Factors affecting timing of closure and non-reversal of temporary ileostomies

Abstract

BackgroundAlthough stoma closure is considered a simple surgical intervention, the interval between construction and reversal is often prolonged, and some ileostomies may never be reversed. We evaluated possible predictors for non-reversal and prolonged interval between construction and reversal.Material and methodsIn a cohort study of ileostomy patients treated in a large teaching hospital, we collected data from the surgical complication and enterostomal therapists’ registries between January 2001 and December 2011. Parameters responsible for morbidity, mortality, length of stay and time interval between construction and reversal were analysed.ResultsOf 485 intentionally temporary ileostomies, 359 were reversed after a median of 5.6 months (IQR 3.8–8.9 months), while 126 (26 %) remained permanent.End ileostomy and intra-abdominal abscess independently delayed reversal. Age, end ileostomy, higher body mass index and preoperative radiotherapy were independent factors for non-reversal. Median duration of hospitalisation for reversal was 7.0 days (5–13 days). Morbidity and mortality were 31 and 0.9 %, respectively. In 20 patients (5.5 %), re-ileostomy was necessary.ConclusionsA substantial number of ileostomies that are intended to be temporary will never be reversed. If reversed, the interval between construction and reversal is longer than anticipated, while morbidity after reversal and duration of hospitalisation are considerable. Besides a temporary ileostomy, there are two other options: no diversion or a permanent colostomy. Shared decision-making is to be preferred in these situations.

Cuidado e saúde em pacientes estomizados

“…Quando analisados separadamente, destacaram-se no presente estudo como principais etiologias no sexo feminino as causas neoplásicas e as doenças inflamatórias intestinais (DII); já para o sexo masculino prevaleceram causas neoplásicas e traumáticas. Em uma análise realizada em serviço de estomizados em Porto Alegre (Rio Grande do Sul), houve concordância quanto à predominância de causa neoplásica em ambos os sexos (25) . Outro estudo também encontrou como segunda causa mais comum no sexo masculino o trauma (18) .…”

“…Uma possibilidade para esse achado tem relação com a forte associação verificada entre as causas traumáticas e o sexo masculino. Os traumas estão associados a eventos de causas externas, aos quais os homens, principalmente mais jovens, possuem maior exposição (18,24,25) . Estudo realizado em 2016 demonstra que esse padrão se estende à população adolescente, na qual todas as colostomias realizadas na faixa etária de 15 a 20 anos ocorreram devido a trauma e 86,3% eram do sexo masculino (26) .…”

Early versus standard closure of temporary ileostomy in patients with rectal cancer: A randomized controlled trial

“…There are no strict recommendations for timing of the ileostomy closure and it varies between different centers, but most of the patients keep their stoma at least 3 months . Although closure within 12 weeks should be aimed .…”

Fortune of temporary ileostomies in patients treated with laparoscopic low anterior resection for rectal cancer

“…This is probably one of the worst scenarios for a patient who recently had a sphincter preserving procedure for rectal cancer and has been expecting to have regular bowel movements through a functional anus after a stoma takedown. However, up to 30% of ‘temporary’ stomas are never closed [910111213141516171819]. Several studies have underlined different factors causing the failure and delay of stoma reversal; but have been criticized, since they analyze heterogeneous patient populations having benign and malignant diseases, elective or emergent procedures, and/or anterior or low anterior resections.…”

“…Several studies have underlined different factors causing the failure and delay of stoma reversal; but have been criticized, since they analyze heterogeneous patient populations having benign and malignant diseases, elective or emergent procedures, and/or anterior or low anterior resections. They also include different types of stomas (i.e., colostomies, ileostomies, and even end stomas in some analyses) [9101112131417]. Finally, survival has never been previously evaluated in these patients.…”