Prolonged diversion after ileal pouch‐anal anastomosis: Is it safe to wait?

Author:

Clancy Cillian1ORCID,Connelly Tara M.1ORCID,Jia Xue1,Lipman Jeremy1,Lightner Amy L.1ORCID,Hull Tracy1,Steele Scott R.1,Holubar Stefan D.1ORCID

Affiliation:

1. Department of Colon and Rectal Surgery Digestive Disease and Surgery Institute, Cleveland Clinic Cleveland Ohio USA

Abstract

AbstractAimDiverting loop ileostomy reversal (DLI‐R) is routinely performed from 2–6 months following ileal pouch‐anal anastomosis (IPAA). The safety of delayed reversal after IPAA is not well‐defined. The aim of this study was to determine if prolonged diversion is associated with adverse outcomes compared to routine closure.MethodsAdult patients undergoing primary IPAA with DLI from 2000 to 2021 were included in this retrospective cohort study from our institutional database. Patients were stratified into tertiles based on timing of reversal: Routine (56–116 days), Delayed (117–180 days), or Prolonged (>6 months). Univariate analysis compared categorical variables between groups. Patients reversed at <8 weeks were excluded.ResultsIn total, 2615 patients underwent DLI‐R following IPAA (3‐stage 61%, 2‐stage 39%; mean age 39.9 years). DLI‐R was performed as Routine, Delayed and Prolonged in 1908 (72.9%), 426 (16.4%) and 281 (10.8%), respectively. Overall, DLI‐R related complications occurred in 12.4% (n = 324). The complication rate in the Routine group was 11% (n = 210), in the Delayed group was 12.2% (n = 52) and in the Prolonged group was 22.1% (n = 62). Reasons for prolonged diversion in the Prolonged group were complications at the time of IPAA in 207 (73.9%) or patient preference/scheduling in 73 (26.1%). DLI‐R >6 months after IPAA due to complications had higher rates of overall complications following ileostomy reversal (OR 2.6, 95% CI 1.85–3.72, p < 0.001) whereas when DLI‐R was delayed due to preference/scheduling outcomes were not different than the Routine group (p = 0.28).ConclusionProlonged time to ileostomy reversal after IPAA is probably safe without increased risk of complications when due to patient preference.

Publisher

Wiley

Subject

Gastroenterology

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3