Ergebnisse der Rückverlagerungen protektiver Loop-Ileostomata-Eine retrospektive Datenanalyse über 8 Jahre

Background and problem: Protective Loop-ileostomies are often contructed after sphincter-sustaining operations of the colon and rectum for temporary protection of the anastomosis. A stoma cannot prevent the appearing of an insufficiency of the anastomosis, but it can reduce its consequences if one appears. However the construction, the presence and the closure of an ileostomy is associated with a critical rate of complications. The aim of this data-analysis was, to gather the morbidity and mortality wich are associated with the closure of loop-ileostomies and to evaluate if there is an appreciable correlation between the postoperative morbidity and the time between the construction and closure of loop-ileostomies in the elective surgery of the rectum. Patients and methods: Data has been collected from all patients who have submitted themselves to a closure of a protective loop-ileostomy from 01.01.1999-31.12.2006 at the Clinic of Visceral-, thorax- and vascular surgery of the Philipps-University of Marburg. During this time 129 closures have been performed at 128 patients. Among these at 81 patients an ileostomy has been closed after an anterior deep resection because of a cancer or an adenoma of the rectum. Results: Complications have appeared after 59 of 129 (45,74%) operations, however these complications were only in 52 (40,31%) cases caused by the closure itself. 49 (38,28%) patients suffered under minor-complications, 6 (4,69%) under major-complications and 11 (8,59%) under general complications. 9 patients (7,03%) received a relaparotomy and 7 patients (5,47%) received a stoma for a second time. The 30-days-mortality was 0,78% with the death of one patient. Among the patients of the elective surgery of the rectum an appreciable correlation between postoperative morbidity and the time between contruction and closure of a stoma could not be proofed. Discussion and conclusion: The closure of a loop-ileostomy has an appreciable risk. This should not surpass its benefit. So the indication for a stoma should be considered critically. Because of our data it is possibe to claim that it is unnecessary to wait 3 month until the closure of a stoma at every patient. It appears as more justified to determine the time of closure according to individual aspects of the patients.