Department of Surgery, Academic Medical Center, Postbox 22660, 1100 DD, Amsterdam, The Netherlands.
Int J Colorectal Dis. 2012 Jan;27(1):49-54. doi: 10.1007/s00384-011-1276-7. Epub 2011 Jul 15.
Defunctioning ileostomies are widely performed in order to prevent or treat anastomotic leakage after colorectal surgery. The aim of the present study was to determine morbidity related to stoma closure and to identify predictive factors of a complicated postoperative course.
A consecutive series of 138 patients were retrospectively analyzed after stoma reversal. Data collection included general demographics and surgery-related aspects. Morbidity related to stoma closure was retrieved from our prospectively collected registry of complications.
In 74 of 138 patients, defunctioning ileostomy was performed after restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA). The remaining ileostomies (n = 64) were constructed after a low colorectal or coloanal anastomosis. A total of 46 complications were recorded in 28 patients resulting in an overall complication rate of 20.3%. Anastomotic leakage rate was 4.3%, and reoperation rate was 8.0%. The number of complications according to the Clavien-Dindo classification was 5 for grade I (10.9%), 26 for grade II (56.5%), 13 for grade III (28.3%), 1 for grade IV (2.2%), and 1 for grade V (2.2%). Multivariate analysis revealed a significantly higher ASA score in the complicated group (P = 0.015, odds ratio 2.6, 95% confidence interval 1.2-5.6).
Closure of a defunctioning ileostomy is associated with 20% morbidity and a reoperation rate of 8%. There is an urgent need for criteria on which a more selective use of a defunctioning ileostomy after low colonic anastomosis or IPAA can be based given its associated morbidity.
预防性回肠造口术被广泛应用于结直肠手术后，以预防或治疗吻合口漏。本研究旨在确定造口关闭相关的发病率，并确定术后复杂病程的预测因素。
回顾性分析了 138 例连续接受造口还纳术的患者。数据收集包括一般人口统计学和手术相关方面。造口关闭相关的发病率是从我们前瞻性收集的并发症登记处获得的。
在 138 例患者中，74 例接受了直肠结肠切除术和回肠袋肛门吻合术（IPAA）后的预防性回肠造口术。其余 64 例造口术是在低位结直肠或结肠肛管吻合术之后构建的。28 例患者共记录了 46 种并发症，总并发症发生率为 20.3%。吻合口漏的发生率为 4.3%，再次手术率为 8.0%。根据 Clavien-Dindo 分类，并发症的数量为 I 级（10.9%）5 例，II 级（56.5%）26 例，III 级（28.3%）13 例，IV 级（2.2%）1 例，V 级（2.2%）1 例。多变量分析显示，复杂组的 ASA 评分显著较高（P=0.015，优势比 2.6，95%置信区间 1.2-5.6）。
预防性回肠造口关闭相关发病率为 20%，再次手术率为 8%。有必要制定标准，以便在低位结直肠吻合或 IPAA 后，更有选择性地使用预防性回肠造口术，因为其相关发病率较高。
