Clin Colon Rectal Surg 2019; 32(03): 171-175
DOI: 10.1055/s-0038-1677004
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diverting Ostomy: For Whom, When, What, Where, and Why

Alexis Plasencia
1   Jackson Memorial Hospital, University of Miami, Miami, Florida
,
Heidi Bahna
2   Division of Colon and Rectal Surgery, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
3   University of Miami at JFK Medical Center, Atlantis, Florida
› Author Affiliations
Further Information

Publication History

Publication Date:
02 April 2019 (online)

Abstract

Fecal diversion is an important tool in the surgical armamentarium. There is much controversy regarding which clinical scenarios warrant diversion. Throughout this article, we have analyzed the most recent literature and discussed the most common applications for the use of a diverting stoma. These include construction of diverting ileostomy or colostomy, ostomy for low colorectal/coloanal anastomosis, inflammatory bowel disease, diverticular disease, and obstructing colorectal cancer. We conclude the following: diverting loop ileostomy is preferred to loop colostomy, an ostomy should be used for a pelvic anastomosis < 5 to 6 cm including coloanal anastomosis and ileo-anal-pouch anastomosis, severe perianal Crohn's disease frequently requires diversion, a primary anastomosis with diverting ileostomy in the setting of diverticular perforation is safe, and a diverting stoma can be used as a bridge to primary resection in the setting of an obstructing malignancy.

 
  • References

  • 1 Geng HZ, Nasier D, Liu B, Gao H, Xu YK. Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loop colostomy after low anterior resection for rectal carcinoma. Ann R Coll Surg Engl 2015; 97 (07) 494-501
  • 2 Rondelli F, Reboldi P, Rulli A. , et al. Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis 2009; 24 (05) 479-488
  • 3 Klink CD, Lioupis K, Binnebösel M. , et al. Diversion stoma after colorectal surgery: loop colostomy or ileostomy?. Int J Colorectal Dis 2011; 26 (04) 431-436
  • 4 Ihnát P, Guňková P, Peteja M, Vávra P, Pelikán A, Zonča P. Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection. Surg Endosc 2016; 30 (11) 4809-4816
  • 5 Mrak K, Uranitsch S, Pedross F. , et al. Diverting ileostomy versus no diversion after low anterior resection for rectal cancer: a prospective, randomized, multicenter trial. Surgery 2016; 159 (04) 1129-1139
  • 6 Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998; 85 (03) 355-358
  • 7 Hanna MH, Vinci A, Pigazzi A. Diverting ileostomy in colorectal surgery: when is it necessary?. Langenbecks Arch Surg 2015; 400 (02) 145-152
  • 8 Baker ML, Williams RN, Nightingale JM. Causes and management of a high-output stoma. Colorectal Dis 2011; 13 (02) 191-197
  • 9 Wong NY, Eu KW. A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon Rectum 2005; 48 (11) 2076-2079
  • 10 Nastro P, Knowles CH, McGrath A, Heyman B, Porrett TR, Lunniss PJ. Complications of intestinal stomas. Br J Surg 2010; 97 (12) 1885-1889
  • 11 Nurkin S, Kakarla VR, Ruiz DE, Cance WG, Tiszenkel HI. The role of faecal diversion in low rectal cancer: a review of 1791 patients having rectal resection with anastomosis for cancer, with and without a proximal stoma. Colorectal Dis 2013; 15 (06) e309-e316
  • 12 Chow A, Tilney HS, Paraskeva P, Jeyarajah S, Zacharakis E, Purkayastha S. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis 2009; 24 (06) 711-723
  • 13 Seifarth C, Kreis ME, Gröne J. Indications and specific surgical techniques in Crohn's disease. Viszeralmedizin 2015; 31 (04) 273-279
  • 14 Yamamoto T, Allan RN, Keighley MR. Effect of fecal diversion alone on perianal Crohn's disease. World J Surg 2000; 24 (10) 1258-1262 , discussion 1262–1263
  • 15 Mueller MH, Geis M, Glatzle J. , et al. Risk of fecal diversion in complicated perianal Crohn's disease. J Gastrointest Surg 2007; 11 (04) 529-537
  • 16 Hong MK, Craig Lynch A, Bell S. , et al. Faecal diversion in the management of perianal Crohn's disease. Colorectal Dis 2011; 13 (02) 171-176
  • 17 Galandiuk S, Kimberling J, Al-Mishlab TG, Stromberg AJ. Perianal Crohn disease: predictors of need for permanent diversion. Ann Surg 2005; 241 (05) 796-801 , discussion 801–802
  • 18 Nordgren S, Fasth S, Hultén L. Anal fistulas in Crohn's disease: incidence and outcome of surgical treatment. Int J Colorectal Dis 1992; 7 (04) 214-218
  • 19 van Overstraeten DeB, Wolthuis AM, Vermeire S. , et al. Intersphincteric proctectomy with end-colostomy for anorectal Crohn's disease results in early and severe proximal colonic recurrence. J Crohn's Colitis 2013; 7 (06) e227-e231
  • 20 Toh JW, Stewart P, Rickard MJ, Leong R, Wang N, Young CJ. Indications and surgical options for small bowel, large bowel and perianal Crohn's disease. World J Gastroenterol 2016; 22 (40) 8892-8904
  • 21 Prabhakar LP, Laramee C, Nelson H, Dozois RR. Avoiding a stoma: role for segmental or abdominal colectomy in Crohn's colitis. Dis Colon Rectum 1997; 40 (01) 71-78
  • 22 El-Hussuna A, Andersen J, Bisgaard T. , et al. Biologic treatment or immunomodulation is not associated with postoperative anastomotic complications in abdominal surgery for Crohn's disease. Scand J Gastroenterol 2012; 47 (06) 662-668
  • 23 Eriksen TF, Lassen CB, Gögenur I. Treatment with corticosteroids and the risk of anastomotic leakage following lower gastrointestinal surgery: a literature survey. Colorectal Dis 2014; 16 (05) O154-O160
  • 24 Myrelid P, Marti-Gallostra M, Ashraf S. , et al. Complications in surgery for Crohn's disease after preoperative antitumour necrosis factor therapy. Br J Surg 2014; 101 (05) 539-545
  • 25 Gu J, Remzi FH, Shen B, Vogel JD, Kiran RP. Operative strategy modifies risk of pouch-related outcomes in patients with ulcerative colitis on preoperative anti-tumor necrosis factor-α therapy. Dis Colon Rectum 2013; 56 (11) 1243-1252
  • 26 Sahami S, Bartels SA, D'Hoore A. , et al. A multicentre evaluation of risk factors for anastomotic leakage after restorative proctocolectomy with ileal pouch-anal anastomosis for inflammatory bowel disease. J Crohn's Colitis 2016; 10 (07) 773-778
  • 27 Kiran RP, da Luz Moreira A, Remzi FH. , et al. Factors associated with septic complications after restorative proctocolectomy. Ann Surg 2010; 251 (03) 436-440
  • 28 Etzioni DA, Mack TM, Beart Jr RW, Kaiser AM. Diverticulitis in the United States: 1998-2005: changing patterns of disease and treatment. Ann Surg 2009; 249 (02) 210-217
  • 29 Power N, Atri M, Ryan S, Haddad R, Smith A. CT assessment of anastomotic bowel leak. Clin Radiol 2007; 62 (01) 37-42
  • 30 Franklin Jr ME, Dorman JP, Jacobs M, Plasencia G. Is laparoscopic surgery applicable to complicated colonic diverticular disease?. Surg Endosc 1997; 11 (10) 1021-1025
  • 31 Penna M, Markar SR, Mackenzie H, Hompes R, Cunningham C. Laparoscopic lavage versus primary resection for acute perforated diverticulitis: review and meta-analysis. Ann Surg 2018; 267 (02) 252-258
  • 32 Vennix S, Morton DG, Hahnloser D, Lange JF, Bemelman WA. ; Research Committee of the European Society of Coloproctocology. Systematic review of evidence and consensus on diverticulitis: an analysis of national and international guidelines. Colorectal Dis 2014; 16 (11) 866-878
  • 33 Oberkofler CE, Rickenbacher A, Raptis DA. , et al. A multicenter randomized clinical trial of primary anastomosis or Hartmann's procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis. Ann Surg 2012; 256 (05) 819-826 , discussion 826–827
  • 34 Bridoux V, Regimbeau JM, Ouaissi M. , et al. Hartmann's procedure or primary anastomosis for generalized peritonitis due to perforated diverticulitis: a prospective multicenter randomized trial (DIVERTI). J Am Coll Surg 2017; 225 (06) 798-805
  • 35 Amelung FJ, Mulder CL, Verheijen PM, Draaisma WA, Siersema PD, Consten EC. Acute resection versus bridge to surgery with diverting colostomy for patients with acute malignant left sided colonic obstruction: systematic review and meta-analysis. Surg Oncol 2015; 24 (04) 313-321