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Ileorectostomy in the older patient
P S Beckwith1, B G Wolff, R C Frazee
1Department of Colorectal Surgery, Iowa Methodist Medical Center, Des Moines.
Diseases of the Colon and Rectum
|April 1, 1992
Summary
Elderly patients undergoing abdominal colectomy and ileorectostomy experience a mild increase in daily bowel movements, which improves over time. This procedure is well-tolerated with a low risk of incontinence.
Area of Science:
- Colorectal Surgery
- Geriatric Gastroenterology
- Surgical Outcomes
Background:
- Abdominal colectomy and ileorectostomy are often avoided in older adults due to concerns about bowel dysfunction.
- Fear of excessive stool frequency and fecal incontinence impacts surgical decisions for elderly patients.
Purpose of the Study:
- To evaluate the impact of abdominal colectomy and ileorectostomy on bowel habits in patients aged 60 and over.
- To compare the long-term bowel function outcomes of elderly patients undergoing colectomy with ileorectostomy versus right hemicolectomy.
Main Methods:
- A prospective study of 32 elderly patients (≥60 years) who underwent abdominal colectomy and ileorectostomy.
- Comparison with age- and sex-matched controls who had undergone right hemicolectomy.
- Detailed assessment of preoperative, early postoperative, and late postoperative bowel habits, including stool frequency and incontinence.
Main Results:
- Patients undergoing ileorectostomy experienced an initial average increase of 3.6 bowel movements daily, decreasing to 1.5 over five years.
- Right hemicolectomy patients showed smaller increases: 0.9 immediately and 0.2 after five years.
- Fecal incontinence was infrequent in both surgical groups.
Conclusions:
- Abdominal colectomy and ileorectostomy in elderly patients lead to a manageable increase in bowel movements, not solely due to right colon loss.
- The procedure is well-tolerated in older adults, with a low risk of incontinence and only a mild increase in stool frequency.