Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R. Increased postoperative complications after protective ileostomy closure delay: An institutional study. World J Gastrointest Surg 2014; 6(9): 169-174 [PMID: 25276286 DOI: 10.4240/wjgs.v6.i9.169]
Corresponding Author of This Article
Ines Rubio-Perez, MD, General and Digestive Surgery Department, La Paz University Hospital, Pso. Castellana 261, 28046 Madrid, Spain. dr.inesrubio@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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World J Gastrointest Surg. Sep 27, 2014; 6(9): 169-174 Published online Sep 27, 2014. doi: 10.4240/wjgs.v6.i9.169
Table 1 Characteristics of the 93 patients who underwent loop ileostomy reversal
Clinical characteristics
n (%)
Patients included, total
93 (100)
Gender
Male
54 (58)
Female
39 (42)
BMI
Underweight
3 (3.1)
Normal weight
44 (47)
Overweight
31 (33.3)
Obese
15 (15.8)
ASA Index
I
5 (5.5)
II
59 (63)
III
29 (31)
Indication for ileostomy
Colorectal cancer
52 (56)
Anastomotic leak
16 (17.2)
IBD
6 (6.4)
Colectomy for polyposis
5 (5.3)
Endometriosis
5 (5.3)
Diverticular disease
3 (3.2)
Intestinal necrosis
1 (1.07)
Pelvi-peritonectomy
1 (1.07)
Post-endoscopy perforation
1 (1.07)
Trauma
1 (1.07)
Adjuvant therapy (in oncological patients)
Chemotherapy
16 (17.2)
Chemo-radiotherapy
35 (37)
Table 2 Characteristics of the ileostomy reversal procedure, including surgical technique and skin closure
Surgical variable
n (%)
Ileostomy closure technique
93 (100)
Stapled anastomosis
9 (9.7)
Handsewn anastomosis
84 (90.3)
Side-to-side with resection
28 (33.3)
End-to-end with resection
8 (9.5)
End-to-end without resection
48 (57.1)
Skin closure technique
70 (100)
Staples
17 (24)
Subcuticular
29 (41)
Interrupted suture
24 (34)
Table 3 Postoperative complications after loop ileostomy reversal in our study
Complications
n (%)
Total patients
38 (40.8)
Ileus
12 (12.9)
Wound infection
12 (12.9)
Rectal bleeding
5 (5.8)
Pseudomembranous colitis
4 (4.3)
Anemia/bleeding
3 (3.2)
Intestinal obstruction
3 (3.2)
Anastomotic leak
2 (2.15)
Urinary tract infection
2 (2.15)
Acute renal failure
2 (2.15)
Abdominal abscess
2 (2.15)
Pneumonia
1 (1)
Intestinal necrosis
1 (1)
Multiple organ failure
1 (1)
Thromboembolism
1 (1)
Sepsis
1 (1)
Evisceration
1 (1)
Clavien-Dindo classification
Grade I
21 (55)
Grade II
9 (24)
Grade III
7 (18)
Grade IV
0 (0)
Grade V
1 (3)
Table 4 Statistically significant conditions/complications in the multivariate analysis and their specific P values
Condition/complication
Statistical significance
Gender (male) and overall complications
P = 0.042
Gender (male) and wound infection
P = 0.007
Age and rectal bleeding
P = 0.006
Complications and time to closure (months)
P = 0.041
Closure > 6 mo and pseudomembranous colitis
P = 0.003
End-to-end intestinal anastomosis (without resection) and postoperative ileus
P = 0.037
Citation: Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R. Increased postoperative complications after protective ileostomy closure delay: An institutional study. World J Gastrointest Surg 2014; 6(9): 169-174