Timing of Closure of a Protective Loop-Ileostomy Can Be Crucial for Restoration of a Functional Digestion

Abstract

Introduction: Protective loop-ileostomy is one of the most common interventions in abdominal surgery to provide an alternative intestinal outlet until sufficient healing of a distal anastomosis has occurred. However, closure of a loop-ileostomy is also associated with complications. Thus, knowledge of the optimal time interval between primary and secondary surgery is crucial.

Methods: Data from 409 patients were retrospectively analyzed regarding complications and risk factors in closure-associated morbidity and mortality. A modified Clavien-Dindo classification of surgical complications was used to evaluate the severity of complications.

Results: A total of 96 (23.5%) patients suffered from postoperative complications after the closure of the loop-ileostomy. Early closure within 150 days from enterostomy (n = 229) was associated with less complications (p < 0.001^**). Looking at the severity of complications, there were significantly more (p = 0.014^*) mild postoperative complications in the late closure group (>150 days). Dysfunctional digestive problems-either (sub-) ileus (p = 0.004^*), diarrhea or stool incontinence (p = 0.003^*)-were the most frequent complications associated with late closure. Finally, we could validate in a multivariate analysis that "time to closure" (p = 0.002^*) is independently associated with the development of complications after closure of a protective loop-ileostomy.

Conclusion: Late closure (>150 days) of a loop-ileostomy is an independent risk factor in post-closure complications in a multivariate analysis. Nevertheless, circumstances of disease and therapy need to be considered when scheduling the closure procedure.

Keywords: closure surgery; dysfunctional digestion; enterostomy; protective loop-ileostomy; surgical complications.

Figure 1

Complications depending on the time to closure of the protective loop-ileostomy.

Figure 2

Hospital stay depending on the time of closure of the protective loop-ileostomy. Statistic: non-parametric Mann–Whitney test.