Loop ileostomy morbidity: timing of closure matters

Abstract

Purpose: Diverting stomas are commonly performed during ileoanal and coloanal anastomoses. We studied a series of patients after loop ileostomy closure to determine risk factors and the impact of the interval from primary operation on morbidity.

Methods: Ninety-three consecutive patients undergoing loop ileostomy closure at a single institution after coloanal or ileoanal anastomosis were retrospectively reviewed. Complications were classified as medical or surgical according to its treatment requirements. Results were correlated to clinical and operative features.

Results: Of the 93 patients, 43 were male and 50 were female with mean age of 56 years. Overall, complication rate was 17.2 percent. The most common complication was small-bowel obstruction. Complications required operative management in 3.2 percent and medical management alone in 14 percent. There was no mortality. There was no correlation between complication occurrence and age, gender, type of suture (manual or mechanical), and operative time. Complications were significantly associated with primary disease and shorter interval between primary operation and ileostomy closure. Regarding the optimal interval between primary surgery and ileostomy closure, the cutoff value for increased risk of developing postoperative complications was 8.5 weeks, below which the risk of such occurrence was significantly higher with a sensitivity rate of 88 percent.

Conclusions: Diverting loop ileostomy adds little cumulative morbidity to the primary operation and is a safe option for diversion to protect a low colorectal anastomosis. To further reduce morbidity, the interval between primary operation and ileostomy closure should be no shorter than 8.5 weeks.