Vergara-Fernández O, Trejo-Avila M, Salgado-Nesme N

Language: English
References: 26
Page: 337-346
PDF size: 190.77 Kb.

ABSTRACT

Background: Despite the advantages of diverting loop ileostomy construction, it is related to complications. Objective: The aim of the study was to determine the risk factors for complications after loop ileostomy closure. Methods: Patients who underwent loop ileostomy closure from January 2010 to March 2018 were retrospectively analyzed. Multivariate logistic regression was used to determine the effect of the potential risk factors on the rate of each complication. Results: A total of 136 patients underwent reversal. Indications for the initial operation were colorectal cancer (39.7%), diverticulitis (25.7%), idiopathic chronic ulcerative colitis (ICUC) (8.1%), familial adenomatous polyposis (FAP) (7.4%), and others (19.1%). Multivariate analysis identified the following risk factors: type of incision (midline laparotomy) (odds ratio [OR] = 6.5) for wound infection; treatment with immunomodulator (OR = 12.5) for anastomotic leak; history of FAP (OR = 9.8) for intestinal obstruction; previous use of immunomodulator (OR = 10.0) and performing reversal through midline incision (OR = 18.9) for reoperation; and ≥ 65 years old (OR = 3.5) for medical complications. The rate of incisional hernia was 11%, and the risk factors were time to closure ‹ 3 months (OR = 6.4) and parastomal hernia (OR = 13.2). Conclusions: Several patient-related and surgical technique factors should be considered at the time of loop ileostomy closure to reduce post-operative morbidity.

REFERENCES

1. Sharma A, Deeb AP, Rickles AS, et al. Closure of defunctioning loop ileostomy is associated with considerable morbidity. Colorectal Dis. 2013;15:458-62.

2. Alberts JC, Parvaiz A, Moran BJ. Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection. Colorectal Dis. 2003;5:478-82.

3. Lightner AL, Pemberton JH. The role of temporary fecal diversion. Clin Colon Rectal Surg. 2017;30:178-83.

4. Gessler B, Haglind E, Angenete E. Loop ileostomies in colorectal cancer patients-morbidity and risk factors for nonreversal. J Surg Res. 2012;178:708-14.

5. Bhangu A, Nepogodiev D, Futaba K, West Midlands Research Collaborative. Systematic review and meta-analysis of the incidence of incisional hernia at the site of stoma closure. World J Surg. 2012;36:973-83.

6. Hsieh MC, Kuo LT, Chi CC, Huang WS, Chin CC. Pursestring closure versus conventional primary closure following stoma reversal to reduce surgical site infection rate: a meta-analysis of randomized controlled trials. Dis Colon Rectum. 2015;58:808-15.

7. Mennigen R, Sewald W, Senninger N, Rijcken E. Morbidity of loop ileostomy closure after restorative proctocolectomy for ulcerative colitis and familial adenomatous polyposis: a systematic review. J Gastrointest Surg. 2014;18:2192-200.

8. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47:1245-51.

9. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.

10. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital infection control practices advisory committee. Infect Control Hosp Epidemiol. 1999;20:250-78.

11. Benson AB, Venook AP, Al-Hawary MM, et al. NCCN guidelines insights: colon cancer, version 2.2018. J Natl Compr Canc Netw. 2018;16:359-69.

12. Hanna MH, Vinci A, Pigazzi A. Diverting ileostomy in colorectal surgery: when is it necessary? Langenbecks Arch Surg. 2015;400:145-52.

13. Man VC, Choi HK, Law WL, Foo DC. Morbidities after closure of ileostomy: analysis of risk factors. Int J Colorectal Dis. 2016;31:51-7.

14. Mirnezami A, Mirnezami R, Chandrakumaran K, et al. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253:890-9.

15. Konishi T, Watanabe T, Kishimoto J, Nagawa H. Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg. 2006;202:439-44.

16. Paun BC, Cassie S, MacLean AR, Dixon E, Buie WD. Postoperative complications following surgery for rectal cancer. Ann Surg. 2010; 251:807-18.

17. Rullier E, Laurent C, Garrelon JL, et al. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998;85:355-8.

18. Gu WL, Wu SW. Meta-analysis of defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer: evidence based on thirteen studies. World J Surg Oncol. 2015;13:9.

19. D’Haeninck A, Wolthuis AM, Penninckx F, D’Hondt M, D’Hoore A. Morbidity after closure of a defunctioning loop ileostomy. Acta Chir Belg. 2011;111:136-41.

20. Mansfield SD, Jensen C, Phair AS, Kelly OT, Kelly SB. Complications of loop ileostomy closure: a retrospective cohort analysis of 123 patients. World J Surg. 2008;32:2101-6.

21. Madani R, Day N, Kumar L, Tilney HS, Gudgeon AM. Hand-sewn versus stapled closure of loop ileostomy: a meta-analysis. Dig Surg. 2018. DOI: 10.1159/000487310 (Article in press).

22. Saha AK, Tapping CR, Foley GT, et al. Morbidity and mortality after closure of loop ileostomy. Colorectal Dis. 2009;11:866-71.

23. Schneider V, Lee LD, Stroux A, et al. Risk factors for reoperation after ileostomy reversal-results from a prospective cohort study. Int J Surg. 2016;36:233-9.

24. Brook AJ, Mansfield SD, Daniels IR, Smart NJ. Incisional hernia following closure of loop ileostomy: the main predictor is the patient, not the surgeon. Surgeon. 2018;16:20-6.

25. Warren JA, Beffa LR, Carbonell AM, et al. Prophylactic placement of permanent synthetic mesh at the time of ostomy closure prevents formation of incisional hernias. Surgery. 2018;163:839-46.

26. Guzmán-Valdivia G. Incisional hernia at the site of a stoma. Hernia. 2008;12:471-4.