Ileoanal anastomosis without covering ileostomy.

Ileoanal anastomosis is usually performed with covering ileostomy. This is primarily done because of fear of pelvic sepsis. Temporary ileostomy may, however, be a source of significant complications. The first 21 patients in the authors clinic were operated upon using covering loop ileostomy in ileoanal operations. These patients had no anastomotic or pouch complications, but there were complications, especially with the closure of the ileostomy. Therefore, a trial of one-stage operations in ileoanal anastomosis was started. Ileoanal anastomosis without ileostomy was performed on 25 consecutive patients. All the patients were operated upon for ulcerative colitis. There was one patient with pelvic abscess who needed diverting ileostomy. Thus, the early failure rate in patients operated upon without ileostomy was 4 percent. There were many other complications among these patients, but no other relaparotomy was needed. The complication rate was not different in patients operated upon without ileostomy compared with the authors first 21 patients operated upon with ileostomy (60 and 52 percent, respectively). Patients with one-stage operation needed a significantly shorter mean hospital stay than patients with two-stage operation (13.6 days and 25.3 days, respectively; P less than 0.001). The use of corticosteroids appears not to be a contraindication for one-stage operation, because there were significantly more patients using corticosteroids in the one-stage group compared with the two-stage group (92 and 62 percent, respectively; P less than 0.05).