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Morbidities after closure of ileostomy: analysis of risk factors

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Low anterior resection is commonly performed for carcinoma of the distal rectum. Diverting ileostomy has been used to decrease the septic consequence of anastomotic leakage and to reduce the re-operation rate. Nevertheless, subsequent closure of ileostomy can be associated with considerable morbidities. This study aimed to evaluate the morbidities after closure of ileostomy and to identify possible risk factors associated with the morbidities.

Methods

Data of patients who underwent closure of ileostomy, after a previous low anterior resection and defunctioning ileostomy for rectal cancer, was reviewed retrospectively. Patient’s demographics, coexisting morbidities, operative details, and post-operative outcomes were analyzed.

Results

From January 2000 to September 2012, 213 patients who underwent ileostomy closure were included. Thirty-five patients developed post-operative complications. The overall complication rate was 16.4 %. The majority of complications could be managed by conservative treatment. Only one patient required re-operation due to intestinal obstruction. There was no 30-day mortality. Age >80 years was an independent risk factor for post-operative complications. Age >80 years was also an independent risk factor for developing urinary retention (p = 0.001) and prolonged ileus (p = 0.02). Closure of ileostomy with hand-sewn techniques showed a higher incidence of post-operative intestinal obstruction (p = 0.049) compared to closure using stapler.

Conclusion

Closure of ileostomy following low anterior resection is associated with acceptable morbidities. Elderly patients tend to have a more complicated post-operative course and require more medical attention. The use of stapler is the preferred method for ileostomy closure as it is associated with less post-operative intestinal obstruction.

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Authors and Affiliations

  1. Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong

    Vivian Chi Mei Man, Hok Kwok Choi, Wai Lun Law & Dominic Chi Chung Foo

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  1. Vivian Chi Mei Man
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  2. Hok Kwok Choi
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  3. Wai Lun Law
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  4. Dominic Chi Chung Foo
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Correspondence to Wai Lun Law.

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Man, V.C.M., Choi, H.K., Law, W.L. et al. Morbidities after closure of ileostomy: analysis of risk factors. Int J Colorectal Dis 31, 51–57 (2016). https://doi.org/10.1007/s00384-015-2327-2

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  • DOI: https://doi.org/10.1007/s00384-015-2327-2

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