...overall rate of symptomatic AL was 13.2% (52 of 394) in patients with DS vs 12.7% (69 of 542) in cases without DS (p = 0.84). Symptomatic AL requiring re-laparotomy occurred in 4.7% (44 of 936) of all patients, occurring in 1.0% (4 of 394) of patients with DS vs 7.4% (40 of 542) of patients without DS (p < 0.001). After PSM, the 2 groups were nearly balanced, and the incidence rates of symptomatic AL in patients with and without DS were 10.9% and 15.8% (p = 0.26). The incidences of AL requiring re-laparotomy in patients with and without DS were 0.6% and 9.1% (p < 0.001)
I don't do a lot of low rectal cancer resections but I find the diverting ileostomy to be an extremely useful tool in my armamentarium in the setting of severe perforated diverticulitis. A lot of these patients need urgent or semi-urgent operative intervention after failure of conservative management. A bowel prep is usually contra-indicated. The pelvis is contaminated. The surrounding tissues are often edematous and friable. In the old days, everyone got a Hartmann's procedure (end colostomy and Hartmann's rectal pouch left in the pelvis. But we found over the years that reversing a Hartmann's colostomy was frought with morbidity. Leaks could occur. Surrounding structures could be injured. And sometimes the post peritonitis scarring resulted in a frozen, socked in pelvis with marginally identifiable anatomy. As a matter of fact, for a variety of reasons, only about 70-75% of Hartmann's colostomies ever get reversed.
My practice is to make liberal use of the loop ileostomy if I have any concern about my pelvic colorectal anastomosis. This allows the new conduit to heal without the stress of fecal matter flowing through it. A barium enema is ordered after 6 weeks or so to confirm healing and the patient is brought back to the OR for a pretty straight forward, far less stress-inducing loop ileostomy reversal.