Elevated risk of stoma outlet obstruction following colorectal surgery in patients undergoing ileal pouch-anal anastomosis: a retrospective cohort study

Abstract

Purpose: Stoma outlet obstruction (SOO) is a complication following colorectal surgery that requires stoma creation. We aimed to clarify the SOO incidence and identify risk factors for SOO after stoma surgery in patients with ulcerative colitis (UC) or rectal cancer.

Methods: The study included 345 patients with sporadic rectal cancer (n = 301) or UC (n = 44) who underwent stoma surgery between 2012 and 2017. Univariate and multivariate analyses were performed to identify risk factors for SOO.

Results: The SOO incidences were 27.3% (n = 12) in patients with UC and 5.6% (n = 17) in patients with sporadic rectal cancer. A multivariate analysis identified UC and loop ileostomy as independent risk factors for SOO. Subanalyses revealed that loop ileostomy was an independent risk factor for patients with UC or sporadic rectal cancer. Most patients who developed SOO were successfully managed with tube drainage through the stoma. However, stoma closure was performed earlier than originally planned in two patients. Among the 29 patients with SOO, 22 (75.9%) developed SOO within 2 weeks postoperatively; the median period between stoma creation and SOO was 6 (range 3-41) days.

Conclusions: UC and loop ileostomy are independent risk factors for postoperative SOO.

Keywords: Colorectal surgery; Complications; Ileal pouch–anal anastomosis; Small bowel obstruction; Stoma outlet obstruction.