Complications of loop ileostomy and ileostomy closure and their implications for extended enterostomal therapy: A prospective clinical study

• Published in: International journal of nursing studies 2008-08, Vol.45 (8), p.1118-1121
• Main Authors: Rathnayake, M.M.G., Kumarage, S.K., Wijesuriya, S.R.E., Munasinghe, B.N.L., Ariyaratne, M.H.J., Deen, K.I.
• Format: Article
• Language: English
• Subjects: Adenomatous Polyposis Coli - surgery; Clinical medicine; Colitis, Ulcerative - surgery; Enterostomal therapy; Female; Health Services Needs and Demand - organization & administration; Hernia, Abdominal - etiology; Hirschsprung Disease - surgery; Humans; Ileostomy; Ileostomy - adverse effects; Ileostomy - nursing; Ileostomy - psychology; Intestinal Fistula - etiology; Intestinal Obstruction - etiology; Long-Term Care - organization & administration; Loop ileostomy; Male; Nurse Clinicians - organization & administration; Nurse's Role; Nursing; Nursing Audit; Nursing Evaluation Research; Patients; Prospective Studies; Quality of life; Rectal Neoplasms - surgery; Rectovaginal Fistula - etiology; Reoperation; Reversal; Skin Care - nursing; Surgery; Surgical techniques; Surgical Wound Infection - etiology; Therapy; Vaginal Fistula - etiology; Workload
• ISSN: 0020-7489; 1873-491X
• DOI: 10.1016/j.ijnurstu.2007.07.015

Patients who have a temporary loop ileostomy have impaired quality of life. Complications associated with a loop ileostomy or ileostomy closure will impair patients’ quality of life further and require extended enterostomal therapy. We performed a prospective audit of loop ileostomy to ascertain the nature of the workload that may be created with ileostomy-related complications. One hundred and forty patients (67 males, 73 females, median age 50 years, range 5–90 years) who received a temporary loop ileostomy were analysed after completion of proformas on a prospective basis between 1999 and 2006. Operation was performed for rectal cancer 100 (71%), familial adenomatous polyposis 14 (10%), ulcerative colitis 21 (15%) and for trauma or Hirchsprung's disease 5 (3%). Complications of loop ileostomy were: retraction 1 (0.7%), ileostomy flux 11 (8%), stomal prolapse 1 (0.7%), parastomal hernia 1 (0.7%), paraileostomy abscess 4 (3%) and severe skin excoriation 9 (6%). The loop ileostomy was reversed in 117 (83%) at a median (range) of 13 weeks (1–60). Ileostomy closure-related complications were: small bowel fistula 1 (0.9%), small bowel obstruction 5 (4.3%) and a stitch sinus in 1 (0.9%). Five women developed recto-vaginal fistula ( n=3; 2.6%), pouch-vaginal fistula ( n=1; 0.9%) and pouch-anal fistula ( n=1; 0.9%) that required extended enterostomal therapy, after loop ileostomy reversal. Nineteen percent of patients following creation of a loop ileostomy and 10.5% of patients after reversal of the ileostomy required extended enterostomal care by a specialized enterostomal therapist, which supported resumption of a normal life.