Surgery-free ileostomy removal shows promise

Temporary percutaneous ileostomy (TPI) following rectal resection is as effective at preventing anastomotic leakage as conventional loop ileostomy (CLI), show the results of an Italian study.

Additionally, it could help reduce the number of perioperative and stoma-related complications, say the authors.

"The [TPI] proposed by our group seems to be a valid alternative to standard ileostomy, ensuring optimal faecal diversion and less patient discomfort, and can be easily removed without surgery," say Fabio Rondelli (University of Perugia, Italy) and colleagues.

The study included 143 patients undergoing rectal resection for adenocarcinoma. There were 75 patients randomly assigned to undergo TPI, where a jejunostomy tube is temporarily placed into the ileum to provide a drainage passage. The remaining 68 patients underwent CLI.

Overall, anastomotic leakage occurred in four patients in the CLI group and one in the TPI group, which was statistically comparable.

Patients in the TPI group stayed longer in hospital at a median of 11 days compared with 8 days in the CLI group. However, CLI patients had a second hospital stay after stoma removal lasting a median 7 days.

There were 32 complications within 30 days of surgery in the CLI group compared with 14 in the TPI group. Patients in the CLI group also experienced more complications related to the closure of the stoma, some of which required surgery. Overall, there were 13 complications in the CLI group and three in the TPI group.

The prevention of anastomotic leakage is an important outcome following rectal resection because, explain the authors, leakage is associated with increased morbidity, perioperative mortality, and risk for recurrence.

"Our retrospective study suggests that this technique of temporary faecal diversion is as effective in protecting the colorectal anastomosis from symptomatic leaks as a conventional loop ileostomy," conclude Rondelli and colleagues in the European Journal of Surgical Oncology.

They believe their technique could be used to avoid the morbidity associated with loop ileostomy closure.

"Future prospective randomized studies are needed to definitively validate the results presented and the role of TPI," they conclude.

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