Abstracts
2002 Digestive Disease Week

# 100667 Abstract ID: 100667 Feasibility of Early Closure of Diverting Ileostomies
R Bakx, O R C Busch, D V Geldere, W A Bemelman, Frederik Slors, J J B V Lanschot, Amsterdam, Netherlands; Amstelveen, Netherlands

Background: A diverting ileostomy is sometimes constructed for the protection of a distal anastomosis. This ileostomy does not prevent leakage but reduces its septic complications. When the distal anastomosis has healed, the ileostomy has lost its protective function. It is difficult to identify the group of patients who really require an ileostomy and therefore its routine application has been proposed by some authors. Elective closure of diverting ileostomies is mostly performed after 2-3 months, although this time-span is not supported by solid data. In this period stoma related complications are reported in up to 40% of the patients. Earlier closure might effectively protect the distal anastomosis and at the same time reduce stoma related complications, reduce stoma related costs and improve quality of life. The aim of this pilot study was to investigate the feasibility of closure of a diverting ileostomy in an early stage, i.e. during the same hospital admission as the primary operation. Methods: Sixteen patients were entered in this pilot study. Informed consent was obtained from all patients. Water-soluble contrast enema radiographic examination was performed preferably 7-8 days after the primary operation to check the distal anastomosis. If patients recovery was uneventful and without clinical or radiographic signs of leakage, patients were planned for ileostomy closure as soon as possible. Results: The 16 patients had a median age of 58 year (range 28-86 years). Five of the patients were female, 11 were male. In 12 of the 16 patients early ileostomy closure was performed after 7-21 days (median 13 days). In 4 patients early ileostomy closure was not performed (2x anastomotic leakage, 1x prolonged recovery after first operation, 1x irradicality/radiotherapy) There were 3 complications after early ileostomy closure; 2 superficial wound infections and 1 i.v. catheter sepsis. No leakage of the proximal anastomosis nor of the distal anastomosis was seen in any of the patients after ileostomy closure. There was no mortality. Conclusion: In 75% of the cases it was feasible to close a diverting ileostomy shortly after the primary operation. This was done with low morbidity and without mortality. A larger prospective study is currently performed to establish its feasibility and safeness as a routine procedure.