Loop Ileostomy vs Total Abdominal Colectomy —A Valid Alternative?

In this issue of JAMA Surgery, Juo et al have presented a study on a US trend in treating fulminant Clostridium difficile colitis with loop ileostomy as an organ-preserving procedure vs performing total abdominal colectomy. With a retrospective cohort study design, Juo et al examined a US national administrative database, the National Inpatient Sample database, with a weighted sampling of treatment choices for C difficile colitis in approximately 20% of associated hospitalizations in nonfederal acute care hospitals in the sampled US states from 2011 through 2015. The study includes 3021 adult patients who underwent surgery for severe C difficile colitis during the study period, of whom 2408 had subtotal colectomies and 613 had loop ileostomies. The annual proportion of patients undergoing only diversion has increased from 11.2% in 2011 to 25.3% in 2015.
Source: JAMA Surgery - Category: Sports Medicine Source Type: research