Loop ileostomy as temporary faecal diversion following total mesorectal excision

• Published in: Annals of the College of Surgeons of Hong Kong Vol. 8; no. 2; p. A5
• Main Authors: JEONG, H.K.M., LAM, S.C.W., LAM, C.Y.W., LAM, S.H.
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Ltd 01.05.2004
• ISSN: 1028-4001; 1442-2034
• DOI: 10.1111/j.1442-2034.2004.207_15.x

Aim: Anastomotic leakage following low anterior resection with total mesorectal excision carries a significant morbidity and mortality. Both loop ileostomy and loop transverse colostomy are common options of temporary faecal diversion to reduce the severity of anastomotic leakage. We use loop ileostomy routinely because of its ease of construction and closure, and low complication rate. Here, we reviewed our result of loop ileostomy. Methods: We reviewed the medical records of all patients who had temporary loop ileostomy constructed following low anterior resection with total mesorectal excision for CA rectum, from 1.1999 to 12.2003. Stoma related morbidity pre and post–closure of loop ileostomy were recorded. Results: Eighty‐eight patients had loop ileostomy constructed and later closed from 1.1999 to 12.2003. Seventeen of them required small bowel resection during closure of the loop ileostomy. Three patients (3.4%) had skin excoriation and one patient (1.1%) had prolonged ileus after the construction of ileostomy (3.4%). After closure of ileostomy, two patients (2.2%) had wound infection and two patients (2.2%) had anastomotic leakage. Six patients (6.8%) developed intestinal obstruction later. Post‐closure intestinal obstruction and anastomotic leakage were found to be associated with small bowel resection during the closure of ileostomy (P=0.042). Conclusion: Loop ileostomy and its closure are associated with low complication rates. We therefore continue to advocate the use of loop ileostomy as a temporary diversion procedure after total mesorectal excision.