Article
Morbidity and mortality associated with closure of protective loop ileostomies – a retrospective study of 265 consecutive patients
Search Medline for
Authors
-
Christiane Hanselmann
- Universitätsklinikum Hamburg-Eppendorf, Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
-
Asad Kutup
- Universitätsklinikum Hamburg-Eppendorf, Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
-
Oliver Zehler
- Universitätsklinikum Hamburg-Eppendorf, Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
-
Yogesh Vashist
- Universitätsklinikum Hamburg-Eppendorf, Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
-
Jakob Izbicki
- Uniklinik Hamburg, Klinik und Poliklinik für Allgemein-, Viszeral- und Thoraxchirurgie, Hamburg
| Published: | April 26, 2013 |
|---|
Outline
Text
Introduction: Protective loop ileostomies are common surgeries to ensure healing of further distally located anastomoses. However, ileostomy closures are associated with high morbidity rates. Our goal was to analyze morbidity and mortality associated with loop ileostomy closure.
Material and methods: We retrospectively analyzed the data of 265 consecutive patients receiving a protective loop ileostomy at our institution between may 2005 and may 2011. Studied parameters were morbidity and mortality after closure, reasons for ileostomy, morbidity associated with loop ileostomies and technique of anastomosis used for closure.
Results: Morbidity associated with presence of loop ileostomies consisted of parastomal hernias (13,2% N=35), prolaps (1,9% N=5) and dehydration requiring hospital readmission for intravenous substitution (6,8% N=18).
Overall mortality after ileostomy closure was 1,6%, the morbidity rate associated with closure was 19,8%, whereas morbidity associated with the presence of ileostomy itself was 27,2%. Of the 265 ileostomies, 253 were closed (95,5%). Anastomotic leaks after closure occurred in 14 patients (5,5%).
Anastomotic techniques were hand sewn end-to-end anastomosis (22,1%, N=56), hand sewn side-to-side anastomosis (48,6%, N=123), hand sewn semicircular anastomosis (25,3%, N=64) and side-to-side stapler anastomosis (5,1%, N=13). Stapler anastomoses had the highest rate of anastomotic insufficiencies (7,7%), followed by hand sewn end-to-end anastomoses (7,1%) compared to hand sewn side-to-side anastomoses (4,9%) and semicircular anastomoses (4,7%).
Other complications after closure were wound infections (5,5%, N=14), incisional site hernias (2%, N=5) and postoperative ileus (2,8%, N=7) requiring revisional surgery in 2 patients.
Conclusion: Considering the significant impact of loop ileostomy on quality of life, the decision for loop ileostomy creation should be made carefully.
Protective loop ileostomy closure is associated with significant morbidity. In our study, one in four patients had complications caused by the stoma itself, and one in five patients had complications after ileostomy closure. The type of closure did not differ between the various techniques in terms of morbidity. Loop ileostomy closure represents a demanding technical procedure and may only be performed by experienced surgeons or under their guidance.
