Defunctioning ileostomy is not associated with reduced leakage in proctocolectomy and ileal pouch anastomosis surgeries for IBD

Saloomeh Sahami, Christianne J. Buskens, Tonia Young Fadok, Pieter J. Tanis, Anthony de Buck van Overstraeten, Albert M. Wolthuis, Willem A. Bemelman, André D'Hoore

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Background: Anastomotic leakage is a serious complication after restorative proctocolectomy with ileal pouch-anal anastomosis. Previous studies have shown significantly decreased leak rates in diverted patients with less severe clinical consequences. The aim of this study was to evaluate short-and long-term outcome of selective ileostomy formation in a multicentre cohort of patients undergoing pouch surgery. Methods: In a retrospective study, 621 patients undergoing pouch surgery for inflammatory bowel disease [IBD] were identified from three large centres. Anastomotic leakage was defined as any leak confirmed by either contrast extravasation on imaging or during surgical re-intervention. Results: In 305 patients [49.1%], primary defunctioning ileostomy was created during pouch surgery and 41 [6.6%] patients received a secondary ileostomy because of a leaking non-diverted pouch. Primary ileostomy formation was associated with male sex, weight loss, American Society of Anesthesiologists score [ASA] > 2, steroid use, one-stage surgery, hand-sewn anastomosis, and blood transfusion. Leak rates were comparable between diverted and non-diverted patients [16.7% vs 17.1%, p = 0.92], which remained unchanged in subgroups with immunosuppressive medication. Having had an ileostomy was demonstrated to be an independent predictor of small bowel obstruction (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.45-4.67) and pouch fistulas [OR 3.05, 95%CI 1.06-8.73]. The 10-year pouch survival was comparable for patients with and without ileostomy [89% versus 88%, p = 0.718]. Conclusions: Leakage rates of diverted and non-diverted pouches in IBD patients were similar and relatively high. Defunctioning was independently associated with long-term complications. A staged approach without defunctioning might be the best strategy.

Original languageEnglish (US)
Pages (from-to)779-785
Number of pages7
JournalJournal of Crohn's and Colitis
Volume10
Issue number7
DOIs
StatePublished - 2016

    Fingerprint

Keywords

  • Anastomotic leakage
  • Defunctioning ileostomy
  • Ileal pouch-anal anastomosis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Sahami, S., Buskens, C. J., Fadok, T. Y., Tanis, P. J., van Overstraeten, A. D. B., Wolthuis, A. M., Bemelman, W. A., & D'Hoore, A. (2016). Defunctioning ileostomy is not associated with reduced leakage in proctocolectomy and ileal pouch anastomosis surgeries for IBD. Journal of Crohn's and Colitis, 10(7), 779-785. https://doi.org/10.1093/ecco-jcc/jjv201