Outpatient Stoma Closure in 130 Patients. Insights From the GRECCAR Multicentric Study

Abstract

Objective: evaluate feasibility and outcomes of outpatient stoma closure.

Background: Stoma closure is a routine procedure still associated with prolonged hospital stays, despite a low complication rate. We hypothesized that it could be performed in an outpatient setting.

Methods: This retrospective observational study analyzed prospectively collected data on outpatient stoma closures across 5 centers (5/2019-10/2024) was conducted. Inclusion required a caregiver on surgery day and no associated procedures. Follow-up consisted of phone consultations, a 24/7 emergency contact line, and routine outpatient appointment.

Results: 130 patients (57% male, median age=60 y, ASA score 1-2=94%) were included. 122 loop ileostomies (94%), 5 loop colostomies (4%) and 3 ileocolostomies(3%) were closed. Stoma had been performed mainly after anterior resection (81%) or ileal pouch-anal anastomosis (9%). The median interval before stoma closure was 70 days [7-2310]. Median operative time was 48 minutes [20-247]. Anastomosis was mainly stapled (55.4%). Wounds were closed either directly (56%) or with a purse-string technique (44%). Same-day discharge was possible for 90% of patients. Main reasons for admission were postoperative pain (n=5) and logistical issues (n=4). Median length of hospital stay was 10 hours.[4-16] 21 patients (16%) were readmitted after a median time of 6 days [1-14] (ileus=9, parietal abscess=5). Severe morbidity (Dindo III) was 3%. Direct wound closure was a risk factor of wound infection (P=0.009). Steroid therapy was a risk factor of morbidity and readmission (P<0.001).

Conclusions: Outpatient stoma closure is a safe and effective approach with low complication and readmission rates when using appropriate protocols.

Keywords: colorectal surgery; enhanced recovery pathway; outpatient surgery; stoma closure.