Colorectal 07

Abstract

Aims: The use of a loop ileostomy is an effective method to protect pelvic anastomoses. Its use has increased recently, although there is some debate as to the routine use of a stoma. A second operation is required to close the stoma, with potential complications. The aim of this study was to assess prospectively the morbidity of closure of loop ileostomy. Methods: All patients scheduled for loop ileostomy closure over a 12‐month period were included. The operative technique, complications and length of stay were recorded. Results: A total of 50 consecutive patients (28 male, 22 female) with a median age (interquartile range, IQR) of 56 years (42–73) underwent ileostomy closure, at a median time (IQR) of 28 weeks (18–48) after formation. Twenty‐four (48 per cent) were formed after low anterior resection for carcinoma, 20 (40 per cent) after ileal pouch anal anastomosis for ulcerative colitis and 6 (12 per cent) after other procedures. Thirty‐eight (76 per cent) had a stapled closure and 12 (24 per cent) sutured. Twelve patients (24 per cent) developed complications; 6 (12 per cent) had intestinal obstruction of which one required a laparotomy, 4 (8 per cent) had wound infections of which one required re‐operation, 1 (2 per cent) had an ileal anastomotic leak and subsequently died and 1 (2 per cent) died from a myocardial infarction. The median length (IQR) of hospital stay was 8 days (7–10). Conclusions: We have demonstrated that a quarter of patients develop complications after loop ileostomy closure. The majority of these are minor. Methods to reduce the number of complications, such as optimum time to closure and distal limb irrigation techniques, need to be studied.