Increased postoperative complications after protective ileostomy closure delay: An institutional study

Abstract

AIM:To study the morbidity and complications associated to ileostomy reversal in colorectal surgery patients, and if these are related to the time of closure. METHODS:A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance. RESULTS:The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy creation was rectal cancer (56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the patients, with 1% mortality. The most frequent were ileus (13%) and wound infection (13%). Pseudomembranous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomy closure (P = 0.041). Male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003). End-to-end intestinal anastomosis without resection was significantly associated with postoperative ileus (P = 0.037). CONCLUSION:Although closure of a protective ileostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Protective ileostomy; Stomas; Stoma-related complications; Surgical infections; Colorectal surgery Core tip: Protective ileostomies are widely used by surgeons for the protection of anastomoses, but they imply a second intervention for reversal. Despite being considered a minor intervention, ileostomy reversal does not lack complications. Adjuvant treatment, complications from the first intervention, or low-priority consideration can delay the closure of the stoma. In our study, we reviewed all complications following ileostomy reversal and found they were considerably high (40%), and increased as did the time (in months) until closure (P = 0.041). In multivariate analysis, male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003).Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R. Increased postoperative complications after protective ileostomy closure delay: An institutional study. World J Gastrointest Surg 2014; 6(9): 169-174 Available from:

Clostridium difficile Infection After Ileostomy Reversal

“…C. difficile colonization was associated with hospitalization within 3 months [10] among patients with chemotherapy occurring within the previous 8 weeks [11] but without well-known risk factors for CDI such as antibiotics usage [12] or acid suppression with proton pump inhibitors (PPIs) [13]. Rubio-Perez et al [14] reported a significant association between A c c e p t e d A r t i c l e pseudomembranous colitis and delayed ileostomy reversal (of greater than 6 months), with the reported defunctioning time ranging from 9 to 15 months in these patients. Our two patients underwent an operation 10 months after the first surgery due to adjuvant chemotherapy.…”

Fatores associados a não reconstrução do trânsito intestinal em pacientes com câncer retal submetidos à ressecção anterior do reto e ileostomia de proteção.

“…From small series of patients to large multicenter studies, it is rare to find references to patients who were freed of the stoma in a time considered ideal, up to 12 weeks after the ARR. The periods described for restoration of bowel continuity after rectal cancer treatment vary between four and 12 months 7,9,11,12,20,25 . Factors related to the delay in the reconstruction of intestinal transit are adjuvant chemotherapy, elderly patients, advanced stages of neoplasia and presence of comorbidities 5,20,24 .…”

A systematic review of Clostridium difficile infection following reversal of ileostomy

“…All the studies included in this systematic review reported a mean defunctioning time of over 6 months. Rubio-Perez et al [17] found a significant association between the occurrence of pseudomembraneous colitis and delayed ileostomy reversal beyond 6 months, with the reported defunctioning time for those affected ranging from 9 to 15 months.…”