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Loop ileostomy may offer ‘viable surgical alternative’ for fulminant C. diff colitis
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Since its introduction in 2011, adoption of diverting loop ileostomy for fulminant Clostridioides difficile colitis has more than doubled, and the procedure appeared to be a viable alternative to total colectomy, according to study findings published in JAMA Surgery.
Peyman Benharash, MD, of the Center for Health Services at the University of California Los Angeles, and colleagues wrote that although there is limited evidence that it improves mortality compared with colectomy, loop ileostomy has caught on because it is less invasive and has an organ-preserving nature.
“These perceived advantages may have lowered the threshold for surgical intervention treating [fulminant C. diff colitis (FCDC)],” they wrote. “In fact, some have hypothesized that the survival benefit observed in patients receiving [loop ileostomy] may arise from the earlier timing of surgical intervention rather than the intrinsic differences attributable to the procedure used.”
Researchers analyzed data from the National Inpatient Sample database to explore the national adoption of loop ileostomy, as well as outcomes compared with total abdominal colectomy as treatment for FCDC. Their analysis comprising 3,021 adult patients who underwent surgery for FCDC between 2011 to 2015, including 2,408 colectomies and 613 loop ileostomies. The primary outcome was in-hospital mortality.
From 2011, when loop ileostomy was first reported for FCDC, to 2015, the annual proportion of patients who underwent only loop ileostomy increased from 11.16% to 25.3%. Researchers found that more loop ileostomies were done within the first day of hospitalization (23.32%) compared with subtotal colectomies within the first day (12.21%; P < .01).
Additionally, Benharash and colleagues found that there was no significant difference in in-hospital mortality rates between loop ileostomy (25.98%) and colectomy (31.18%).
“We found that since the description of [loop ileostomy] and colonic lavage as a viable surgical option for FCDC in 2011, a clear change in procedure choice for FCDC has taken place throughout the United States,” they wrote. “While results from randomized clinical trials and a better understanding of functional outcomes are both needed, it appears that [loop ileostomy] is a viable alternative for acute care surgeons during management of FCDC.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.
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