Kitahara T, Sato Y, Oshiro T, Matsunaga R, Nagashima M, Okazumi S. Risk factors for postoperative stoma outlet obstruction in ulcerative colitis. World J Gastrointest Surg 2020; 12(12): 507-519 [PMID: 33437402 DOI: 10.4240/wjgs.v12.i12.507]
Corresponding Author of This Article
Yu Sato, MD, Lecturer, Department of Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura 285-8741, Chiba, Japan. yu.sato@med.toho-u.ac.jp
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Tomoaki Kitahara, Yu Sato, Takashi Oshiro, Rie Matsunaga, Makoto Nagashima, Shinichi Okazumi, Department of Surgery, Toho University Sakura Medical Center, Sakura 285-8741, Chiba, Japan
Author contributions: Kitahara T designed and performed the research and wrote the paper; Sato Y and Matsunaga R designed the research and contributed to the analysis; Oshiro T, Nagashima M, and Okazumi S provided clinical advice and supervised the report; and all authors have approved the final version of the article to be published.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Toho University Sakura Medical Center (IRB approval code: S19026, Toho University Sakura Medical Center).
Informed consent statement: Patients were not required to give informed consent in order to be included in the study because the analysis used anonymous clinical data that were obtained after each patient had agreed to treatment by written consent. The details of the study were published on the home page of Toho University Sakura Medical Center.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu Sato, MD, Lecturer, Department of Surgery, Toho University Sakura Medical Center, 564-1, Shimoshizu, Sakura 285-8741, Chiba, Japan. yu.sato@med.toho-u.ac.jp
Received: August 3, 2020 Peer-review started: August 3, 2020 First decision: September 17, 2020 Revised: September 28, 2020 Accepted: November 13, 2020 Article in press: November 13, 2020 Published online: December 27, 2020
ARTICLE HIGHLIGHTS
Research background
The standard procedure for ulcerative colitis (UC) is restorative proctocolectomy with ileal pouch-anal anastomosis, and it is common to perform two- or three-stage restorative proctocolectomy with diverting ileostomy.
Research motivation
Stoma outlet obstruction (SOO) often occurs after surgery for UC but its causes are not well known.
Research objectives
To identify the risk factors for SOO after stoma surgery in patients with UC.
Research methods
A retrospective study of 148 UC patients. Univariate and multivariate analyses were performed to identify risk factors for SOO and recurring SOO.
Research results
SOO occurred in 25 (16.9%) patients. In the multivariate analysis, loop ileostomy (OR = 6.361; 95%CI 1.322-30.611; P = 0.021) and maximum stoma drainage volume (OR = 1.000; 95%CI 1.000-1.001; P = 0.015) were found to be independent risk factors for SOO. Among the 25 patients with SOO, seven (28.0%) patients repeatedly developed SOO during the period of observation. Rectus abdominis muscle thickness was an independent risk factor for recurring SOO (OR = 2.676; 95%CI 1.176-4.300; P = 0.008).
Research conclusions
High maximum stoma drainage volume and loop ileostomy were independent risk factors for SOO in this study. In patients with a thick rectus abdominis muscle, the risk of SOO recurrence is high.
Research perspectives
Surgeons should be aware of the importance of fluid management and careful selection of the stoma position in patients with thick rectus abdominis muscles to prevent SOO recurrence. Alternative surgical procedures that can avoid loop ileostomy are required.
