Sandostatin as a "hormonal" temporary protective ileostomy in patients with total or subtotal colectomy

We describe our experience with the use of a new method of so-called "hormonal" ileostomy by using Octreotide, a long-acting analog of the inhibitory peptide Somatostatin (Sandostatin Novartis), aiming to advocate protective ileostomy or colostomy, in patients who underwent total or subtotal colectomy for ulcerative colitis or obstruction of left colon, due to carcinoma or diverticulitis.

"Hormonal" protective ileostomy by using Sandostatin (Novartis) was performed in 10 patients after subtotal colectomy for ulcerative or left colon obstruction without a protective ileostomy or colostomy. Sandostatin 0.5 mg/mL was given from the day of operation to the 10th postoperative day, in a dose of 2 x 3 per day subcutaneously. The time of return of peristalsis, number of bouts of diarrhea and postoperative complications were evaluated.

The patients were classified in two groups: First group (40% of all patients) with bowel obstruction and second group (60% of all patients) with ulcerative colitis. In the first group the mean time of return of peristalsis was 4.5 days and the mean number of bouts of diarrhea was 4.2 per day. One patient was reoperated for intraabdominal abscess and the morbidity was 50% with minor postoperative complications. In the second group the mean time of peristalsis return was 5 days and the mean number of bouts of diarrhea was 5.4 per day. One patient was reoperated for intestinal bleeding and the morbidity was 60% with minor postoperative complications.

The use of Octreotide appears to serve as a useful adjunctive and important role in controlling intestinal output, so that it is an available method of "hormonal" protective ileostomy in very low rectal or anal anastomosis, by avoiding a second operation for ileostomy or colostomy closure and reducing the median hospital stay and total socioeconomic cost.