Ileostomy in ulcerative colitis. Results in 149 patients.

The operative mortality among 144 patients treated with proctocolectomy and ileostomy for ulcerative colitis was 7.6%. Half the patients had fulminating colitis. Only 4 patients died during the follow-up period. Intestinal obstruction needing laparatomy occurred in 8.6%. Ileostomy revisions have been carried out in 13%, and significantly more often in females than males owing to a higher frequency of stoma retraction. Other ileostomy problems (leakage, skin soreness, excoriation) were experienced by nearly half the patients. These problems were episodic in the majority and could usually be remedied by instruction and new devices. Less than 7% used colostomy bags. In the remainder the changing interval appeared to be a measure of ileostomy success. The average length of the ileostomy spout was significantly longer in males without ileostomy problems (5.8 cm) than in males having leakage (3.7 cm). This difference was not apparent in females. Working and sexual impairment was rare. The success of an ileostomy depends on proper management, i.e., access to expert advice, instruction, training, follow-up, and adequate supplies of appliances. A stoma therapist on the staff is therefore extremely valuable.