Interim Chair and Program Director Ochsner Clinic Foundation, United States
Objectives: A diverting loop ileostomy (DIL) is used to protect a distal anastomosis at risk of leakage. While patients typically prefer early DLI take down, surgeons vary in opinion regarding the optimal timing of closure. The objective of this study was to evaluate whether the timing of closure of a DLI impacts outcomes.
Methods: A retrospective review was performed on all patients aged >12 years who underwent DLI creation within a single healthcare system between 2012-2020. Data was extracted from the electronic medical record. Patient characteristics and post-operative outcomes were compared across ileostomies closed in < 2 months, 2-4 months, and >4 months. Outcomes examined included anastomotic leak, other complications, reintervention, and death within 30 days. Comparison of continuous measures was carried out via Wilcoxon rank-sum test, and categorical measures were compared with the chi-squared or Fisher’s exact test as appropriate with a significance level of 0.05 used for all tests.
Results: A total of 500 DLIs were analyzed for the study, 455 (91%) of which were closed. The majority of DLIs were protecting a distal anastomosis (94%). Nearly all (97%) patients undergoing DLI closure underwent evaluation of the distal anastomosis to rule out a leak prior to closure. Postoperative outcomes are summarized in the Table below:
None of the variables analyzed in this study demonstrated a statistically significant difference between groups. Furthermore, the three groups were similar regarding patient characteristics and comorbid conditions.
Conclusion: Early closure of a diverting loop ileostomy results in similar post-operative outcomes to later closure. In patients otherwise fit for surgery, DLI closure can be safely performed within two months of creation.
