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Presenter: Douglas G., Farmer, Los Angeles, United States
Authors: Douglas G. Farmer1, Robert S. Venick2, Yvonne E. Esmailian1, Laura Wozniak2, Sue V. McDiarmid2, Ronald W. Busuttil1
Douglas G. Farmer1, Robert S. Venick2, Yvonne E. Esmailian1, Laura Wozniak2, Sue V. McDiarmid2, Ronald W. Busuttil1
1Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; 2Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
Introduction: Ileostomy (OST) formation is a cornerstone of intestinal transplantation (ITx). OST complication rates in non-transplant patients are 15-50% but have not been described after ITx. The aim of this study was to review our experience with the ITx OST to define complications and outcomes.
Materials and Methods: A retrospective, IRB-approved, single center review of a prospective database was undertaken. Criteria for OST takedown included normal graft function and ≥ 3mo s/p ITx. Preop workup included graft biopsy and GI contrast studies. Surgical techniques related to OST formation and takedown were recorded. All complications related to the procedures were included. Standard statistical analysis was undertaken.
Results: Between November 1991 and May 2011, 115 ITx were performed in 97 patients. 74% were children; mean age: 12.1 yr ± 13.9 yrs. ITx types was most commonly liver-intestine (61%). 2 did not have an OST. The most common type of OST was a distal end-OST with a proximal ileocolostomy (56%).
There was a 19.5% complication rate including prolapse (n=8) and ischemia (n=6). Patients with OST complication required more operations post ITx (4.9 ± 2.4 vs 3.3 ±2.6, p=0.02) and had takedown surgery earlier (282 ± 213d vs 509 ± 419d, p=0.09). There were no other differences between patients including graft ischemia, pt age, or size.
15/113 patients were deemed to have permanent ileostomy. 98/113 were eligible for OST takedown; 49 underwent the procedure at 457 ± 391d post ITx. The other 49 did not undergo the procedure due to graft loss or pending surgery. There was an 18% complication rate after OST takedown; obstruction (n=4) was most common. Patients with complications required more re-operations as compared to those without complications (6.2 ± 2.9 vs 3.7 ± 2.4, p=0.0074). There was a trend toward increased complications in smaller patients. Despite these issues, there was no difference in median survival.
Discussion: The OST is an important part of ITx. Complications have not been well reported. Herein, we find that the ITx OST has a significant complication rate leading to surgical revision and/or early OST takedown. In OST takedown patients, there is a significant complication rate with the most troubling being obstruction. Further in depth study is needed to elucidate which patients are at risk for complications in an effort to reduce morbidity
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