The Outcome After Restorative Proctocolectomy With or Without Defunctioning Ileostomy

Abstract

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 in septic 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.

Comprehensive pouch clinic concept for follow-up of patients after ileal pouch anal anastomosis: Report of 3 yearsʼ experience in a tertiary referral center

“…An alternative explanation might have been that 1-stage surgery is associated with fewer early postoperative complications. However, our experience is similar to previously published results, 33 where complications of 1-stage were comparable, and not less than multistage procedures. Thus, the better pouch function after 1-stage surgery cannot be attributed to fewer early postoperative complications We asked whether specific pathologic findings in the colectomy specimens may be predictive of the development of pouchitis, as controversial reports in the literature exist.…”

Proximal Diversion at the Time of Ileal Pouch-Anal Anastomosis for Ulcerative Colitis

“…Accordingly, the outcomes of these studies may be influenced by differences between patients who had an ileostomy and those who did not. This is illustrated in the study by Remzi et al 19 which compared 1,725 patients who had IPAA with an ileostomy and 277 patients who had IPAA without an ileostomy. Although there were no differences in the rates of anastomotic leak and pelvic sepsis between groups, the patients who were not given an ileostomy were younger, they weighed less, they were taking lower doses of steroids, and their operations were less difficult.…”

Defunctioning Ileostomy Following Restorative Proctocolectomy

“…10 However,e xclusion criteria were patients on steroids or if the intra-operative leak test was positive. The study was small with 23 patients having an ileostomy and 22 without an ileostomy.T he authors found no difference in the incidence of pelvic sepsis between the two groups but the study was underpowered to address this question.…”

“…Whether diverted or not, there was no difference in septic complications or function. 10 In as eries of 300 ileo-anal pouchesw ithout diversion, 11 48% were taking steroids at the time of operation. Sepsis occurred in 21 (7%) patients, but secondary diversion was necessary in only 26 (8.7%), with pouch excision necessary in 8( 2.7%).…”