Defunctioning loop ileostomy and stapled side-to-side closure has low morbidity

Low pelvic anastomoses are associated with a high leak rate. Therefore, defunctioning loop ileostomies are being increasingly fashioned to protect against the consequences of a leak. However, the reported complication rates of such stoma creation and closure is between 5.7-69%.

To determine the outcome associated with construction and side-to-side closure of loop ileostomies in one specialist unit.

Data were obtained from a computer audit and case note analysis.

Between 1994 and 1998, 71 patients (41 M, 30 F) with a median age of 51 years (range 19-88 years) had a loop ileostomy constructed for: (i) 26 ileoanal pouches; (ii) 36 left colonic and rectal resections; and (iii) 9 for other reasons. Side-to-side stoma closure was achieved using a GIA linear stapler through a parastomal incision. The median hospital stay following stoma creation was 12 days (range 7-63 days) and stoma closure was 7 days (range 6-16 days). The median time to closure was 140 days (range 10-790 days). There were no ileostomy-related deaths. There were 10 (13.8%) ileostomy-related complications, 4 following creation and 6 following closure.

Loop ileostomy is easy to create and close and is associated with a low morbidity. Therefore, we recommend a defunctioning ileostomy as a procedure of choice for temporary faecal diversion for complex colorectal surgery.