TH5.13 Stoma reversal post emergency laparotomy

Abstract

Aims Approximately a fifth of stomas have to be sited in emergency setting and the National Bowel Cancer Audit found almost one third of patients undergoing anterior resection do not have reversal of their stoma within 18 months following surgery. We aim to explore the reversal rate of stoma post emergency laparotomy (EmLap). Methods Retrospective analysis was performed on all patients undergoing EmLap over 12 months (2018) from one site using the local ELLSA (Emergency Laparoscopic and Laparotomy Scottish Audit) database. Demographic, indication for surgery, stoma formation/ type, 30-days morbidity and mortality were collected. Follow-up and stoma reversal data were evaluated at 12 months postoperative. Results 205 patients underwent EmLap (52.5% female, median age 66 years). 42% (n=85) had emergency stoma formation: 58% ileostomy, 42% colostomy. Of those who had stoma formed (51% female, median age 67 years), 45% presented with bowel obstruction and 24% had new colorectal cancer diagnosis. Of those alive at follow-up (89%), 19% had stoma reversed (1:1 ileostomy:colostomy; mean reversal time 11 months). Of the 81% not reversed: 28% declined, 12% were unfit, 4% technically not feasible, 4% on waiting list, 11% had 30-day mortality. The remaining 22% had no documented stoma reversal discussion (5%) or no follow-up (17%). Conclusions Compared to the elective setting, the stoma reversal rate post-EmLap is significantly lower (reversal of ileostomy 9.5% in this study vs 85% in Close-IT study). Although this may reflect a higher risk surgical population, post-EmLap pathways should consider routine follow up to ensure shared decision making.