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INTRODUCTION: The main goal of gastrointestinal stomas is to divert the faecal stream from technically difficult anastomoses or intestinal obstruction. Current tendency is to avoid definitive stomas, temporary loop stomas are commonly used to protect high risk anastomosis or sections of the distal bowel. The aim of this study was to determine and compare the morbi-mortality after loop stomas closure. METHODS: Retrolective, observational and comparative study was conducted. The files of patients submitted to loop ileostomy or colostomy closure from 1981 to 2001 were reviewed. Statistical analysis was performed by the Fisher's exact test and the Mann-Whitney U test. RESULTS: From a total of 107 procedures included, 73% were ileostomy closures and 27% colostomy closures. The mean age was 46 years (14-88). Protection of anastomoses was the most common indication in both stoma groups. The colostomy group had a larger interval days between stoma creation and closure than the ileostomy group (172.3 days vs. 125.6 days p = 0.008). Stoma closure was performed by hand sewn sutures in 81.3% patients and by stapled technique in 19.7% patients. The mean operative time for stoma closure was higher for colostomy group than for ileostomy (108.1 min vs. 88.3 min, p = 0.04). Colostomy group patients required a midline abdominal incisions more often than ileostomy group (21.4 vs. 2.5% p = 0.04). Morbidity rates were 7.6% for the ileostomy group and 10.3% for the colostomy group. Colostomy closure required a longer length of stay. There was no mortality. CONCLUSION: The results of this study showed that stoma closure was a well tolerated procedure with low morbidity and no mortality rates. The result suggest that ileostomy closure is a simpler procedure.

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Sao analisados 26 doentes submetidos à estomia na vigência de peritonite por abdome agudo nao traumático. A faixa etária variou de 25 a 83 anos, com média de idade de 51 anos. Nao houve predomínio quanto ao sexo. O abdome agudo obstrutivo (AAO) foi a causa mais freqüente de peritonite (11 casos), seguido do abdome agudo perfurativo (AAP) em 8, abdome agudo vascular (AAV) em 5 e inflamatório (AAI) em 2. Na maioria dos doentes (65 por cento) foi realizada ileostomia à Brooke. Em apenas 4 praticou-se jejunostomia, observando-se má evoluçao. A mortalidade global foi de 54 por cento. A realizaçao de estomia ou anastomose primária na presença de peritinite constitui um tema com muitas controvérsias. Nesta artigo sao discutidas as indicaçoes e os problemas envolvendo a exteriorizaçao intestinal na urgência.

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Twenty-six patients showing peritonitis due to nontraumatic acute abdomen were submitted to ostomy. Mean age was 51 years (range 25-83), being 13 males and 13 females. Bowel obstruction (BO) was the most frequent cause of peritonitis (11 cases), followed by intestinal perforation (IP) (8 cases), acute mesenteric infarction (AMI) (5 cases), and acute abdomen of inflammatory/infectious origin (AAIO) (2 cases). Brook's ileostomy was performed on 65% of the patients. Jejunostomy was performed only in 4 patients, leading to a bad evolution. Overall mortality was 54%. Primary ostomy or anastomosis in cases of peritonitis constitute a highly controversial theme. Indications and problems involving the intestinal exteriorization in emergency surgery urgency are herein discussed.

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The study included 33 newborns with the diagnosis of intestinal atresia after discarding those of the duodenum. According to the clinical conditions of the patient and of the malformation, surgery was carried out by derivative ileostomy or primary anastomosis. Survivorship reaches 67% for ileostomy and 65% for anastomosis which are much higher figures than those obtained before.

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