Defunctioning ileostomy is not associated with reduced leakage in proctocolectomy and ileal pouch @entity254 surgeries for XXXX .

@entity1 @entity834 @entity353 @entity254 @entity29 @entity7943 @entity1744 @entity479
BACKGROUND: @entity834 is a serious complication after restorative proctocolectomy with ileal pouch-anal @entity254 . Previous studies have shown significantly decreased leak rates in diverted @entity1 with less severe clinical consequences. The aim of this study was to evaluate short and long term outcome of selective ileostomy formation in a multicentre cohort of @entity1 undergoing pouch surgery. METHODS: In a retrospective study, 621 @entity1 undergoing pouch surgery for @entity29 ( @entity29 ) were identified from three large centres. @entity834 was defined as any leak confirmed by either contrast extravasation on imaging or during surgical re-intervention. RESULTS: In 305 @entity1 (49.1%), primary defunctioning ileostomy was created during pouch surgery and 41 (6.6%) @entity1 received a secondary ileostomy because of a leaking non-diverted pouch. Primary ileostomy formation was associated with male sex, @entity353 , @entity7943 > 2, @entity479 use, one-stage surgery, hand-sewn @entity254 and blood transfusion. Leak rates were comparable between diverted and non-diverted @entity1 (16.7% vs 17.1%, p=0.92), which remained unchanged in subgroups with immunosuppressive medication. Having had an ileostomy was demonstrated to be an independent predictor of @entity1744 (OR 2.58, 95%CI 1.45 - 4.67) and pouch fistulas (OR 3.05, 95%CI 1.06 - 8.73). The 10-year pouch survival was comparable for @entity1 with and without ileostomy (89% versus 88%, P=0.718). CONCLUSIONS: Leakage rates of diverted and non-diverted pouches in @entity29 @entity1 were similar and relatively high. Defunctioning was independently associated with long-term complications. A staged approach without defunctioning might be the best strategy.
