Retrospective Study
Copyright ©The Author(s) 2020.
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 value
Age1 (yr), (range)48 (13-84)50 (13-77)48 (14-84)0.614
Gender
Male95 (64.2%)18 (72.0%)77 (62.6%)0.372
Female53 (35.8%)7 (28.0%)46 (37.4%)
Indication for surgery
Medical intractability118 (79.7%)16 (64.0%)102 (82.9%)0.032
Malignancy or dysplasia30 (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
Pancolitis137 (92.6%)24 (96.0%)113 (91.9%)0.691
Left-sided colitis11 (7.4%)1 (4.0%)10 (8.1%)
Proctitis0 (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
Mild25 (16.9%)6 (24.0%)19 (15.4%)0.341
Moderate71 (48.0%)14 (56.0%)57 (46.3%)
Severe38 (25.7%)4 (16.0%)34 (27.6%)
Fulminant14 (9.5%)1 (4.0%)13 (10.6%)
Total glucocorticoid dose from onset of UC to surgery2
10000 mg or more9 (7.3%)2 (10.0%)7 (6.7%)0.637
Less than 10000 mg115 (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 value
Surgical approach
Laparoscopy146 (98.6%)25 (100.0%)121 (98.4%)1.000
Open2 (1.4%)0 (0.0%)2 (1.6%)
Site of stoma
Right85 (57.4%)10 (40.0%)75 (61.0%)0.053
Left63 (42.6%)15 (60.0%)48 (39.0%)
Type of stoma
End58 (39.2%)3 (12.0%)55 (44.7%)0.002
Loop90 (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
Yes21 (22.8%)7 (35.0%)14 (19.4%)0.123
None71 (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
FactorOdds ratio95%CI
P value
LowerUpper
Malignancy or dysplasia0.5580.1561.9910.369
Total glucocorticoid dose 1 mo before surgery0.9980.9951.0010.244
Preoperative total protein level1.2200.6862.1680.499
Loop ileostomy7.3151.51435.3320.013
Maximum stoma drainage volume1.0001.0001.0010.035
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 value
Age1 (yr), (range)41 (13-71)41 (14-71)41 (13-67)0.690
Gender
Male54 (60.0%)17 (54.8%)37 (62.7%)0.469
Female36 (40.0%)14 (45.2%)22 (37.3%)
Indication for surgery
Medical intractability72 (80.0%)26 (83.9%)46 (78.0%)0.506
Malignancy or dysplasia18 (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
Pancolitis84 (93.3%)29 (93.5%)55 (93.2%)0.662
Left-sided colitis6 (6.7%)2 (6.5%)4 (6.8%)
Proctitis000
Disease duration1 (mo), (range)38 (1-336)21 (1-252)56 (1-336)0.016
Disease severity
Mild17 (18.9%)6 (19.4%)11 (18.6%)0.471
Moderate44 (48.9%)12 (38.7%)32 (54.2%)
Severe21 (23.3%)9 (29.0%)12 (20.3%)
Fulminant8 (8.9%)4 (12.9%)4 (6.8%)
Total glucocorticoid dose from onset of UC to surgery2
10000 mg or more7 (9.3%)2 (8.7%)5 (9.4%)0.644
Less than 10000 mg69 (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 value
Surgical approach
Laparoscopy89 (98.9%)30 (96.8%)59 (100%)0.344
Open1 (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
Yes22 (24.4%)8 (25.8%)14 (23.7%)0.827
None68 (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
Yes6 (6.7%)06 (10.2%)0.072
None84 (93.3%)31 (100%)53 (89.8%)
Postoperative complications (Clavien-Dindo classification)
Grade 1 or less47 (52.2%)15 (48.4%)32 (54.2%)0.598
Grade 2 or higher43 (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 value
Age1 (yr), (range)50.5 (13-77)50 (16-71)0.745
Gender
Male6 (33.3%)6 (85.7%)0.337
Female12 (66.7%)1 (14.3%)
Indication for surgery
Medical intractability12 (66.7%)4 (57.1%)0.499
Malignancy or dysplasia6 (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
Pancolitis17 (94.4%)7 (100.0%)0.720
Left-sided colitis1 (5.6%)0 (0.0%)
Proctitis0 (0.0%)0 (0.0%)
Disease duration1 (mo), (range)40.5 (3-336)49 (15-108)0.923
Disease severity
Mild5 (27.8%)1 (14.3%)0.141
Moderate11 (61.1%)3 (42.9%)
Severe1 (5.6%)3 (42.9%)
Fulminant1 (5.6%)0 (0.0%)
Total glucocorticoid dose from onset of UC to surgery2
10000 mg or more110.521
Less than 10000 mg135
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 value
Surgical approach
Laparoscopy18 (100.0%)7 (100.0%)
Open0 (0.0%)0 (0.0%)
Site of stoma
Right6 (33.3%)4 (57.1%)0.261
Left12 (66.7%)3 (42.9%)
Type of stoma
End3 (16.7%)0 (0.0%)0.355
Loop15 (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
FactorOdds ratio95%CI
P value
LowerUpper
Rectus abdominal muscle thickness at umbilical level2.2491.1764.3000.014