A future role for loop ileostomy in colorectal surgery?

Thirty patients underwent a defunctioning loop ileostomy. Elective ileostomy was performed in 23 patients to protect a potentially vulnerable colorectal anastomosis and in one patient as a permanent faecal diversion for colonic atony. Six emergency loop ileostomies were performed; in four patients after colonic perforations and in two patients as a primary treatment secondary to colonic anastomotic leakage. Peri-operatively, none of the patients with an elective operation died. Four patients with an emergency operation, however, all died of irreversible peritoneal sepsis. Complications were a diversion colitis and an abdominal sepsis after anastomotic leakage in a second patient who required a re-operation. During follow-up (up to four years) one patient suffered from an episode of severe dehydration six months after operation. The ileal continuity was, without mortality, restored in 23 patients. Two patients had a wound infection with, in one of them, a late cicatricial hernia. In our experience, a defunctioning loop ileostomy is a relatively safe procedure and is, in our opinion, preferable to loop colostomy for temporary faecal diversion. The high mortality following emergency loop ileostomy reflects the bad prognosis of these patients and indicates the need for resection of the primary disease.