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Efficacy of Diverting Ostomy in Colorectal Anastomotic Leaks
Riley K. Kitamura*, Desmond T. Huynh, John-William Carroll, Julia Chen, Celia M. Divino
Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
Introduction: Anastomotic leak (AL) is a devastating complication of colorectal surgery. It is associated with increased morbidity and mortality1-3, and higher risk of permanent ostomy and reoperation.4-6 Loop diversion is a known alternative approach in the management of AL with similar or better outcomes than anastomotic revision.1,4 We compared the efficacy of diverting stoma versus anastomotic revision in the management of colorectal leaks.
Methods: Patients who developed colorectal AL at the Mount Sinai Hospital from 2003 - 2013 were identified retrospectively and were separated based on surgical approach: Loop diversion (LD) versus Anastomotic Revision (AR). AR was defined as anastomotic resection or revision and diversion with or without over-sewing of the distal stump (Hartmann's procedure). Diversion insufficiency was defined as reoperation, drainage, and creation or revision of an end stoma in either group. Patients were followed up to 30 days after they were initially operated on for AL.
Results: 139 patients with colorectal AL managed operatively were identified. 87 (62.6%) in the LD and 52 (37.4%) in the AR group. 8 (9.2%) patients in the LD, and 6 (11.5%) patients in the AR group required reoperation and were insufficient (p=0.772). Similarly, there was no difference in the rate of hospital days or SICU days between groups. Patients in the LD group were significantly younger (p = 0.003), and had a lower rate of diverticulosis (p = 0.03). [Table 1]
Conclusions: There is no significant difference inreoperation rates, hospital stay, or SICU days between groups. This study shows that the creation of a diverting loop ileostomy is and effective treatment for AL and is equally efficacious as anastomotic revision and formation of an end stoma in the management of colorectal anastomotic leaks.
Table 1: Clinical Characteristics and Follow-up
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