Retrospective Study
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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2020; 12(12): 507-519
Published online Dec 27, 2020. doi: 10.4240/wjgs.v12.i12.507
Table 1 Patient characteristics in the compared groups
Overall (n = 148) SOO (+) (n = 25) SOO (-) (n = 123) P valueAge1 (yr), (range) 48 (13-84) 50 (13-77) 48 (14-84) 0.614 Gender Male 95 (64.2%) 18 (72.0%) 77 (62.6%) 0.372 Female 53 (35.8%) 7 (28.0%) 46 (37.4%) Indication for surgery Medical intractability 118 (79.7%) 16 (64.0%) 102 (82.9%) 0.032 Malignancy or dysplasia 30 (20.3%) 9 (36.0%) 21 (17.1%) BMI1 (kg/m2 ), (range) 20.1 (11.7-36.1) 19.8 (14.8-25.5) 20.3 (11.7-36.1) 0.634 Mayo endoscopic score1 (range) 3 (0-3) 2 (0-3) 3 (0-3) 0.186 Extent of disease Pancolitis 137 (92.6%) 24 (96.0%) 113 (91.9%) 0.691 Left-sided colitis 11 (7.4%) 1 (4.0%) 10 (8.1%) Proctitis 0 (0.0%) 0 (0.0%) 0 (0.0%) Disease duration1 , (mo), (range) 33 (0-413) 40.5 (3-336) 33 (0-413) 0.535 Disease severity Mild 25 (16.9%) 6 (24.0%) 19 (15.4%) 0.341 Moderate 71 (48.0%) 14 (56.0%) 57 (46.3%) Severe 38 (25.7%) 4 (16.0%) 34 (27.6%) Fulminant 14 (9.5%) 1 (4.0%) 13 (10.6%) Total glucocorticoid dose from onset of UC to surgery2 10000 mg or more 9 (7.3%) 2 (10.0%) 7 (6.7%) 0.637 Less than 10000 mg 115 (92.7%) 18 (90.0%) 97 (93.3%) Total glucocorticoid dose 1 mo before surgery1 (mg), (range) 0 (0-1720) 0 (0-765) 0 (0-1720) 0.026 Preoperative total protein level1 (g/dL), (range) 6.4 (2.5-9.3) 6.8 (4.5-9.3) 6.3 (2.5-8.6) 0.048 Preoperative albumin level1 (g/dL), (range) 3.2 (1.4-4.9) 3.6 (2.0-4.6) 3.1 (1.4-4.9) 0.203 Preoperative white blood cell count1 (cells/μL), (range) 7455 (1850-20080) 7500 (2660-16670) 7450 (1850-20080) 0.543 Preoperative C-reactive protein level1 (mg/dL), (range) 1.4 (0.0-32.4) 1.1 (0.0-8.8) 1.57 (0.0-32.4) 0.335 Onodera Prognostic Nutritional index1 (range) 37.8 (15.9-57.5) 39.3 (29.2-56.9) 37.6 (15.9-57.5) 0.274
Table 2 Operative details and outcomes and computed tomography measurements in the compared groups
Overall (n = 148) SOO (+) (n = 25) SOO (-) (n = 123) P valueSurgical approach Laparoscopy 146 (98.6%) 25 (100.0%) 121 (98.4%) 1.000 Open 2 (1.4%) 0 (0.0%) 2 (1.6%) Site of stoma Right 85 (57.4%) 10 (40.0%) 75 (61.0%) 0.053 Left 63 (42.6%) 15 (60.0%) 48 (39.0%) Type of stoma End 58 (39.2%) 3 (12.0%) 55 (44.7%) 0.002 Loop 90 (60.8%) 22 (88.0%) 68 (55.3%) Operative time1 (min), (range) 346 (208-631) 339 (234-595) 347 (208-631) 0.890 Intraoperative bleeding1 (mL), (range) 73.5 (4-1316) 51 (5-811) 80 (4-1316) 0.310 Maximum stoma drainage volume1 (mL), (range) 1800 (150-7800) 2300 (450-5230) 1690 (150-7800) 0.004 Days from surgery to maximum stoma drainage volume1 (d), (range) 6 (1-22) 8 (2-21) 4 (1-22) 0.326 Adhesions below the ileostomy2 Yes 21 (22.8%) 7 (35.0%) 14 (19.4%) 0.123 None 71 (77.2%) 13 (65.0%) 58 (80.6%) Rectus abdominal muscle thickness at umbilical level1 (mm), (range) 9.6 (3.6-15.7) 10.4 (6.1-14.2) 9.6 (3.6-15.7) 0.189 Subcutaneous fat thickness at umbilical level1 (mm), (range) 15.5 (2.4-52.3) 11.6 (6.6-36.0) 16.3 (2.4-52.3) 0.051
Table 3 Multivariate analysis of risk factors associated with stoma outlet obstruction
Factor Odds ratio 95%CI P valueLower Upper Malignancy or dysplasia 0.558 0.156 1.991 0.369 Total glucocorticoid dose 1 mo before surgery 0.998 0.995 1.001 0.244 Preoperative total protein level 1.220 0.686 2.168 0.499 Loop ileostomy 7.315 1.514 35.332 0.013 Maximum stoma drainage volume 1.000 1.000 1.001 0.035
Table 4 Patients characteristics in relation to stoma sidedness with ileal pouch-anal anastomosis
Overall (n = 90) Right side (n = 31) Left side (n = 59) P valueAge1 (yr), (range) 41 (13-71) 41 (14-71) 41 (13-67) 0.690 Gender Male 54 (60.0%) 17 (54.8%) 37 (62.7%) 0.469 Female 36 (40.0%) 14 (45.2%) 22 (37.3%) Indication for surgery Medical intractability 72 (80.0%) 26 (83.9%) 46 (78.0%) 0.506 Malignancy or dysplasia 18 (20.0%) 5 (16.1%) 13 (22.0%) BMI1 (kg/m2 ), (range) 19.8 (13.9-36.1) 21.8 (16.0-27.8) 19.3 (13.9-36.1) 0.023 Mayo endoscopic score1 (range) 3 (0-3) 3 (0-3) 3 (0-3) 0.878 Extent of disease Pancolitis 84 (93.3%) 29 (93.5%) 55 (93.2%) 0.662 Left-sided colitis 6 (6.7%) 2 (6.5%) 4 (6.8%) Proctitis 0 0 0 Disease duration1 (mo), (range) 38 (1-336) 21 (1-252) 56 (1-336) 0.016 Disease severity Mild 17 (18.9%) 6 (19.4%) 11 (18.6%) 0.471 Moderate 44 (48.9%) 12 (38.7%) 32 (54.2%) Severe 21 (23.3%) 9 (29.0%) 12 (20.3%) Fulminant 8 (8.9%) 4 (12.9%) 4 (6.8%) Total glucocorticoid dose from onset of UC to surgery2 10000 mg or more 7 (9.3%) 2 (8.7%) 5 (9.4%) 0.644 Less than 10000 mg 69 (90.7%) 21 (91.3%) 48 (90.6%) Total glucocorticoid dose 1 mo before surgery1 (mg), (range) 0 (0-1000) 0 (0-595) 0 (0-1000) 0.955 Preoperative total protein level1 (g/dL), (range) 6.45 (4.2-9.3) 6.4 (4.2-8.5) 6.45 (4.2-9.3) 0.919 Preoperative albumin level1 (g/dL), (range) 3.45 (1.8-4.9) 3.6 (2.1-4.8) 3.4 (1.8-4.9) 0.586 Preoperative white blood cell count1 (cells/μL), (range) 7315 (2660-20080) 6120 (2660-10630) 8770 (2850-20080) < 0.001 Preoperative C-reactive protein level1 (mg/dL), (range) 0.78 (0.01-17.41) 0.48 (0.01-8.78) 1.06 (0.02-17.41) 0.155 Onodera Prognostic Nutritional index1 (range) 41.4 (22.2-57.5) 39.6 (24.7-57.5) 42.0 (22.2-57.5) 0.977
Table 5 Operative details and outcomes and computed tomography measurements in relation to stoma sidedness with ileal pouch-anal anastomosis
Overall (n = 90) Right side (n = 31) Left side (n = 59) P valueSurgical approach Laparoscopy 89 (98.9%) 30 (96.8%) 59 (100%) 0.344 Open 1 (1.1%) 1 (3.2%) 0 Operative time1 (min), (range) 346 (222-631) 347 (227-487) 339 (222-631) 0.393 Intraoperative bleeding1 (mL), (range) 61.5 (5-741) 52 (5-337) 63 (5-741) 0.959 Maximum stoma drainage volume1 (mL), (range) 2000 (150-5230) 1900 (150-4600) 2000 (400-5230) 0.577 Days from surgery to maximum stoma drainage volume1 (d), (range) 6 (1-21) 6 (1-21) 6 (1-14) 0.051 Rectus abdominal muscle thickness at umbilical level1 (mm), (range) 9.8 (5.7-15.7) 10.65 (6.3-13.6) 9.5 (5.7-15.7) 0.228 Subcutaneous fat thickness at umbilical level1 (mm), (range) 15.7 (2.9-52.3) 16.9 (7.2-42.5) 13.8 (2.9-52.3) 0.058 Stoma outlet obstruction Yes 22 (24.4%) 8 (25.8%) 14 (23.7%) 0.827 None 68 (75.6%) 23 (74.2%) 45 (76.3%) Distance from pouch to stoma (cm), (range) 30 (30-50) 30 (30-50) 40 (30-50) < 0.001 IPAA dehiscence Yes 6 (6.7%) 0 6 (10.2%) 0.072 None 84 (93.3%) 31 (100%) 53 (89.8%) Postoperative complications (Clavien-Dindo classification) Grade 1 or less 47 (52.2%) 15 (48.4%) 32 (54.2%) 0.598 Grade 2 or higher 43 (47.8%) 16 (51.6%) 27 (45.8%)
Table 6 Patient characteristics in the stoma outlet obstruction group
sSOO (n = 18) rSOO (n = 7) P valueAge1 (yr), (range) 50.5 (13-77) 50 (16-71) 0.745 Gender Male 6 (33.3%) 6 (85.7%) 0.337 Female 12 (66.7%) 1 (14.3%) Indication for surgery Medical intractability 12 (66.7%) 4 (57.1%) 0.499 Malignancy or dysplasia 6 (33.3%) 3 (42.9%) BMI1 (kg/m2 ), (range) 18.9 (14.8-25.5) 21.8 (19.0-24.2) 0.158 Mayo endoscopic score1 (range) 2 (0-3) 2 (0-3) 0.657 Extent of disease Pancolitis 17 (94.4%) 7 (100.0%) 0.720 Left-sided colitis 1 (5.6%) 0 (0.0%) Proctitis 0 (0.0%) 0 (0.0%) Disease duration1 (mo), (range) 40.5 (3-336) 49 (15-108) 0.923 Disease severity Mild 5 (27.8%) 1 (14.3%) 0.141 Moderate 11 (61.1%) 3 (42.9%) Severe 1 (5.6%) 3 (42.9%) Fulminant 1 (5.6%) 0 (0.0%) Total glucocorticoid dose from onset of UC to surgery2 10000 mg or more 1 1 0.521 Less than 10000 mg 13 5 Total glucocorticoid dose 1 mo before surgery1 (mg), (range) 0 (0-765) 0 (0-280) 0.745 Preoperative total protein level1 (g/dL), (range) 6.8 (4.8-9.3) 6.8 (4.5-8.1) 0.745 Preoperative albumin level1 (g/dL), (range) 3.5 (2.0-4.6) 4.2 (2.3-4.6) 0.657
Table 7 Operative details and outcomes and computed tomography measurements in the stoma outlet obstruction group
sSOO (n = 18) rSOO (n = 7) P valueSurgical approach Laparoscopy 18 (100.0%) 7 (100.0%) Open 0 (0.0%) 0 (0.0%) Site of stoma Right 6 (33.3%) 4 (57.1%) 0.261 Left 12 (66.7%) 3 (42.9%) Type of stoma End 3 (16.7%) 0 (0.0%) 0.355 Loop 15 (83.3%) 7 (100.0%) Operative time1 (min), (range) 333 (234-595) 345 (258-441) 0.929 Intraoperative bleeding1 (mL), (range) 56.5 (5-811) 51 (20-78) 0.495 Maximum stoma drainage volume1 (mL), (range) 2250 (450-5230) 2660 (800-4600) 0.492 Rectus abdominal muscle thickness at umbilical level1 (mm), (range) 9.3 (6.1-13.3) 12.7 (8.9-14.2) 0.006 Subcutaneous fat thickness at umbilical level1 (mm), (range) 11.5 (6.6-36.0) 11.6 (7.3-20.4) 0.836
Table 8 Multivariate analysis of the risk factors for repeated stoma outlet obstruction
Factor Odds ratio 95%CI P valueLower Upper Rectus abdominal muscle thickness at umbilical level 2.249 1.176 4.300 0.014