Short Term Outcome of Early Closure of Diverting Loop Ileostomy in Patients with Emergency Benign Colo-Rectal Pathologies; a Prospective Controlled Pilot Study

Introduction: The aim of creating loop ileostomy is to avoid complications of anastomotic leak after colonic anastomosis procedure. This has to be balanced with the consequences of prolonged diversion. The aim of this study is to investigate the short-term outcome of early closure of loop ileostomy in cases diverted for emergency benign indications after distal colectomies and primary anastomosis.Patients and method: 30 patients presented in the emergency department with destructive colonic and rectal injuries who underwent left colonic, sigmoid, or rectal resection with primary anastomosis and diverting loop ileostomy procedure, were recruited for early loop ileostomy reversal. Patients were observed for stoma complications before reversal operation, in addition to the feasibility of reversal and postoperative complications developed in the first month after restoration of bowel continuity. Findings were compared to those of the last 30 correlated patients in our database who had their ileostomy reversed after 3-6 months. Results: Before reversal, 3 patients developed peristomal dermatitis, 2 cases developed retraction, 5 cases developed dehydration and electrolyte imbalance. Failure of anastomosis healing occurred in 3 cases with 3 other patients excluded for failure of labs normalization. Uneventful reversal operation was done to the rest of cases. After reversal, 8 cases of wound infection and 2 cases of localized collection were detected, all managed non-operatively. 1 case needed re-laparotomy for colonic perforation away from the anastomosis.Conclusion: Upon a strict selection criterion, short-term diversion with loop ileostomies is an appealing, feasible option for non-malignant indications of fecal diversion in coloproctology.