Utility of routine histological examination of ileostomy reversals

Purpose: Diverting ileostomies are frequently used when bowel anastomosis is not feasible or to divert faeces from high-risk anastomoses. Despite being unrelated and distant to the initial pathology, histopathological examination is commonly requested. The aim of this study is to identify the benefit of histopathological analysis of these specimens and their impact on patient management. Methods: A retrospective review was conducted on all patients who underwent a reversal of ileostomy at a tertiary referral teaching hospital between January 2016 to July 2021. Patient demographics, stoma indication, histopathological reports and post-operative outcomes were reviewed. Results: The study identified 87 cases of ileostomy reversals between January 2016 and July 2021. The mean age of the patients was 58 years old; 62 (71.2%) patients were male. Seventy-three (83.9%) stomas were formed electively, the majority of these for ultralow or low anterior resections (39 and 17 patients respectively). A further 13 (14.9%) stomas were formed in the emergency setting, 1/13 (7.7%) cases were due to a malignant pathology and 12/13 (92.3%) were benign conditions. Overall, forty-three samples were reviewed, 42 (97.7%) of these showed normal small bowel histopathology and malignancy was identified in only 1 (2.3%) specimen. Due to frailty, there was no further active management for the patient with the malignant pathology. Conclusion: Selective histopathological examination may be of value in macroscopically suspicious or high-risk patients for peritoneal disease based on primary pathology, however the utility in routine use requires further evaluation.