Closure of transverse loop colostomy and loop ileostomy

Ann R Coll Surg Engl 1998; 80: 33-35

Closure of transverse loop ileostomy David P Edwards

colostomy and

Douglas R Donaldson

FRCSEd

MD FRCS

Consultant Surgeon

Surgical Registrar

Elliot M Chisholm

loop

ChM FRCS

Consultant Surgeon

St Peter's Hospital, Chertsey, Surrey

Key words: Loop colostomy; Loop ileostomy; Closure; Complications; Wound infection

The aim of a defunctioning stoma is to protect patients from the consequences of faecal leakage and pelvic sepsis, should it occur. A retrospective audit of 77 patients who had undergone closure of a loop stoma between 1988 and 1996 was performed. Sixty patients had either transverse loop colostomy (52) or loop ileostomy (8) to defunction distal colorectallanal anastomoses or pathology, and 17 patients had a loop ileostomy to defunction an ileoanal pouch. Those who had restorative proctocolectomy experienced a much higher (24%) complication rate than the loop colostomy group (5%), despite similar perioperative care and surgery performed by surgeons of equivalent seniority. The complication rate of ileostomy closure in pouch patients is similar to other published series. As a result of these findings, a selective approach to the use of loop ileostomy to protect pouches has been introduced. The absence of wound infections in our series would suggest that primary closure of the stomal wound without drainage can be achieved.

Although many procedures involving the distal colon and rectum can be performed as a one-stage operation, there are instances when a defunctioning stoma

is

recom-

mended. These would include coloanal and ileoanal reconstruction, and colorectal anastomoses < 7 cm from the anal verge (1). Loop stomas may also be performed to defunction distal colorectal pathology, including fistula and stenosis and have the advantage that closure may be performed without recourse to full laparotomy. The complications Present appointment and correspondence to: Mr D P Edwards, Surgical Registrar, Medical Countermeasures (Trauma), CBD Porton Down, Salisbury, Wiltshire SP4 OJQ

related to the stoma must be less than those of a leakage. Minor morbidity of having a stoma are difficult to quantify, but closure has a measurable morbidity. Complication rates for closure of loop stomas in leading centres range from 5% to 61% (2). This study was undertaken to assess the complication rate and postoperative stay of patients undergoing closure of a loop stoma in our hospital.

Patients and methods A total of 77 patients had closure of a loop stoma in an 8 year period between April 1988 and March 1996 and the diagnosis requiring surgery is shown in Table I. The procedure was performed by a consultant or higher surgical trainee in all cases. Coloanal, and colorectal anastomoses