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Loop ileostomy in rectal cancer surgery: factors predicting reversal and stoma related morbidity

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Abstract

Purpose

Loop ileostomy is performed in rectal cancer surgery to decrease the impact of anastomotic leak but it is associated with a significant complication rate. This study aimed to analyze the morbidity related to diverting ileostomy and to identify factors predictive of complications related to stoma management and reversal, as well as conversion into a permanent ileostomy.

Methods

A retrospective study was conducted on 112 patients submitted to oncological rectal resection and defunctioning ileostomy in a Portuguese colorectal unit between March 2012 and March 2019.

Results

Loop ileostomy was responsible for 13% of index surgery morbidity and 15% of patients’ readmissions due to high output, stoma stenosis and parastomal hernia. Ileostomy was reversed in 89% cases with 7% Clavien-Dindo ≥ IIIb complications. An association was established between diabetes and higher stoma management morbidity (OR: 3.28 [95% CI: 1.039-10.426]. p = 0.041). Likewise, diabetes (OR: 0.17 [95% CI: 0.038; 6.90], p=0.015), oncological disease stage ≥ III (OR: 0.10 [95% CI: 0.005; 0.656], p=0.047) and index rectal surgery morbidity (OR: 0.23 [95% CI: 0.052; 0.955], p=0.041) were associated with less ileostomy closure. Complications of the index surgery also related to higher stoma reversal morbidity (OR: 5.11 [95% CI: 1.665; 16.346], p=0.005).

Conclusions

Diabetes and complications of index rectal surgery were identified as predictive of ileostomy morbidity, closure rate and associated complications. It is essential to adjust treatment decisions to patient’s morbidity risk and adopt a more selective approach concerning the use of an ileostomy.

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Availability of data and material

The datasets analyzed during the current study are available in the Hospital Beatriz Ângelo informatics hospital database (Soarien), available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Surgical Department, Hospital Beatriz Ângelo, Lisbon, Portugal

    Susana Ourô, Marisa P. Ferreira, Diogo Albergaria & Rui Maio

  2. NOVA Medical School, Lisbon, Portugal

    Susana Ourô, Diogo Albergaria & Rui Maio

Authors
  1. Susana Ourô
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  2. Marisa P. Ferreira
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  3. Diogo Albergaria
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  4. Rui Maio
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Contributions

Susana Ourô: study conception and design, acquisition, analysis and interpretation of the data, drafting of the article, critical revision of the article for important intellectual content, final approval of the article; Marisa P Ferreira: study conception and design, acquisition, analysis and interpretation of the data, drafting of the article, critical revision of the article for important intellectual content, final approval of the article; Diogo Albergaria: critical revision of the article for important intellectual content, final approval of the article; Rui Maio: critical revision of the article for important intellectual content, final approval of the article.

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Correspondence to Susana Ourô.

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Ethics approval/Consent to participate/Consent for publication

The present study was approved by the Ethics Committee and Institutional Review Board of Hospital Beatriz Ângelo with no formal Informed consent required due to its methodology and anonymity. The study protocol was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.

Competing interests

The authors declare no competing interests.

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Susana Ourô and Marisa P. Ferreira are co-first authors

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Ourô, S., Ferreira, M.P., Albergaria, D. et al. Loop ileostomy in rectal cancer surgery: factors predicting reversal and stoma related morbidity. Langenbecks Arch Surg 406, 843–853 (2021). https://doi.org/10.1007/s00423-021-02169-x

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  • DOI: https://doi.org/10.1007/s00423-021-02169-x

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