Loop ileostomy is a safe option for fecal diversion

Abstract

This study was undertaken to prospectively assess all morbidity and mortality associated with temporary loop ileostomy. Eighty-three consecutive patients of a median age of 45 years required temporary fecal diversion after either ileoanal or low colorectal anastomosis (n = 72), for perianal Crohn's disease (n = 5), or for other reasons (n = 6). All loop ileostomies were supported with a rod, and fecal diversion was maintained for a mean of 10 weeks. To date, 67 patients have had re-establishment of intestinal continuity. Stoma closure was affected through a parastomal incision in 64 patients; in three, a laparotomy was required. The closure was stapled side to side in 49 patients, while a hand-sewn anastomosis was done in the other 18 patients; all skin wounds were left open. The mean length of surgery for ileostomy closure was 56 minutes, and the mean hospital stay was five days. Nine patients (10.8 percent) developed 10 complications, nine of which required hospitalization. Specifically, four patients developed dehydration and electrolyte abnormalities secondary to high stoma output, and two had anastomotic leaks that spontaneously healed following conservative management. One patient developed a superficial wound infection that spontaneously drained itself. One patient developed a partial small bowel obstruction that resolved without surgery after a four-day hospitalization. One stoma retracted after supporting rod removal and prompted premature closure. There was no stomal ischemia, hemorrhage, prolapse, or mortality in this series. Thus, loop ileostomy is a safe way to achieve fecal diversion.

A Comparative Study between Santulli Ileostomy and Loop Ileostomy

“…Reported incidence of dehydration ranges from 2.2-20% [19]. These patients have to be on a stringent diet and anti-diarrheal medication often [20].…”

“…Gallstones occur with gallstone pancreatitis especially if the ileostomy closure is delayed [18]. Anastomotic leaks from ileostomy reversal site in up to 8.3% are mentioned in the literature [17,19]. The incidence of wound infection has been reported from 1.3%-18.3% while incisional hernia occurs in up to 11.9% of patients after ileostomy closure [17].…”

Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis

“…Two have favored loop transverse colostomy 12,14 , and two have recommended ileostomy 11,15 . In other non-randomized studies, construction of a loop ileostomy has been the preference, in the absence of any hard evidence favoring loop colostomy 16,17,18 . Both types of stoma present high complication rates, with considerable mortality rates 19 .…”

Role of Ileostomy in Enteric Perforation

“…Waxner et al (1993) also suggest the use of supportive rods. 13 In this current study, majority of perforation occurred in the 1 st week of the disease. Patients who perforate in the first 2 weeks have the better prognosis.…”

“…Similar studies conducted previously also had 91.66-100% patients being managed conservatively. 13,[26][27][28] CONCLUSION Non-specific perforations are the most common cause of ileal perforation followed by typhoid and tuberculosis. There was a male preponderance with the male to female ratio as 5:1.…”