The Role of Prophylactic Diverting Loop Ileostomy in Preventing Leaks in High Risk Intraperitoneal Colonic Anastomosis: A Literature Review

Abstract

Introduction: The anastomotic leak occurs in approximately 3-15% of patients who undergo colon and rectal surgery and can lead to significant morbidity and mortality. Prophylactic Diverting Loop Ileostomy (DLI) is done at times to prevent the anastomotic leak in high risk intraperitoneal colonic anastomosis. The role of DLI to prevent intraperitoneal colonic anastomosis leak is not well defined and we present the first review of literature to address this subject. Aim: To do a literature review and study the role of prophylactic DLI for intraperitoneal colonic anastomosis. Materials and Methods: We searched the PubMed, Google Scholar and Cochrane Library database and also searched the reference of the relevant articles. After the extensive search, we got nine articles on this subject for review. Results: For destructive colon injury with hypotension requiring more than four units of packed red blood cells or with significant co-morbidities, the high risk anastomosis becomes safer with a prophylactic DLI. For patients with pathological perforations, DLI can be added to safeguard colonic anastomosis if there are two or more risk factors for anastomotic leak. Patients not falling in above groups may not require prophylactic DLI for intraperitoneal colonic anastomosis. Conclusion: Prophylactic DLI should be done to safeguard intraperitoneal colonic anastomosis only when there are multiple risk factors for the anastomotic leak.

Keywords

• anastomotic leak
• colonic injury
• colonic perforations
• colonic surgery