eP260 - End Ileostomy Reduced the Risk of Stoma Outlet Obstruction in Patients Undergoing Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis

Sunday, June 2, 2024

11:45 AM – 11:50 AM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Takayuki Ogino, MD, PhD

Associate professor
Osaka University
Osaka University
Suita, Osaka, Japan

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

YS

Yuki Sekido

Disclosure information not submitted.

Author(s)

MT

Mitsunobu Takeda, M.D., Ph.D.

Assistant professor
Department of Gastroenterological Surgery, Osaka University
Suita, Osaka, Japan

Disclosure information not submitted.

Author(s)

TH

Tsuyoshi Hata

Disclosure information not submitted.

Author(s)

AH

Atsushi Hamabe, M.D.,Ph.D.

Assistant professor
Gastroenterological surgery
Suita, Osaka, Japan

Disclosure information not submitted.
NM

Norikatsu Miyoshi, FASCRS

Assistant Professor
Osaka University
Suita, Osaka, Japan

Disclosure information not submitted.
MU

Mamoru Uemura, MD, PhD

Associate Professor
Osaka University
Suita City, Osaka, Japan

Disclosure information not submitted.
TM

Tsunekazu Mizushima, M.D., Ph.D.

Specially-appointed professor
Thetapeutics for inflammatory bowel disease
Suita, Osaka, Japan

Disclosure information not submitted.
YD

Yuichiro Doki, M.D., Ph.D.

Professor
Gastroenterological surgery
Suita, Osaka, Japan

Disclosure information not submitted.
HE

Hidetoshi Eguchi, MD, PhD

Professor
Graduate School of Medicine, Osaka University
Suita, Osaka, Japan

Disclosure information not submitted.

Purpose/Background: Stoma outlet obstruction (SOO) is troubling complication after restorative proctocolectomy (RPC) and ileal-pouch anal anastomosis (IPAA). SOO occurred with an incidence of 20–40% after RPC and IPAA compared with that of less than 15% after low anterior resection for rectal cancer. Previous study of anatomical risk factors reported that SOO was more common in patients with a longer distance between the root of their superior mesenteric artery and the bottom of the external anal sphincter (rSMA-bEAS), and suggested in case that the ileal mesentery to pouch is under excessive tension, the ileum near ileostomy could twist easily, leading to SOO. Therefore, we changed the method of stoma creation from loop ileostomy (LI) to end ileostomy (EI) to reduce tension of pouch and prevent SOO. In this study, we aimed to verify whether temporary EI reduces the incidence of SOO compared to LI in patients undergoing RPC and IPAA.Methods/Interventions: This study included 106 consecutive patients who underwent RPC and IPAA with diverting ileostomy. These cases were grouped by type of ileostomy (LI or EI), and analyzed based on clinical characteristics and computed tomography (CT)-based anatomical factors.Results/Outcomes: 75 patients had loop ileostomy and 31 had end ileostomy. The two groups were comparable for patients’ characteristics except that the preoperative steroid use was 65.3% in LI, significantly higher than in EI (38.7%; P = 0.0116). The two groups did not differ regarding anatomical factors about thickness of abdominal wall and height adjusted rSMA-bEAS. Surgery-related factors were also no differences. More than 90 % of patients in both groups were performed using a laparoscopic approach. The incidence of SOO in EI was 3 (9.7%), which tended to be lower compared with 20 (26.7%) in LI (P = 0.0536). Multivariable logistic regression analysis was performed to assess which factors were independently associated with SOO. Patients with EI had a significantly lower risk of SOO than those with LI (OR 0.18, 95% CI 0.03–0.92; p= 0.0399). High output syndrome (HOS) was risk factor to develop SOO (OR 4.46, 95% CI 1.31–15.17; p= 0.0165), and heigh adjusted rSMA-bEAS was also associated with significantly higher SOO incidence (OR 1.04, 95% CI 1.00–1.08; p= 0.0265).Conclusion/

Discussion: EI could reduce SOO after RPC and IPAA. The reduction of mesenteric tension using EI might also be a solution to difficult cases of anastomosis.