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A retrospective cohort study on renal morbidity related to stoma type in inflammatory bowel disease patients following colectomy and ileal pouch-anal anastomosis surgery

Lundström, Simon LU orcid ; Buchwald, Pamela LU and Agger, Erik LU orcid (2024) In Scandinavian Journal of Surgery 113(3). p.202-210
Abstract
Abstract
Background and objective:
Defunctioning loop ileostomy (DLI) is frequently used to decrease the consequences of anastomotic leak after ileal pouch-anal anastomosis (IPAA) surgery but is controversial because of stoma-associated morbidity. The aim of this study was to describe stoma-associated morbidity in IPAA–DLI patients compared with terminal ileostomy patients.
Methods:
Patients treated with colectomy for inflammatory bowel disease at Skåne University Hospital, Sweden, between 2005 and 2021 were eligible for inclusion. Terminal stoma-related morbidity was measured until 12 months after colectomy, IPAA surgery, or conversion to ileorectal anastomosis, whichever occurred first. DLI-related morbidity was measured... (More)
Abstract
Background and objective:
Defunctioning loop ileostomy (DLI) is frequently used to decrease the consequences of anastomotic leak after ileal pouch-anal anastomosis (IPAA) surgery but is controversial because of stoma-associated morbidity. The aim of this study was to describe stoma-associated morbidity in IPAA–DLI patients compared with terminal ileostomy patients.
Methods:
Patients treated with colectomy for inflammatory bowel disease at Skåne University Hospital, Sweden, between 2005 and 2021 were eligible for inclusion. Terminal stoma-related morbidity was measured until 12 months after colectomy, IPAA surgery, or conversion to ileorectal anastomosis, whichever occurred first. DLI-related morbidity was measured until 12 months after IPAA surgery or stoma closure, whichever occurred first. Laboratory data were reviewed up to 18 months after surgery since patients without complications were rarely subjected to blood sampling. Data on patient characteristics, renal function, surgical complications, and readmissions were collected retrospectively. Primary outcomes were DLI- and terminal ileostomy-related renal morbidity, whereas secondary outcomes focused on stoma-related complications.
Results:
The study cohort consisted of 165 patients with terminal ileostomy after colectomy (median (interquartile range (IQR)): stoma time 30 (15–74) months) and 42 patients with IPAA–DLI (median (IQR): stoma time 4 (3–5) months). One case of anastomotic IPAA leakage was observed. IPAA–DLI patients more often required hospital care due to high-volume stoma output immediately after surgery (0–30 days, 29%) compared with terminal ileostomy patients (4%, p < 0.001). There were no significant differences in acute renal injury (p = 0.073) or chronic renal failure (p = 0.936) incidences between the groups. DLI closure was achieved in 95% of IPAA–DLI patients, with 5% suffering Clavien–Dindo complications > 2.
Conclusions:
IPAA–DLI patients exhibited higher incidence of short-term high-volume stoma output without higher rates of acute renal injury or chronic renal failure compared with terminal ileostomy patients in this small single-center retrospective study suggesting that the risk of renal morbidity in IPAA–DLI patients may have been overestimated. (Less)
Abstract (Swedish)

Please use this url to cite or link to this publication:
author
; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian Journal of Surgery
volume
113
issue
3
pages
202 - 210
publisher
Finnish Surgical Society
external identifiers
  • pmid:38414142
  • scopus:85186580964
ISSN
1799-7267
DOI
10.1177/14574969241228411
language
Swedish
LU publication?
yes
id
0ca1d9ca-c36c-414f-ae20-5a307ef5b752
date added to LUP
2024-02-28 16:58:09
date last changed
2024-10-14 12:00:45
@article{0ca1d9ca-c36c-414f-ae20-5a307ef5b752,
  abstract     = {{Abstract<br/>Background and objective:<br/>Defunctioning loop ileostomy (DLI) is frequently used to decrease the consequences of anastomotic leak after ileal pouch-anal anastomosis (IPAA) surgery but is controversial because of stoma-associated morbidity. The aim of this study was to describe stoma-associated morbidity in IPAA–DLI patients compared with terminal ileostomy patients.<br/>Methods:<br/>Patients treated with colectomy for inflammatory bowel disease at Skåne University Hospital, Sweden, between 2005 and 2021 were eligible for inclusion. Terminal stoma-related morbidity was measured until 12 months after colectomy, IPAA surgery, or conversion to ileorectal anastomosis, whichever occurred first. DLI-related morbidity was measured until 12 months after IPAA surgery or stoma closure, whichever occurred first. Laboratory data were reviewed up to 18 months after surgery since patients without complications were rarely subjected to blood sampling. Data on patient characteristics, renal function, surgical complications, and readmissions were collected retrospectively. Primary outcomes were DLI- and terminal ileostomy-related renal morbidity, whereas secondary outcomes focused on stoma-related complications.<br/>Results:<br/>The study cohort consisted of 165 patients with terminal ileostomy after colectomy (median (interquartile range (IQR)): stoma time 30 (15–74) months) and 42 patients with IPAA–DLI (median (IQR): stoma time 4 (3–5) months). One case of anastomotic IPAA leakage was observed. IPAA–DLI patients more often required hospital care due to high-volume stoma output immediately after surgery (0–30 days, 29%) compared with terminal ileostomy patients (4%, p &lt; 0.001). There were no significant differences in acute renal injury (p = 0.073) or chronic renal failure (p = 0.936) incidences between the groups. DLI closure was achieved in 95% of IPAA–DLI patients, with 5% suffering Clavien–Dindo complications &gt; 2.<br/>Conclusions:<br/>IPAA–DLI patients exhibited higher incidence of short-term high-volume stoma output without higher rates of acute renal injury or chronic renal failure compared with terminal ileostomy patients in this small single-center retrospective study suggesting that the risk of renal morbidity in IPAA–DLI patients may have been overestimated.}},
  author       = {{Lundström, Simon and Buchwald, Pamela and Agger, Erik}},
  issn         = {{1799-7267}},
  language     = {{swe}},
  month        = {{02}},
  number       = {{3}},
  pages        = {{202--210}},
  publisher    = {{Finnish Surgical Society}},
  series       = {{Scandinavian Journal of Surgery}},
  title        = {{A retrospective cohort study on renal morbidity related to stoma type in inflammatory bowel disease patients following colectomy and ileal pouch-anal anastomosis surgery}},
  url          = {{http://dx.doi.org/10.1177/14574969241228411}},
  doi          = {{10.1177/14574969241228411}},
  volume       = {{113}},
  year         = {{2024}},
}