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Complications associated with loop ileostomy: analysis of risk factors

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Abstract

Background

Loop ileostomy is a common surgical procedure but is associated with complications such as outlet obstruction (OO), parastomal hernia (PH), and high-output stoma (HOS). This study aimed to identify risk factors for these complications, as well as their causal relationships.

Methods

The study included 188 consecutive patients who underwent loop ileostomy between April 2016 and September 2021. Clinical factors and postoperative stoma-related complications (OO, HOS, and PH) were analyzed retrospectively. Stoma-related factors were evaluated using specific measurements from computed tomography (CT) scans. The incidence, clinical course, and risk factors for the stoma-related complications were investigated.

Results

OO was diagnosed in 28 cases (15.7%), PH in 60 (32%), and HOS in 57 (31.8%). A small longitudinal stoma diameter at the rectus abdominis level on CT and a right-sided stoma were significantly associated with OO. Creation of an ileostomy for anastomotic leakage was independently associated with HOS. Higher body weight and a large longitudinal stoma diameter at the rectus abdominis level on CT were significantly associated with PH. There was a significant relationship between the occurrence of OO and HOS. However, the association between OO and PH was marginal.

Conclusion

This study identified key risk factors for OO, HOS, and PH as complications of loop ileostomy and their causal relationships. Our findings provide insights that may guide the prevention and management of complications related to loop ileostomy.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Cottam J, Richards K, Hasted A, Blackman A (2007) Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. Colorectal Dis 9(9):834–838

    Article  CAS  PubMed  Google Scholar 

  2. Babakhanlou R, Larkin K, Hita AG, Stroh J, Yeung SC (2022) Stoma-related complications and emergencies. Int J Emerg Med 15(1):17

    Article  PubMed  PubMed Central  Google Scholar 

  3. Oliveira L, Reissman P, Nogueras J, Wexner SD (1997) Laparoscopic creation of stomas. Surg Endosc 11(1):19–23

    Article  CAS  PubMed  Google Scholar 

  4. Fujii T, Morita H, Sutoh T, Yajima R, Tsutsumi S, Asao T et al. (2015) Outlet obstruction of temporary loop diverting ileostomy. Hepatogastroenterology 62(139):602–605

    PubMed  Google Scholar 

  5. Ohira G, Miyauchi H, Hayano K, Kagaya A, Imanishi S, Tochigi T et al. (2018) Incidence and risk factor of outlet obstruction after construction of ileostomy. J Anus Rectum Colon 2(1):25–30

    Article  PubMed  PubMed Central  Google Scholar 

  6. Okada S, Hata K, Emoto S, Murono K, Kaneko M, Sasaki K et al. (2018) Elevated risk of stoma outlet obstruction following colorectal surgery in patients undergoing ileal pouch-anal anastomosis: a retrospective cohort study. Surg Today 48(12):1060–1067

    Article  PubMed  Google Scholar 

  7. Okita Y, Araki T, Kondo S, Fujikawa H, Yoshiyama S, Hiro J et al. (2017) Clinical characteristics of stoma-related obstruction after ileal pouch-anal anastomosis for ulcerative colitis. J Gastrointest Surg 21(3):554–559

    Article  PubMed  Google Scholar 

  8. Tamura K, Matsuda K, Yokoyama S, Iwamoto H, Mizumoto Y, Murakami D et al. (2019) Defunctioning loop ileostomy for rectal anastomoses: predictors of stoma outlet obstruction. Int J Colorectal Dis 34(6):1141–1145

    Article  PubMed  Google Scholar 

  9. Carne PW, Robertson GM, Frizelle FA (2003) Parastomal hernia. Br J Surg 90(7):784–793

    Article  CAS  PubMed  Google Scholar 

  10. Pilgrim CH, McIntyre R, Bailey M (2010) Prospective audit of parastomal hernia: prevalence and associated comorbidities. Dis Colon Rectum 53(1):71–76

    Article  PubMed  Google Scholar 

  11. Shiraishi T, Nishizawa Y, Ikeda K, Tsukada Y, Sasaki T, Ito M (2020) Risk factors for parastomal hernia of loop stoma and relationships with other stoma complications in laparoscopic surgery era. BMC Surg 20(1):141

    Article  PubMed  PubMed Central  Google Scholar 

  12. Arenas Villafranca JJ, López-Rodríguez C, Abilés J, Rivera R, Gándara Adán N, Utrilla NP (2015) Protocol for the detection and nutritional management of high-output stomas. Nutr J 14:45

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hara Y, Miura T, Sakamoto Y, Morohashi H, Nagase H, Hakamada K (2020) Organ/space infection is a common cause of high output stoma and outlet obstruction in diverting ileostomy. BMC Surg 20(1):83

    Article  PubMed  PubMed Central  Google Scholar 

  14. Takeda M, Takahashi H, Haraguchi N, Miyoshi N, Hata T, Yamamoto H et al. (2019) Factors predictive of high-output ileostomy: a retrospective single-center comparative study. Surg Today 49(6):482–487

    Article  CAS  PubMed  Google Scholar 

  15. Takehara Y, Nakagawa M, Kobayashi H, Kakisako K, Takano Y, Seki J et al. (2022) A technique for constructing diverting loop ileostomy to prevent outlet obstruction after rectal resection and total colectomy: a retrospective single-center study. Surg Today 52(4):587–594

    Article  PubMed  Google Scholar 

  16. Abe T, Nishimura J, Yasui M, Matsuda C, Haraguchi N, Nakai N et al. (2021) Risk factors for outlet obstruction in patients with diverting ileostomy following rectal surgery. J Anus Rectum Colon 5(3):254–260

    Article  PubMed  PubMed Central  Google Scholar 

  17. Erwin-Toth P, Barrett P (1997) Stoma site marking: a primer. Ostomy Wound Manage 43(4):18–22

    CAS  PubMed  Google Scholar 

  18. Kuwahara K, Mokuno Y, Matsubara H, Uji M, Kobayashi I, Iyomasa S (2022) Risk factors for stoma outlet obstruction: preventing this complication after construction of diverting ileostomy during laparoscopic colorectal surgery. Jma j 5(2):207–215

    PubMed  PubMed Central  Google Scholar 

  19. Mizushima T, Kameyama H, Watanabe K, Kurachi K, Fukushima K, Nezu R et al. (2017) Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch anal anastomosis with diverting loop-ileostomy for ulcerative colitis. Ann Gastroenterol Surg 1(2):122–128

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sasaki S, Nagasaki T, Oba K, Akiyoshi T, Mukai T, Yamaguchi T et al. (2021) Risk factors for outlet obstruction after laparoscopic surgery and diverting ileostomy for rectal cancer. Surg Today 51(3):366–373

    Article  PubMed  Google Scholar 

  21. Enomoto H, Suwa K, Takeuchi N, Hannya Y, Tsukazaki Y, Ushigome T et al. (2021) Risk of outlet obstruction associated with defunctioning loop ileostomy in rectal cancer surgery. Cancer Diagn Progn 1(5):465–470

    Article  PubMed  PubMed Central  Google Scholar 

  22. Nightingale JMD (2022) How to manage a high-output stoma. Frontline Gastroenterol 13(2):140–151

    Article  CAS  PubMed  Google Scholar 

  23. Hiramoto Y, Kawahara H, Matsumoto T, Takeda M, Misawa T, Yanaga K (2019) Preoperative neutrophil-lymphocyte ratio is a predictor of high-output ileostomy after colorectal surgery. Anticancer Res 39(6):3265–3268

    Article  CAS  PubMed  Google Scholar 

  24. Baker ML, Williams RN, Nightingale JM (2011) Causes and management of a high-output stoma. Colorectal Dis 13(2):191–197

    Article  CAS  PubMed  Google Scholar 

Download references

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Authors and Affiliations

Authors

Contributions

Y.M. led the manuscript writing and coordinated the research efforts. N.A., R.K., and H.N. contributed to data collection and analysis. G.Y. and S.H. assisted in manuscript revision and provided critical feedback. All authors reviewed the manuscript and approved the final version for publication.

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Correspondence to Suguru Hasegawa.

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Matsumoto, Y., Aisu, N., Kajitani, R. et al. Complications associated with loop ileostomy: analysis of risk factors. Tech Coloproctol 28, 60 (2024). https://doi.org/10.1007/s10151-024-02926-2

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