Abstract
The aim of a defunctioning stoma is to protect patients from the consequences of faecal leakage and pelvic sepsis, should it occur. A retrospective audit of 77 patients who had undergone closure of a loop stoma between 1988 and 1996 was performed. Sixty patients had either transverse loop colostomy (52) or loop ileostomy (8) to defunction distal colorectal/anal anastomoses or pathology, and 17 patients had a loop ileostomy to defunction an ileoanal pouch. Those who had restorative proctocolectomy experienced a much higher (24%) complication rate than the loop colostomy group (5%), despite similar perioperative care and surgery performed by surgeons of equivalent seniority. The complication rate of ileostomy closure in pouch patients is similar to other published series. As a result of these findings, a selective approach to the use of loop ileostomy to protect pouches has been introduced. The absence of wound infections in our series would suggest that primary closure of the stomal wound without drainage can be achieved.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Altomare D. F., Pannarale O. C., Lupo L., Palasciano N., Memeo V., Rubino M. Protective colostomy closure: the hazards of a "minor" operation. Int J Colorectal Dis. 1990 May;5(2):73–78. doi: 10.1007/BF00298472. [DOI] [PubMed] [Google Scholar]
- Grobler S. P., Hosie K. B., Keighley M. R. Randomized trial of loop ileostomy in restorative proctocolectomy. Br J Surg. 1992 Sep;79(9):903–906. doi: 10.1002/bjs.1800790916. [DOI] [PubMed] [Google Scholar]
- Hackam D. J., Rotstein O. D. Stoma closure and wound infection: an evaluation of risk factors. Can J Surg. 1995 Apr;38(2):144–148. [PubMed] [Google Scholar]
- Hosie K. B., Grobler S. P., Keighley M. R. Temporary loop ileostomy following restorative proctocolectomy. Br J Surg. 1992 Jan;79(1):33–34. doi: 10.1002/bjs.1800790111. [DOI] [PubMed] [Google Scholar]
- Jenkinson L. R., Houghton P. W., Steele K. V., Donaldson L. A., Crumplin M. K. The Biethium bridge--an advance in stoma care. Ann R Coll Surg Engl. 1984 Nov;66(6):420–422. [PMC free article] [PubMed] [Google Scholar]
- Karanjia N. D., Corder A. P., Holdsworth P. J., Heald R. J. Risk of peritonitis and fatal septicaemia and the need to defunction the low anastomosis. Br J Surg. 1991 Feb;78(2):196–198. doi: 10.1002/bjs.1800780221. [DOI] [PubMed] [Google Scholar]
- Lewis P., Bartolo D. C. Closure of loop ileostomy after restorative proctocolectomy. Ann R Coll Surg Engl. 1990 Jul;72(4):263–265. [PMC free article] [PubMed] [Google Scholar]
- Senapati A., Nicholls R. J., Ritchie J. K., Tibbs C. J., Hawley P. R. Temporary loop ileostomy for restorative proctocolectomy. Br J Surg. 1993 May;80(5):628–630. doi: 10.1002/bjs.1800800529. [DOI] [PubMed] [Google Scholar]
- Thomson J. P., Hawley P. R. Results of closure of loop transverse colostomies. Br Med J. 1972 Aug 19;3(5824):459–462. doi: 10.1136/bmj.3.5824.459. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wexner S. D., Taranow D. A., Johansen O. B., Itzkowitz F., Daniel N., Nogueras J. J., Jagelman D. G. Loop ileostomy is a safe option for fecal diversion. Dis Colon Rectum. 1993 Apr;36(4):349–354. doi: 10.1007/BF02053937. [DOI] [PubMed] [Google Scholar]
- Winslet M. C., Barsoum G., Pringle W., Fox K., Keighley M. R. Loop ileostomy after ileal pouch-anal anastomosis--is it necessary? Dis Colon Rectum. 1991 Mar;34(3):267–270. doi: 10.1007/BF02090168. [DOI] [PubMed] [Google Scholar]
- Wong R. W., Rappaport W. D., Witzke D. B., Putnam C. W., Hunter G. C. Factors influencing the safety of colostomy closure in the elderly. J Surg Res. 1994 Aug;57(2):289–292. doi: 10.1006/jsre.1994.1147. [DOI] [PubMed] [Google Scholar]
- van de Pavoordt H. D., Fazio V. W., Jagelman D. G., Lavery I. C., Weakley F. L. The outcome of loop ileostomy closure in 293 cases. Int J Colorectal Dis. 1987 Nov;2(4):214–217. doi: 10.1007/BF01649508. [DOI] [PubMed] [Google Scholar]