Risk factors and management of stoma-related obstruction after laparoscopic colorectal surgery with diverting ileostomy

Obstructive and secretory complications of diverting ileostomy

“…Forced stoma rotation by 180-degree with IPAA significantly increases the incidence of SBO; bowel kinking at or below the fascia is presumably responsible for the obstruction[ 21 ]. In contrast, recent reports have shown that stoma rotation did not increase the incidence of SOO/SRO[ 11 , 12 , 15 , 18 , 20 ]. The reason for the SOO/SRO associated with high output from the stoma has already been described in the Etiology section.…”

“…Okita et al [ 11 ] proposed a definition of SBO at the stoma site that has the following criteria: (1) Radiographically confirmed dilatation of the oral stoma limb; (2) Increase in stomal output and relief of symptoms after trans-stomal tube decompression; and (3) Exclusion of SBO other than that at the stoma site. Some of the subsequent reports have followed these criteria for diagnosis[ 10 , 12 - 14 ], while others have used more simplified criteria, such as SBO at the stoma site with radiographic confirmation excluding paralytic ileus[ 15 - 17 ].…”

“…SOO/SRO occurs in 5.4%-27.3% of patients with DI[ 10 - 18 ]. Risk factors are classified into the following categories: patient characteristics[ 10 , 11 , 13 , 16 , 19 ] (young age, low body mass index, thick subcutaneous fat, thick RAM, and long distance between the superior mesenteric artery root and the bottom of the external anal sphincter), disease[ 15 ] (ulcerative colitis), surgical factors[ 12 , 14 , 20 - 22 ] (laparoscopic surgery, rotation of stoma limb, IPAA, two-stage surgery for ulcerative colitis, and short distance from the anastomosis to the stoma site), and stoma functions[ 10 , 17 ] (high output from stoma). The risk factors are summarized in Table 1 .…”

“…As a disease-related factor, ulcerative colitis has been reported as an independent risk factor for SOO/SRO, but the specific reason remains unclear[ 15 ]. It is speculated that the risk may not be due to the disease itself; rather, it refers to the surgical procedure of total proctocolectomy with IPAA with DI (also known as the first of the two-stage surgery)[ 12 , 20 ]. If the length of the diverted bowel (between the stoma and pouch) is too short, strong tension in the mesentery may occur, and it is difficult to revert if bowel twisting or mesenteric torsion occurs.…”

“…If the length of the diverted bowel (between the stoma and pouch) is too short, strong tension in the mesentery may occur, and it is difficult to revert if bowel twisting or mesenteric torsion occurs. If the length is too long, bowel twisting, kinking, or angulation may occur; however, a spontaneous resolution is expected in such cases[ 12 , 18 ]. Several studies have shown an increased risk of SOO/SRO in laparoscopic surgery[ 18 , 22 ].…”