%0 Journal Article
%T Comparison between Tube Ileostomy and Loop Ileostomy as a Diversion Procedure
%A Vijayraj Patil
%A Abhishek Vijayakumar
%A M. B. Ajitha
%A Sharath Kumar L
%J ISRN Surgery
%D 2012
%R 10.5402/2012/547523
%X Aim. Loop ileostomy has high complication rates and causes much patient inconvenience. This study was performed to compare the outcome of tube versus loop ileostomy in management of ileal perforations. Patients and Methods. From July 2008 to July 2011, all patients with ileal perforation on laparotomy where a defunctioning proximal protective loop ileostomy was considered advisable were chosen for study. Patients were randomly assigned to undergo either tube ileostomy or classical loop ileostomy as the diversion procedure. Tube ileostomy was constructed in the fashion of feeding jejunostomy, with postoperative saline irrigation. Results. A total of 60 diversion procedures were performed over the period with 30 for each of tube and loop ileostomy. Typhoid and tuberculosis formed the most common etiology for ileal perforation. The complication rate of tube ileostomy was 33%. Main complications related to tube ileostomy were peritubal leak, tube blockage. In patients with loop, overall complications in 53% majority were peristomal skin irritation and wound infection following ileostomy closure. Two patients developed obstruction following ileostomy closure which needed reoperation. Conclusions. Tube ileostomy is effective and feasible as a diversion procedure and has reduced morbidity. It can be used as an alternative to loop ileostomy. 1. Introduction Emergency laparotomy for intestinal perforation and obstruction surgeons are faced with difficult decision to perform stoma for fecal diversion; an even more difficult task is explaining the need for stoma to patient. Creation of a diverting stoma has its own set of complications including stomal retraction, prolapse, or necrosis; para-ileostomy infection/abscess and fistula; intestinal obstruction; skin irritation/excoriation; mucosal ulceration; offensive odors; prestomal ileitis; diarrhea; and hemorrhage [1]. The need for frequent change of the costly ileostomy appliance because of the leakage following loss of seal imposes great financial burden, especially in developing countries. A need for second surgery for closure of stoma adds on to financial burden and unnecessary delays due to nonprioritization of stoma closure due to high case volume. The closure of the intestinal stoma is also frequently followed by complications in 17%¨C27% of patients [2, 3]. These complications include fever, wound infection, abdominal septic complications, leak from ileostomy closure, intestinal obstruction, incisional hernia, and death. We designed this prospective study to assess the feasibility and outcome of proximal
%U http://www.hindawi.com/journals/isrn.surgery/2012/547523/