Comparison of complications associated with diverting stoma after pouch surgery for ulcerative colitis or anterior resection for rectal cancer

Abstract Background: The standard surgical procedure for ulcerative colitis (UC), including UC-associated cancer (UCAC), is total proctocolectomy (TPC) with mucosal resection and ileal-pouch anal anastomosis (IPAA). TPC and IPAA complications should be considered during the perioperative period. This study aimed to clarify problems associated with diverting loop stoma in TPC and IPAA based on complications during stoma construction and perioperative results of stoma closure. Methods:Thirty-two patients who underwent TPC and IPAA with diverting loop ileostomy for ulcerative colitis (TPC group) and 26 patients who underwent concurrent low anterior resection with diverting loop ileostomy for lower rectal cancer (LAR group) were included. We retrospectively evaluated complications during stoma construction and the perioperative results of stoma closure between the two groups. Results:The height of the oral side of the stoma was lower in the TPC group than in the LAR group. Stoma-related complications were particularly common. In stoma closure, the TPC group had a higher rate of intestinal resection and a later postoperative resumption of food intake. There were no significant differences in the incidence of Clavien-Dindo Grade 2 or higher complications or length of hospital stay. Conclusions:Diverting loop stomas constructed withTPC and IPAA had a higher frequency of stoma-related complications and required intestinal resection for stoma closure. With appropriate surgical procedure and postoperative management, the postoperative outcomes were comparable to those of stoma closure in LAR.