Loop ileostomy reversal after colon and rectal surgery

A single institutional 5-year experience in 944 patients

Gaetano Luglio, Rajesh Pendlimari, Stefan D. Holubar, Robert R. Cima, Heidi Nelson

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background: Diverting loop ileostomy is used to mitigate the sequelae of anastomotic dehiscence. Objective: To report the rate of complications after ileostomy reversal using standardized definitions to aid physicians who are deciding whether to divert anastomoses. Methods: Patients who underwent diverting loop ileostomy closure from January 1, 2005, through February 28, 2010, were identified using a prospective database. Perioperative variables and 30-day outcomes were reviewed. Complications were graded according to the Clavien- Dindo Classification, in which grade III, IV, or V represents major complications. Univariate analysis assessed the relationship between operative variables and surgical outcomes. Results:Atotal of 944 patients underwent reversal: 43.1% were women, the mean age was 47.2 years, the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 25.7, and 18.5% wereAmerican Society of Anesthesiologists class III or IV. Indications for the initial operation were ulcerative colitis (49.5%), rectal cancer (27.5%), diverticular disease (6.8%), and other (16.1%). Anastomotic technique for reversal was sutured fold-over in 466 patients (49.4%), stapled in 315 (33.4%), and handsewn end to end in 163 (17.3%). After reversal, the mean time to first bowel movement, tolerance of soft diet, and discharge from hospital was 2.6, 3.7, and 5.2 days, respectively. Handsewn cases had longer operative times and longer times to bowel movement, soft diet, and discharge. Overall, complications occurred in 203 patients (21.5%), including 45 patients (4.8%) who experienced a major complication; there were no deaths within 30 days. Conclusion: Ileostomy closure is associated with a low rate of major grade III and IV complications and should be reserved for patients who have a predicted postoperative major complication rate of 5% or more without diversion.

Original languageEnglish (US)
Pages (from-to)1191-1196
Number of pages6
JournalArchives of Surgery
Volume146
Issue number10
DOIs
StatePublished - Oct 2011

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Ileostomy
Colon
Diet
Rectal Neoplasms
Operative Time
Ulcerative Colitis
Body Mass Index
Databases
Physicians
Weights and Measures

ASJC Scopus subject areas

  • Surgery

Cite this

Loop ileostomy reversal after colon and rectal surgery : A single institutional 5-year experience in 944 patients. / Luglio, Gaetano; Pendlimari, Rajesh; Holubar, Stefan D.; Cima, Robert R.; Nelson, Heidi.

In: Archives of Surgery, Vol. 146, No. 10, 10.2011, p. 1191-1196.

Research output: Contribution to journalArticle

Luglio, Gaetano ; Pendlimari, Rajesh ; Holubar, Stefan D. ; Cima, Robert R. ; Nelson, Heidi. / Loop ileostomy reversal after colon and rectal surgery : A single institutional 5-year experience in 944 patients. In: Archives of Surgery. 2011 ; Vol. 146, No. 10. pp. 1191-1196.
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abstract = "Background: Diverting loop ileostomy is used to mitigate the sequelae of anastomotic dehiscence. Objective: To report the rate of complications after ileostomy reversal using standardized definitions to aid physicians who are deciding whether to divert anastomoses. Methods: Patients who underwent diverting loop ileostomy closure from January 1, 2005, through February 28, 2010, were identified using a prospective database. Perioperative variables and 30-day outcomes were reviewed. Complications were graded according to the Clavien- Dindo Classification, in which grade III, IV, or V represents major complications. Univariate analysis assessed the relationship between operative variables and surgical outcomes. Results:Atotal of 944 patients underwent reversal: 43.1{\%} were women, the mean age was 47.2 years, the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 25.7, and 18.5{\%} wereAmerican Society of Anesthesiologists class III or IV. Indications for the initial operation were ulcerative colitis (49.5{\%}), rectal cancer (27.5{\%}), diverticular disease (6.8{\%}), and other (16.1{\%}). Anastomotic technique for reversal was sutured fold-over in 466 patients (49.4{\%}), stapled in 315 (33.4{\%}), and handsewn end to end in 163 (17.3{\%}). After reversal, the mean time to first bowel movement, tolerance of soft diet, and discharge from hospital was 2.6, 3.7, and 5.2 days, respectively. Handsewn cases had longer operative times and longer times to bowel movement, soft diet, and discharge. Overall, complications occurred in 203 patients (21.5{\%}), including 45 patients (4.8{\%}) who experienced a major complication; there were no deaths within 30 days. Conclusion: Ileostomy closure is associated with a low rate of major grade III and IV complications and should be reserved for patients who have a predicted postoperative major complication rate of 5{\%} or more without diversion.",
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AB - Background: Diverting loop ileostomy is used to mitigate the sequelae of anastomotic dehiscence. Objective: To report the rate of complications after ileostomy reversal using standardized definitions to aid physicians who are deciding whether to divert anastomoses. Methods: Patients who underwent diverting loop ileostomy closure from January 1, 2005, through February 28, 2010, were identified using a prospective database. Perioperative variables and 30-day outcomes were reviewed. Complications were graded according to the Clavien- Dindo Classification, in which grade III, IV, or V represents major complications. Univariate analysis assessed the relationship between operative variables and surgical outcomes. Results:Atotal of 944 patients underwent reversal: 43.1% were women, the mean age was 47.2 years, the mean body mass index (calculated as weight in kilograms divided by height in meters squared) was 25.7, and 18.5% wereAmerican Society of Anesthesiologists class III or IV. Indications for the initial operation were ulcerative colitis (49.5%), rectal cancer (27.5%), diverticular disease (6.8%), and other (16.1%). Anastomotic technique for reversal was sutured fold-over in 466 patients (49.4%), stapled in 315 (33.4%), and handsewn end to end in 163 (17.3%). After reversal, the mean time to first bowel movement, tolerance of soft diet, and discharge from hospital was 2.6, 3.7, and 5.2 days, respectively. Handsewn cases had longer operative times and longer times to bowel movement, soft diet, and discharge. Overall, complications occurred in 203 patients (21.5%), including 45 patients (4.8%) who experienced a major complication; there were no deaths within 30 days. Conclusion: Ileostomy closure is associated with a low rate of major grade III and IV complications and should be reserved for patients who have a predicted postoperative major complication rate of 5% or more without diversion.

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