P4-17. Does a defunctioning loop ileostomy make restorative proctocolectomy safer? A retrospective case series review

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Lisa Massey [1], Jessica Leese [1], Stuart Maxwell [1], Walter Douie [1]
Affiliates: [1] Plymouth Hospitals NHS Trust.

Background
Restorative proctocolectomy is routinely performed in our institution with a ‘protective’ loop ileostomy. This ileostomy can incur its own complications and these may outweigh the benefits. Should we be changing out practice and selectively omitting this ileostomy?

Methods
Retrospective data collection was undertaken over 11 years (2004-2014) from databases and case notes. Complications were categorised as pouch (anastomotic leak, pelvic collections) or stoma (bowel obstruction ascribed to the ileostomy, anastomotic leakage following closure, ileostomy site hernias and high output stoma requiring readmission).

Results
Data was complete in 92 patients with 35 two stage and 57 three stage procedures, 71 performed open and 21 laparoscopic-assisted. Forty-one (45%) experienced at least one complication, 14 (15%) pouch and 33 (36%) stoma. Five patients (5.4%) developed pouch leak with the loss of one pouch. Nine (10%) developed pelvic collections.
Fourteen patients (15%) were readmitted with dehydration prior to stoma closure. Eleven (12%) developed stoma-related bowel obstruction, 6 following laparoscopic surgery (P:0.008). Three patients (3.2%) experienced anastomotic leakage following ileostomy closure. Six (6.5%) developed an ileostomy site hernia.

Conclusion
Protective ileostomy has significant morbidity and pouch loss is rare. Stoma-related bowel obstruction was significantly higher in our laparoscopic cohort. Omission of the ileostomy should be considered, especially in the laparoscopic era.