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Comment & Response
November 6, 2019

Loop Ileostomy a Viable Alternative for Clostridium difficile Colitis?

Author Affiliations
  • 1Jyoban Hospital of Tokiwa Foundation, Iwaki-City, Fukushima, Japan
  • 2Department of Surgery, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Minato-ku, Tokyo, Japan
JAMA Surg. Published online November 6, 2019. doi:https://doi.org/10.1001/jamasurg.2019.4698

To the Editor Juo et al1 found that no significant difference was observed between loop ileostomy (LI) and total abdominal colectomy (TAC) for treating fulminant Clostridium difficile colitis (FCDC) in their retrospective cohort study. The overall in-hospital mortality rate for patients undergoing surgery for FCDC was 30.1%, with no significant difference between LI and TAC (26.0% vs 31.1%; P = .28). The findings would be beneficial for patients with FCDC because LI could be less invasive and maintain physiologic functions of colon compared with TAC. However, we are concerned about the higher rates of operative wound disruption (5.6% vs 2.3%; P = .04) and surgical site infection (SSI) (8.9% vs 3.6%; P = .01) among patients receiving LI compared with TAC, which is inconsistent with the prior study2 that showed the lower SSI rate for LI compared with TAC (2.1% vs 10.5%; P < .07).

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