Temporary Loop Ileostomy versus Loop Colostomy for Distal Colonic Anastomosis in Emergency Cases
Anastomotic leakage is one of the most important surgical complications
Background: Anastomotic leakage is one of the most important surgical complications of distal colonic surgery, and it has been of great concern due to high occurrence of morbidity and mortality, affecting long-term survival. The proximal diversion, either by a colostomy or an ileostomy, prevents fecal flow through the anastomosis, minimizes the consequences of the anastomotic leak. The preference of loop ileostomy or colostomy is still controversial.
Objectives: To assess the evidence of using of loop ileostomy compared to loop colostomy for protection of distal colonic anastomosis and comparing the safety and effectiveness.
Methods: A prospective study was designed at Al-Yarmouk Teaching Hospital including patients who were admitted to the surgical ward during the period between the 1st of Nov. 2013 to the 1st of Nov. 2015 with emergency distal colonic pathology both (traumatic and non-traumatic) treated by primary repair or anastomosis with proximal protective stoma. Patients were followed during the early post-operative period and the data were collected regarding, complications of the stoma, leak or disruption in the distal colonic repair or anastomosis, patientâ€™s satisfaction and compliance with the stoma.
Results: This study included 57 patients with distal colonic anastomosis with proximal stoma protection, Thirty nine (68.42%) patients with loop colostomy and 18(31.57%) with loop ileostomy. Distal colonic anastomosis leak occurred in (5.12%) in colostomy and (5.55%) in ileostomy group.Â The overall complication rate for colostomy was (30.76%) and for ileostomy was (11.11%). Post closure complications were (21.62%) for colostomy and (11.67%) for ileostomy. General acceptance was the same for both groups.
Conclusion: There was no deference in distal anastomosis leak rate between loop colostomy and loop ileostomy. The incidence of overall complications of loop ileostomy was less than that for loop colostomy. Post closure complications occurred less frequently with loop ileostomy than loop colostomy.
Keywords: Loop ileostomy, Loop colostomy, Emergency, Colonic anastomosis.Iraqi Medical Journal Vol. 63, No. 1, January 2017; p.78-86.
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