EP 233 How Does Formation of Defunctioning Ileostomy in Anterior Resection Affect Short Term Outcomes?
Oliver Claydon, Rachel Thavayogan, Jamie MatherAbstract
Aims
Defunctioning loop ileostomy during anterior resection of rectum protects high-risk colorectal anastomoses, but may be associated with complications, readmissions and longer hospital stay. This retrospective study aims to compare the early post-operative outcomes between patients with and without defunctioning ileostomy.
Methods
All adult patients who underwent left colon resection with primary colo-colic or colo-rectal anastomosis from 01/01/2015 to 31/12/2024 were included. Outcome data was obtained from hospital records. Outcomes were Clavien-Dindo 3+ (CD3+) complications, length of hospital stay (LOHS), and 30-day readmissions. Chi-squared test was used to analyse categorical data and one-tailed Mann-Whitney U test for continuous data.
Results
304 cases were included. 93 patients (30.6%) had defunctioning ileostomy formed during primary operation; 211 patients (69.4%) were not defunctioned. Overall mean LOHS was 7.9 days; CD3+ complication rate was 13.5%; 30-day readmission rate 11.3%. CD3+ complication rate was significantly higher in patients without stoma (16.1 vs 7.53%); as was anastomotic leak rate (9.95% vs 4.34%). Anastomotic leak was the most common complication in patients without stomas; and stoma ischaemia/abscess the most common in patients with stomas. If no CD3+ complication occurred post-operatively, patients with stoma had significantly higher LOHS (7.98 vs 6.17 days). Patients with stoma had a higher readmission rate, although this was not statistically significant.
Conclusions
Defunctioning stoma reduces post-operative complication rate, but can be associated with longer hospital stay and readmission rate. Patients undergoing stoma should be pre-operatively counselled and provided with effective post-operative and stoma care.