[Clinical assessment of the closure of a temporary diverting ileostomy]

Closure of the temporary diverting ileostomy is technically easy procedure but may have its own side effects, such as obstruction and anastomotic leak. The aim of this study was designed to assess the results of the closure of the protective ileostomy in the group of patients' operated on for inflammatory bowel disease and other inflammatory conditions with inflammatory exudate and to compare them with those who underwent surgery for uncomplicated colorectal cancer and precancerous conditions. Radiological examination of the efferent ileostomy loop was performed preoperatively to assess its influence on surgical strategy and postoperative complications resulting from the disturbances of passage of the intestinal contents.

This is a retrospective review of 48 patients divided into 2 groups: patients who suffered from inflammatory bowel disease or peritonitis (group I, n = 16) and patients with uncomplicated malignant disease or precancerous conditions of the gastrointestinal tract (group II, n = 32). Moreover, 18 patients (group A) without preoperative radiological assessment were compared with 30 patients (group B) in whom such examination was carried out. Statistical analysis was performed by using of the U-Mann-Whitney, the Fisher's exact and Student's t-tests. The differences were considered significant for levels of less than 0.05.

Postoperative complications (obstruction and anastomotic dehiscence) occurred in 9 patients (18.7%). Seven patients (14.6%) were reoperated on: 6 patients in group 1 (37.5%) and 1 patient in group II (3.1%), (p = 0.013). Out of all postoperative complications that required secondary surgery, 22.2% of them occurred in patients who did not have preoperative radiological examination performed and 10% of them had patients in whom radiological assessment was done. Radiological findings revealed efferent ileostomy loop stenosis in 4 patients (13.3%) what influenced the operative strategy.

Postoperative complications rate was high (18.7%). Closure of the temporary diverting ileostomy in patients with inflammatory bowel disease or any other inflammatory conditions within the peritoneal cavity are at the increased risk of complications than in those with malignant diseases or precancerous conditions. Preoperative radiological examination of the efferent ileostomy loop is useful in planning of surgical approach and influences improved treatment results.