980;281:4ll-4.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands

    Roel Bakx M.D., Olivier R. C. Busch M.D., Willem A. Bemelman M.D., J. Frederik M. Slors M.D. & J. Jan B. van Lanschot M.D.

  2. Department of Surgery, Isala Clinics, Zwolle (previously Amstelveen General Hospital), The Netherlands

    Dirk van Geldere M.D.

Authors
  1. Roel Bakx M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Olivier R. C. Busch M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dirk van Geldere M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Willem A. Bemelman M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Frederik M. Slors M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Jan B. van Lanschot M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported in part by Dutch Digestive Diseases Foundation. Poster presentation at Digestive Disease Week, San Francisco, California, May 20, 2002. Presented at the meeting of the Dutch Society of Gastroenterology, Veldhoven, the Netherlands, March 21, 2002.

About this article

Cite this article

Bakx, R., Busch, O.R.C., van Geldere, D. et al. Feasibility of early closure of loop ileostomies. Dis Colon Rectum 46, 1680–1684 (2003). https://doi.org/10.1007/BF02660775

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02660775

Key words

Search

Navigation