TEMPORARY LOOP ILEOSTOMY FOR RESTORATIVE PROCTOCOLECTOMY

The aim of a defunctioning ileostomy after restorative proctocolectomy is to mitigate the consequences of pelvic sepsis, should it occur. Ho wever, there are complications related to the ileostomy itself. Of 310 patients (174 male and 136 female; mean age 33.2 years) who underwent restorative proctocolectomy between 1976 and 1990, 296 had a covering ileostomy and 14 did not. The stoma has been closed in 263 (88.9 per cent) at a median interval from formation of 12.0 weeks. Ileostomy-rel ated complications before closure occurred in 17 patients (5.7 per cen t). Laparotomy for obstruction due to the ileostomy was required in se ven patients (2.4 per cent). Retraction requiring revision occurred in three patients (1.0 per cent), an abscess behind the stoma in one (0. 3 per cent) and miscellaneous appliance problems in seven (2.4 per cen t). Following closure, 59 patients overall (22.4 per cent) developed a n ileostomy-related complication. There were 30 cases of small bowel o bstruction, treated conservatively in 19 (7.2 per cent) and by laparot omy in 11 (4.2 per cent). Peritonitis requiring laparotomy occurred in three patients (1.1 per cent) and two (0.8 per cent) developed an ent erocutaneous fistula. There were 14 (5.3 per cent) wound infections an d 16 (6.1 per cent) other miscellaneous problems. Significant complica tions associated with a temporary ileostomy were less frequent in this series than in some other reports. Obstruction was the most common co mplication and fistula was rare.