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International Journal of Colorectal Disease

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01-05-2011 | Original Article

Renal impairment caused by temporary loop ileostomy

Authors: Nicole Beck-Kaltenbach, Katja Voigt, Bernhard Rumstadt

Published in: International Journal of Colorectal Disease | Issue 5/2011

Abstract

Purpose

Creation of a temporary loop ileostomy is a standard surgical procedure. This study was undertaken to determine whether dehydration associated with the ileostomy causes renal impairment.

Methods

The prospective data from 107 consecutive patients undergoing temporary loop ileostomy between 2004 and 2009 was evaluated. GFR was calculated at the time of hospital discharge after constructing the ileostomy and at the time of deciding to close the ileostomy.

Results

The average GFR at the time of discharge after constructing the ileostomy was a median of 92.50 (60.75–223.88); at the time of deciding to close the ileostomy, it was 75.25 (4–135.13) ml/min/1.73 m² (p < 0.001). In 20 patients renal function decreased, with a GFR <60 ml/min/1.73 m² during the ileostomy period; in six of these 20 patients, the decrease was severe (GFR <30 ml/min/1.73 m²). Underlying diseases, reasons for constructing ileostomies, sex, and time interval to closure did not affect renal function. Patients in whom GFR was decreased at the time of deciding to close the ileostomy presented with significantly more closure-related surgical complications.

Conclusions

Renal impairment is a well-known potential complication of loop ileostomy. To avoid this complication, close control and backup support is recommended in these patients.

Rondelli F, Reboldi P, Rulli A et al (2009) Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis 24:479–488PubMedCrossRef

Tilney HS, Parvinder SS, Lovegrove RE et al (2007) Comparison of outcomes following ileostomy versus colostomy for defunctioning colorectal anastomoses. World J Surg 31:1142–1151PubMedCrossRef

Levey AS, Bosch JP, Lewis JB et al (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 130:461–470PubMed

National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39(Suppl 1):S1–S266

Nightingale JM, Lennard-Jones JE, Walker ER, Farthing MJ (1992) Oral salt supplements to compensate for jejunostomy losses: comparison of sodium chloride capsules, glucose electrolyte solution, and glucose polymer electrolyte solution. Gut 33(6):759–761PubMedCrossRef

Edwards DP, Leppington-Clark A, Sexton R et al (2001) Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial. Br J Surg 88:360–363PubMedCrossRef

Law WL, Chu KW, Choi HK (2002) Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision. Br J Surg 89:704–708PubMedCrossRef

Rullier E, Le Toux N, Laurent C et al (2001) Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery. World J Surg 25:274–277PubMedCrossRef

Tocchi A, Mazzoni G, Miccini M et al (2002) Use of ileostomy and colostomy as temporal derivation in colorectal surgery. G Chir 23:48–52PubMed

10.

Baker ML, Williams RN, Nightingale JM (2010) Causes and management of a high output stoma. Colorectal Dis. 2009 Nov 3. (Epub ahead of print)

11.

Bax TW, McNevin MS (2007) The value of diverting loop ileostomy on the high-risk colon and rectal anastomosis. Am J Surg 193:585–588PubMedCrossRef

12.

Phang PT, Hain JM, Perez-Amirez S et al (1999) Techniques and complications of ileostomy takedown. Am J Surg 177:463–466PubMedCrossRef

13.

Thalheimer A, Bueter M, Kortuem M et al (2006) Morbidity of temporary loop ileostomy in patients with colorectal cancer. Dis Colon Rectum 49:1–7CrossRef

14.

Wexner SD, Taranow DA, Johansen OB et al (1993) Loop ileostomy is a safe option for fecal diversion. Dis Colon Rectum 36:349–354PubMedCrossRef

15.

Feinberg SM, McLeod RS, Cohen Z (1987) Complications of loop ileostomy. Am J Surg 153:102–106PubMedCrossRef

16.

Stevens LA, Coresh J, Greene T et al (2006) Assessing kidney function—measured and estimated glomerular filtration rate. N Engl J Med 354:2473–2483PubMedCrossRef

17.

Rule AD, Larson TS, Bergstralh EJ et al (2004) Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med 141:929–937PubMed

18.

Go A, Cherrow G, Fan D et al (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalisation. N Engl J Med 351:1296–1305PubMedCrossRef

19.

Weise WJ, Serrano FA, Fought J, Gennari FJ (2008) Acute electrolyte and acid-base disorders in patients with ileostomies: a case series. Am J Kidn Dis 52(3):494–500CrossRef

20.

Bakx R, Busch ORC, Bemelman WA et al (2004) Morbidity of temporary loop ileostomies. Dig Surg 21:277–281PubMedCrossRef

21.

Hesp WL, Lubbers EJ, de Boer HH et al (1986) Anastomotic insufficiency in small bowel surgery-incidence and treatment. Langenbecks Arch Surg 368:105–111

22.

Kairaluoma M, Rissanen H, Kultti V et al (2002) Outcome of temporary stomas. A prospective study of temporary intestinal stomas constructed between 1989 and 1996. Dig Surg 19:45–51PubMedCrossRef

23.

Khoo RE, Cohen MM, Chapman GM et al (1994) Loop ileostomy for temporary fecal diversion. Am J Surg 167:519–522PubMedCrossRef

24.

Saha AK, Tapping CR, Foley GT et al (2009) Morbidity and mortality after closure of loop ileostomy. Colorectal Dis 11:866–871PubMedCrossRef

25.

Mathiessen P, Hallböök O, Rutegärd J et al (2007) Defunctioning stomas reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214CrossRef

26.

Dehni N, Schlegel RD, Cunningham C et al (1998) Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis. Br J Surg 85:1114–1117PubMedCrossRef

Title: Renal impairment caused by temporary loop ileostomy
Authors: Nicole Beck-Kaltenbach
Katja Voigt
Bernhard Rumstadt
Publication date: 01-05-2011
Publisher: Springer-Verlag
Published in: International Journal of Colorectal Disease / Issue 5/2011
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-010-1086-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Renal impairment caused by temporary loop ileostomy

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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