Skip to main content
SpringerLink
Log in

Elevated risk of stoma outlet obstruction following colorectal surgery in patients undergoing ileal pouch–anal anastomosis: a retrospective cohort study

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Stoma outlet obstruction (SOO) is a complication following colorectal surgery that requires stoma creation. We aimed to clarify the SOO incidence and identify risk factors for SOO after stoma surgery in patients with ulcerative colitis (UC) or rectal cancer.

Methods

The study included 345 patients with sporadic rectal cancer (n = 301) or UC (n = 44) who underwent stoma surgery between 2012 and 2017. Univariate and multivariate analyses were performed to identify risk factors for SOO.

Results

The SOO incidences were 27.3% (n = 12) in patients with UC and 5.6% (n = 17) in patients with sporadic rectal cancer. A multivariate analysis identified UC and loop ileostomy as independent risk factors for SOO. Subanalyses revealed that loop ileostomy was an independent risk factor for patients with UC or sporadic rectal cancer. Most patients who developed SOO were successfully managed with tube drainage through the stoma. However, stoma closure was performed earlier than originally planned in two patients. Among the 29 patients with SOO, 22 (75.9%) developed SOO within 2 weeks postoperatively; the median period between stoma creation and SOO was 6 (range 3–41) days.

Conclusions

UC and loop ileostomy are independent risk factors for postoperative SOO.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg. 1994;81:1224–6.

    Article  CAS  Google Scholar 

  2. Eberl T, Jagoditsch M, Klingler A, Tschmelitsch J. Risk factors for anastomotic leakage after resection for rectal cancer. Am J Surg. 2008;196:592–8.

    Article  Google Scholar 

  3. Warschkow R, Steffen T, Thierbach J, Bruckner T, Lange J, Tarantino I. Risk factors for anastomotic leakage after rectal cancer resection and reconstruction with colorectostomy. A retrospective study with bootstrap analysis. Ann Surg Oncol. 2011;18:2772–82.

    Article  Google Scholar 

  4. Ulrich AB, Seiler C, Rahbari N, Weitz J, Buchler MW. Diverting stoma after low anterior resection: more arguments in favor. Dis Colon Rectum. 2009;52:412–8.

    Article  Google Scholar 

  5. Tilney HS, Sains PS, Lovegrove RE, Reese GE, Heriot AG, Tekkis PP. Comparison of outcomes following ileostomy versus colostomy for defunctioning colorectal anastomoses. World J Surg. 2007;31:1142–51.

    Article  Google Scholar 

  6. Shiomi A, Ito M, Maeda K, Kinugasa Y, Ota M, Yamaue H, et al. Effects of a diverting stoma on symptomatic anastomotic leakage after low anterior resection for rectal cancer: a propensity score matching analysis of 1,014 consecutive patients. J Am Coll Surg. 2015;220:186–94.

    Article  Google Scholar 

  7. Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P. Factors associated with clinically significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg. 2002;26:499–502.

    Article  Google Scholar 

  8. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998;85:355–8.

    Article  CAS  Google Scholar 

  9. Ng KH, Ng DC, Cheung HY, Wong JC, Yau KK, Chung CC, et al. Obstructive complications of laparoscopically created defunctioning ileostomy. Dis Colon Rectum. 2008;51:1664–8.

    Article  CAS  Google Scholar 

  10. Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246:207–14.

    Article  Google Scholar 

  11. Tsikitis VL, Larson DW, Poola VP, Nelson H, Wolff BG, Pemberton JH, et al. Postoperative morbidity with diversion after low anterior resection in the era of neoadjuvant therapy: a single institution experience. J Am Coll Surg. 2009;209:114–8.

    Article  Google Scholar 

  12. Tan WS, Tang CL, Shi L, Eu KW. Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg. 2009;96:462–72.

    Article  CAS  Google Scholar 

  13. Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis. 2010;12:958–64.

    Article  CAS  Google Scholar 

  14. Marcello PW, Roberts PL, Schoetz DJ Jr, Coller JA, Murray JJ, Veidenheimer MC. Obstruction after ileal pouch–anal anastomosis: a preventable complication? Dis Colon Rectum. 1993;36:1105–11.

    Article  CAS  Google Scholar 

  15. Francois Y, Dozois RR, Kelly KA, Beart RW Jr, Wolff BG, Pemberton JH, et al. Small intestinal obstruction complicating ileal pouch–anal anastomosis. Ann Surg. 1989;209:46–50.

    Article  CAS  Google Scholar 

  16. Dolejs S, Kennedy G, Heise CP. Small bowel obstruction following restorative proctocolectomy: affected by a laparoscopic approach? J Surg Res. 2011;170:202–8.

    Article  Google Scholar 

  17. MacLean AR, Cohen Z, MacRae HM, O’Connor BI, Mukraj D, Kennedy ED, et al. Risk of small bowel obstruction after the ileal pouch–anal anastomosis. Ann Surg. 2002;235:200–6.

    Article  Google Scholar 

  18. Dafnis G. Early and late surgical outcomes of ileal pouch–anal anastomosis within a defined population in Sweden. Eur J Gastroenterol Hepatol. 2016;28:842–9.

    Article  Google Scholar 

  19. Mizushima T, Kameyama H, Watanabe K. Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch–anal anastomosis with diverting loop-ileostomy for ulcerative colitis. Ann Gastroenterol Surg. 2017;1:122–8.

    Article  Google Scholar 

  20. Kameyama H, Hashimoto Y, Shimada Y, Yamada S, Yagi R, Tajima Y, et al. Small bowel obstruction after ileal pouch–anal anastomosis with a loop ileostomy in patients with ulcerative colitis. Ann Coloproctol. 2018;34:94–100.

    Article  Google Scholar 

  21. Poon JT, Law WL, Chu KW. Small bowel obstruction following low anterior resection: the impact of diversion ileostomy. Langenbecks Arch Surg. 2004;389:250–5.

    Article  Google Scholar 

  22. Suwa K, Ushigome T, Ohtsu M, Narihiro S, Ryu S, Shimoyama Y, et al. Risk factors for early postoperative small bowel obstruction after anterior resection for rectal cancer. World J Surg. 2018;42:233–8.

    Article  Google Scholar 

  23. Eto K, Kosuge M, Ohkuma M, Noaki R, Neki K, Ito D, et al. Defunctioning ileostomy is a key risk factor for small bowel obstruction after colorectal cancer resection. Anticancer Res. 2018;38:1789–95.

    PubMed  Google Scholar 

  24. Fujii T, Morita H, Sutoh T, Yajima R, Tsutsumi S, Asao T, et al. Outlet obstruction of temporary loop diverting ileostomy. Hepatogastroenterology. 2015;62(139):602–5.

    PubMed  Google Scholar 

  25. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  Google Scholar 

  26. Colvin HMH, Eguchi H, Takiguchi S, Doki Y, Mori M. Gastroenterological surgery in Japan: The past, the present and the future. Ann Gastroenterol Surg. 2017;1:5–10.

    Article  Google Scholar 

  27. Aberg H, Pahlman L, Karlbom U. Small-bowel obstruction after restorative proctocolectomy in patients with ulcerative colitis. Int J Colorectal Dis. 2007;22:637–42.

    Article  Google Scholar 

  28. Carlsen E, Bergan A. Technical aspects and complications of end-ileostomies. World J Surg. 1995;19:632–6.

    Article  CAS  Google Scholar 

  29. Kim MJ, Kim YS, Park SC, Sohn DK, Kim DY, Chang HJ, et al. Risk factors for permanent stoma after rectal cancer surgery with temporary ileostomy. Surgery. 2016;159:721–7.

    Article  Google Scholar 

  30. Dinnewitzer A, Jager T, Nawara C, Buchner S, Wolfgang H, Ofner D. Cumulative incidence of permanent stoma after sphincter preserving low anterior resection of mid and low rectal cancer. Dis Colon Rectum. 2013;56:1134–42.

    Article  Google Scholar 

  31. Junginger T, Gonner U, Trinh TT, Lollert A, Oberholzer K, Berres M. Permanent stoma after low anterior resection for rectal cancer. Dis Colon Rectum. 2010;53:1632–9.

    Article  Google Scholar 

  32. Lim SW, Kim HJ, Kim CH, Huh JW, Kim YJ, Kim HR. Risk factors for permanent stoma after low anterior resection for rectal cancer. Langenbecks Arch Surg. 2013;398:259–64.

    Article  Google Scholar 

  33. Lindgren R, Hallbook O, Rutegard J, Sjodahl R, Matthiessen P. What is the risk for a permanent stoma after low anterior resection of the rectum for cancer? A six-year follow-up of a multicenter trial. Dis Colon Rectum. 2011;54:41–7.

    Article  Google Scholar 

  34. Ogilvie JW Jr, Dietz DW, Stocchi L. Anastomotic leak after restorative proctosigmoidectomy for cancer: what are the chances of a permanent ostomy? Int J Colorectal Dis. 2012;27:1259–66.

    Article  Google Scholar 

  35. Fasth S, Hulten L. Loop ileostomy: a superior diverting stoma in colorectal surgery. World J Surg. 1984;8:401–7.

    Article  CAS  Google Scholar 

  36. Winslet MC, Drolc Z, Allan A, Keighley MR. Assessment of the defunctioning efficiency of the loop ileostomy. Dis Colon Rectum. 1991;34:699–703.

    Article  CAS  Google Scholar 

Download references

Funding

This work was supported in part by the Grants-in-Aid for Scientific Research (C: Grant No. 17K10622).

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Satoshi Okada, Keisuke Hata, Shigenobu Emoto, Koji Murono, Manabu Kaneko, Kazuhito Sasaki, Kensuke Otani, Takeshi Nishikawa, Toshiaki Tanaka, Kazushige Kawai & Hiroaki Nozawa

Authors
  1. Satoshi Okada
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keisuke Hata
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shigenobu Emoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Koji Murono
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Manabu Kaneko
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kazuhito Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kensuke Otani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takeshi Nishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Toshiaki Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kazushige Kawai
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hiroaki Nozawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors made substantial contributions to the conception and design of the study (or acquisition, analysis, and interpretation of the data).

Corresponding author

Correspondence to Satoshi Okada.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest regarding this study.

Ethical standards

This study was approved by the Ethics Committees of the University of Tokyo [No. 3252-(5)]. The authors would also like to thank Enago (http://www.enago.jp) for the English language review.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Okada, S., Hata, K., Emoto, S. et al. Elevated risk of stoma outlet obstruction following colorectal surgery in patients undergoing ileal pouch–anal anastomosis: a retrospective cohort study. Surg Today 48, 1060–1067 (2018). https://doi.org/10.1007/s00595-018-1698-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-018-1698-8

Keywords

Search

Navigation