The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases

Chow, Andre; Tilney, H. S.; Paraskeva, Paraskevas; Jeyarajah, Santhini; Zacharakis, Emmanouil; Purkayastha, Sanjay

doi:10.1007/s00384-009-0660-z

Cited by 375 publications

(346 citation statements)

References 77 publications

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“…It has been speculated that stoma closure can be another risk factor for PMC, which associates all the previous to an excluded and defunctioned bowel with altered flora, that could be more susceptible to C.diff ity [8] . In a recent systematic review [7] , the high morbidity associated to ileostomy reversal raised concerns over the real indication of diverting stomas related to clinical outcomes, and if a better selection of patients should be made. Luglio et al [9] , consider that if there is a > 5% risk of anastomotic leak in the primary operation, a protective stoma must be created.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical infection of the wound is always a relevant one. A recent systematic review on ileostomy reversal reported an overall mortality of 0.4% [7] , with values ranging from 0% to 4% in different studies. The aim of our study was to review our institutional series of ileostomy reversals and identify possible risk factors for postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

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Increased postoperative complications after protective ileostomy closure delay: An institutional study

Rubio-Perez¹,

León²,

Pastor³

et al. 2014

WJGS

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AIM:To study the morbidity and complications associated to ileostomy reversal in colorectal surgery patients, and if these are related to the time of closure. METHODS:A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance. RESULTS:The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy creation was rectal cancer (56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the patients, with 1% mortality. The most frequent were ileus (13%) and wound infection (13%). Pseudomembranous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomy closure (P = 0.041). Male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003). End-to-end intestinal anastomosis without resection was significantly associated with postoperative ileus (P = 0.037). CONCLUSION:Although closure of a protective ileostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Protective ileostomy; Stomas; Stoma-related complications; Surgical infections; Colorectal surgery Core tip: Protective ileostomies are widely used by surgeons for the protection of anastomoses, but they imply a second intervention for reversal. Despite being considered a minor intervention, ileostomy reversal does not lack complications. Adjuvant treatment, complications from the first intervention, or low-priority consideration can delay the closure of the stoma. In our study, we reviewed all complications following ileostomy reversal and found they were considerably high (40%), and increased as did the time (in months) until closure (P = 0.041). In multivariate analysis, male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003).Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R. Increased postoperative complications after protective ileostomy closure delay: An institutional study. World J Gastrointest Surg 2014; 6(9): 169-174 Available from:

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Rubio-Perez¹,

León²,

Pastor³

et al. 2014

WJGS

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“…However, diverting loop‐ileostomy potentially increases the risks for stoma‐related complications including small bowel obstruction (SBO), stoma prolapse, stoma retraction, parastomal hernia, parastomal dermatitis, and mucocutaneous dehiscence. Risks for stoma‐related complications are reportedly 5‐46% 6, 7, 8, 9…”

Section: Introductionmentioning

confidence: 99%

Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch anal anastomosis with diverting loop‐ileostomy for ulcerative colitis

Mizushima

Kameyama

Watanabe

et al. 2017

Annals of Gastroent Surgery

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Small bowel obstruction (SBO) often occurs after total proctocolectomy and ileal pouch anal anastomosis with diverting loop‐ileostomy for ulcerative colitis. Little is known about the association between SBO and surgical procedures for diverting loop‐ileostomy. We conducted a multicenter, retrospective questionnaire survey. Unlinkable anonymized data on ileostomy procedures and ileostomy‐related complications including SBO were collected from institutions specializing in surgery for inflammatory bowel disease. In total, 515 patients undergoing total proctocolectomy and ileal pouch anal anastomosis with loop‐ileostomy among 1022 patients with ulcerative colitis undergoing surgery during a 3‐year period between 2012 and 2014 were analyzed. Twenty‐nine patients without information on complications were excluded. Incidence of ileostomy‐related complications and factors associated with the development of small bowel obstruction were determined in 486 patients. The most common complications were parastomal dermatitis (n=169, 34.8%), SBO (n=111, 22.8%), mucocutaneous dehiscence (n=59, 12.1%), stoma prolapse (n=21, 4.3%), parastomal hernia (n=12, 2.5%), and stoma retraction (n=11, 2.3%). Incidence of small bowel obstruction was significantly higher in patients with distance from the ileal pouch to the ileostomy of less than 30 cm and in patients undergoing laparoscopic surgery. Procedures for diverting loop‐ileostomy after surgery for ulcerative colitis varied among institutions. Incidence of small bowel obstruction was high after total proctocolectomy and ileal pouch anal anastomosis with diverting loop‐ileostomy. Shorter distance between the pouch and the stoma and the laparoscopic surgery were risk factors for SBO in univariate analysis.

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“…A meta-analysis in 2009 concluded that stoma closure results in additional morbidity for 17% of patients, a 3.7% reoperation rate and 0.4% mortality rate. 22 Furthermore, prior to reversal, stomas have been associated with complications like dermatitis, parastomal hernia, stenosis, hemorrhage, prolapse, retraction and dehydration in up to 60% of patients, 12,[23][24][25] and the incidence increases with the duration of the stoma. 12 Therefore, we sought to further characterize factors associated with non-reversal and delayed reversal among elderly patients, those most at risk for non-reversal, to aid in pre-operative counseling and realistic expectation setting.…”

Section: Discussionmentioning

confidence: 99%

Do older Americans undergo stoma reversal following low anterior resection for rectal cancer?

Dodgion¹,

Neville²,

Lipsitz³

et al. 2010

JCO

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Objective-For low-lying rectal cancers, proximal diversion can reduce anastomotic leak after sphincter preserving surgery; however, evidence suggests that such temporary diversions are often not reversed. We aimed to evaluate non-reversal and delayed stoma reversal in elderly patients undergoing low anterior resection (LAR). The authors report no conflict of interest. Design-SEER-MedicareAuthor Contributions: Dodgion -study design, analysis and interpretation of data, manuscript preparation. Neville -acquisition of data, manuscript preparation. Lipsitz -study design, analysis and interpretation of data, manuscript preparation. Schrag -study design, interpretation of data, manuscript preparation. Breen -study design, interpretation of data, manuscript preparation. Greenberg -study design, analysis and interpretation of data, manuscript preparation and project oversight.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access

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The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases

Cited by 375 publications

References 77 publications

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch anal anastomosis with diverting loop‐ileostomy for ulcerative colitis

Do older Americans undergo stoma reversal following low anterior resection for rectal cancer?

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