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Comparative Study
. 2025 May;55(5):638-645.
doi: 10.1007/s00595-024-02944-5. Epub 2024 Oct 23.

Temporary loop end ileostomy reduces the risk of stoma outlet obstruction: a comparative clinical study in patients undergoing restorative proctocolectomy and ileal pouch-anal anastomosis

Takayuki Ogino  1 , Yuki Sekido  2 , Tsunekazu Mizushima  3 , Makoto Fujii  4 , Ryota Mori  2 , Mitsunobu Takeda  2 , Tsuyoshi Hata  2 , Atsushi Hamabe  2 , Norikatsu Miyoshi  2 , Mamoru Uemura  2 , Yuichiro Doki  2 , Hidetoshi Eguchi  2
Affiliations
Comparative Study

Temporary loop end ileostomy reduces the risk of stoma outlet obstruction: a comparative clinical study in patients undergoing restorative proctocolectomy and ileal pouch-anal anastomosis

Takayuki Ogino et al. Surg Today. 2025 May.

Abstract

Purpose: Stoma outlet obstruction (SOO) is a serious complication of restorative proctocolectomy (RPC) and ileal pouch-anal anastomosis (IPAA). When the ileal mesentery to the pouch is under excessive tension, the ileum near the ileostomy twists easily, causing SOO. Loop-end ileostomy (EI) for fecal diversion was introduced in 2021 to prevent SOO, and we aimed to verify whether temporary EI reduces the incidence of SOO in RPC and IPAA patients relative to loop ileostomy (LI).

Methods: This study included 106 consecutive RPC and IPAA patients with a diverting ileostomy and categorized them into LI (n = 75) or EI (n = 31) groups. The clinical characteristics of the patients were analyzed and compared.

Results: Patient characteristics were similar between the groups, except for higher preoperative steroid use in the LI group (38.7%; p = 0.0116). There were no significant differences between the groups in anatomical factors, such as abdominal wall thickness and the height-adjusted distance between the root of the superior mesenteric artery and the bottom of the external anal sphincter. There were no significant differences in surgery-related factors, with ≥ 90% of the patients in each group undergoing laparoscopic procedures. A multivariate logistic regression analysis revealed that EI significantly reduced the risk of SOO relative to LI (OR, 0.18; 95% CI 0.03-0.92; p = 0.0399).

Conclusion: EI reduced SOO levels after RPC and IPAA and may be beneficial for cases in which anastomosis is challenging.

Keywords: Ileal pouch-anal anastomosis; Restorative proctocolectomy; Small bowel obstruction; Stoma outlet obstruction; Ulcerative colitis.

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Conflict of interest statement

Declarations. Conflicts of interest: The authors declare no conflicts of interest in association with the present study.

Figures

Fig. 1
Fig. 1
Stoma outlet obstruction (SOO) due to angulation of the ileum near the stoma site. The arrow indicates the obstruction site
Fig. 2
Fig. 2
Tension of the ileal mesentery. The red arrow indicates the traction force from the ileal pouch-anal anastomosis. a Loop ileostomy causes cephalocaudal tension on the ileal mesentery. b This tension can be alleviated by loop end ileostomy
Fig. 3
Fig. 3
Flowchart of patient selection. RPC restorative proctocolectomy, IPAA ileal pouch-anal anastomosis
Fig. 4
Fig. 4
How to create loop end ileostomy at the umbilicus. The circle indicates the oral side, and the star indicates the anal side. a Partial division of the mesentery. b Transection of the intestinal tract. c Closure of the anal stump. d Add the fixation of the intestine for the next surgery for stoma closure. e Open at the top position
See this image and copyright information in PMC

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References

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