SELECTIVE OMISSION OF LOOP ILEOSTOMY IN RESTORATIVE PROCTOCOLECTOMY

Omission of a temporary ileostomy in patients undergoing restorative p roctocolectomy is controversial. Although fewer operations may be requ ired and some complications avoided, the risks of anastomotic dehiscen ce and pelvic sepsis may be greater. Patients undergoing restorative p roctocolectomy with no ileostomy (Group NI, n=72) were compared retros pectively with patients given a conventional loop ileostomy (Group I, n=30). Criteria for avoiding faecal diversion included: absence of sev ere acute colitis, good nutritional status and favourable surgery with creation of a sound, tension-free anastomosis. Steroid intake was not a contraindication to single-stage surgery. Delayed stomas were neces sary in 8% of Group NI. For Groups NI and I, the rates of anastomotic leak (3% vs 3%), pelvic sepsis without demonstrable leak(3% vs 0%), po uch fistula (3% vs 10%) and intestinal obstruction (8% vs 3%) were sim ilar. Closure of the temporary ileostomy in Group I was associated wit h a 10% complication rate. Cumulative post-operative hospital stay was significantly less in Group NI (median 11 vs 16 days). Functional res ults at 1 year were similar. A temporary loop ileostomy can be safely avoided in carefully selected patients undergoing restorative proctoco lectomy.