title: Loop ileostomy morbidity: timing of closure matters.
abstract: OBJECTIVE
  Diverting stomas are commonly performed during ileoanal and coloanal anastomoses. We studied a series of patients after loop ileostomy closure to determine risk factors and the impact of the interval from primary operation on morbidity.
  
  
  METHODS
  Ninety-three consecutive patients undergoing loop ileostomy closure at a single institution after coloanal or ileoanal anastomosis were retrospectively reviewed. Complications were classified as medical or surgical according to its treatment requirements. Results were correlated to clinical and operative features.
  
  
  RESULTS
  Of the 93 patients, 43 were male and 50 were female with mean age of 56 years. Overall, complication rate was 17.2 percent. The most common complication was small-bowel obstruction. Complications required operative management in 3.2 percent and medical management alone in 14 percent. There was no mortality. There was no correlation between complication occurrence and age, gender, type of suture (manual or mechanical), and operative time. Complications were significantly associated with primary disease and shorter interval between primary operation and ileostomy closure. Regarding the optimal interval between primary surgery and ileostomy closure, the cutoff value for increased risk of developing postoperative complications was 8.5 weeks, below which the risk of such occurrence was significantly higher with a sensitivity rate of 88 percent.
  
  
  CONCLUSIONS
  Diverting loop ileostomy adds little cumulative morbidity to the primary operation and is a safe option for diversion to protect a low colorectal anastomosis. To further reduce morbidity, the interval between primary operation and ileostomy closure should be no shorter than 8.5 weeks.
authors.affiliation: Institute of Colorectal Surgery, Rua Manuel da Nóbrega 1564, 04001-005 São Paulo, SP, Brazil. rodrigo.operez@gmail.com
authors.forename: Rodrigo Oliva
authors.initials: RO
authors.lastname: Perez
authors.forename: Angelita
authors.initials: A
authors.lastname: Habr-Gama
authors.forename: Victor E
authors.initials: VE
authors.lastname: Seid
authors.forename: Igor
authors.initials: I
authors.lastname: Proscurshim
authors.forename: Afonso H
authors.initials: AH
authors.lastname: Sousa
authors.forename: Desidério R
authors.initials: DR
authors.lastname: Kiss
authors.forename: Marcelo
authors.initials: M
authors.lastname: Linhares
authors.forename: Manuela
authors.initials: M
authors.lastname: Sapucahy
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gama-Rodrigues
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000601:surgery; D000714:Anastomosis, Surgical; D002648:Child; D003106:Colon / Q000601:surgery; D005260:Female; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy; D012372:ROC Curve; D012189:Retrospective Studies; D054047:Surgical Stomas; D013997:Time Factors; D016896:Treatment Outcome