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Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 4/2006

01-04-2006

The Outcome After Restorative Proctocolectomy With or Without Defunctioning Ileostomy

Authors: Feza H. Remzi, M.D., Victor W. Fazio, M.B., M.S., F.R.C.S., Emre Gorgun, M.D., Boon S. Ooi, M.D., Jeff Hammel, M.S., Miriam Preen, B.S.N., R.N., James M. Church, M.B., B.Ch., Khaled Madbouly, M.D., Ian C. Lavery, M.B., B.S.

Published in: Diseases of the Colon & Rectum | Issue 4/2006

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Purpose

Controversy exists regarding the safety for omission of diverting ileostomy in restorative proctocolectomy because of fears of increased septic complications. This study was designed to evaluate the outcomes of restorative proctocolectomy in a consecutive series of patients by comparing postoperative complications, functional results, and quality of life in patients with and without diverting ileostomy.

Methods

Data regarding demographics, length of stay, surgical characteristics, and complications were reviewed and recorded according to the presence (n= 1,725) or absence (n = 277) of a diverting ileostomy at the time of pelvic pouch surgery. Criteria for omission of ileostomy included: stapled anastomosis, tension-free anastomosis, intact tissue rings, good hemostasis, absence of airleaks, malnutrition, toxicity, anemia, and prolonged consumption of steroids. Functional outcome and quality of lifeindicators were prospectively recorded and compared.

Results

Patients in the ileostomy group had greater body surface area and older mean age at time of surgery, were taking greater doses of steroids preoperatively, and required more blood transfusions at the time of surgery compared with the one-stage (P < 0.05). There were no differences between the two groups in septic complications (P > 0.05). Early postoperative ileus was more common in the one-stage group (P < 0.001). There were no differences between the groups in quality of life and functional outcomes.

Conclusions

For carefully selected patients undergoing restorative proctocolectomy with ileal pouch-anal anastomosis, omission of diverting ileostomy is a safe procedure that does not lead to an increase inseptic complications or mortality. Quality of life and functional results are similar to those who undergo ileal pouch-anal anastomosis with diversion, provided that certain selection factors are considered.
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Metadata
Title
The Outcome After Restorative Proctocolectomy With or Without Defunctioning Ileostomy
Authors
Feza H. Remzi, M.D.
Victor W. Fazio, M.B., M.S., F.R.C.S.
Emre Gorgun, M.D.
Boon S. Ooi, M.D.
Jeff Hammel, M.S.
Miriam Preen, B.S.N., R.N.
James M. Church, M.B., B.Ch.
Khaled Madbouly, M.D.
Ian C. Lavery, M.B., B.S.
Publication date
01-04-2006
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 4/2006
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-006-0509-2

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