DIVERTING LOOP VERSUS END ILEOSTOMY DURING ILEOANAL PULLTHROUGH PROCEDURE FOR ULCERATIVE-COLITIS

A two-stage ileoanal pullthrough procedure (IAPP) is often used for pa tients with ulcerative colitis (UC) requiring proctocolectomy. We anal yzed the recent University of California at Los Angeles experience wit h diverting end and loop ileostomies in patients undergoing a two-stag e IAPP. A retrospective analysis of 21 patients with UC undergoing loo p ileostomy between March 1992 and March 1995 was performed. Compariso n was made with 21 age- and gender-matched patients undergoing end ile ostomy between January 1991 and December 1995. There was no mortality or major septic complications. A second laparotomy was required in all patients with end ileostomies, whereas loop ileostomies were closed w ithout abdominal exploration. During ileostomy closure, operative time and mean hospital stay were significantly reduced with the use of loo p ileostomy. The time to oral feeding was not significantly different between end and loop ileostomy groups after ileostomy closure. The com plication rate after IAPP was similar between groups. However, after i leostomy closure, the complication rate was significantly reduced with the use of loop ileostomy. We conclude that loop ileostomy is a desir able option for UC patients undergoing intestinal diversion during IAP P. Loop ileostomies can be created easily and without an increase in o perative time. Subsequent ileostomy closure can be performed as a loca l procedure, which may shorten operative time and length of hospital s tay.