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The Outcome After Restorative Proctocolectomy With or Without Defunctioning Ileostomy

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Diseases of the Colon & Rectum

Purpose

Controversy exists regarding the safety for omission of diverting ileostomy in restorative proctocolectomy because of fears of increased septic complications. This study was designed to evaluate the outcomes of restorative proctocolectomy in a consecutive series of patients by comparing postoperative complications, functional results, and quality of life in patients with and without diverting ileostomy.

Methods

Data regarding demographics, length of stay, surgical characteristics, and complications were reviewed and recorded according to the presence (n= 1,725) or absence (n = 277) of a diverting ileostomy at the time of pelvic pouch surgery. Criteria for omission of ileostomy included: stapled anastomosis, tension-free anastomosis, intact tissue rings, good hemostasis, absence of airleaks, malnutrition, toxicity, anemia, and prolonged consumption of steroids. Functional outcome and quality of lifeindicators were prospectively recorded and compared.

Results

Patients in the ileostomy group had greater body surface area and older mean age at time of surgery, were taking greater doses of steroids preoperatively, and required more blood transfusions at the time of surgery compared with the one-stage (P < 0.05). There were no differences between the two groups in septic complications (P > 0.05). Early postoperative ileus was more common in the one-stage group (P < 0.001). There were no differences between the groups in quality of life and functional outcomes.

Conclusions

For carefully selected patients undergoing restorative proctocolectomy with ileal pouch-anal anastomosis, omission of diverting ileostomy is a safe procedure that does not lead to an increase inseptic complications or mortality. Quality of life and functional results are similar to those who undergo ileal pouch-anal anastomosis with diversion, provided that certain selection factors are considered.

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Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA

    Feza H. Remzi M.D., Victor W. Fazio M.B., M.S., F.R.C.S., Emre Gorgun M.D., Boon S. Ooi M.D., Miriam Preen B.S.N., R.N., James M. Church M.B., B.Ch., Khaled Madbouly M.D. & Ian C. Lavery M.B., B.S.

  2. Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA

    Jeff Hammel M.S.

  3. Department of Colorectal Surgery/A30, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio, 44195, USA

    Feza H. Remzi M.D.

Authors
  1. Feza H. Remzi M.D.
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  2. Victor W. Fazio M.B., M.S., F.R.C.S.
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  3. Emre Gorgun M.D.
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  9. Ian C. Lavery M.B., B.S.
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Correspondence to Feza H. Remzi M.D..

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Remzi, F.H., Fazio, V.W., Gorgun, E. et al. The Outcome After Restorative Proctocolectomy With or Without Defunctioning Ileostomy. Dis Colon Rectum 49, 470–477 (2006). https://doi.org/10.1007/s10350-006-0509-2

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  • DOI: https://doi.org/10.1007/s10350-006-0509-2

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