Complications of loop ileostomy closure in patients with rectal tumor.
BACKGROUND
Loop ileostomy is customary after very low rectal anastomosis to reduce the rate of pelvic sepsis that can result from anastomotic leakage. To evaluate complications of stoma closure is important to maximize the benefit of making the defunctioning stoma. The aim of this study was to examine possible risk factors associated with complications, especially wound infections, after loop ileostomy closure in patients with rectal tumor.


METHODS
Data from 125 consecutive patients who underwent an elective closure of loop ileostomy after primary rectal tumor resection from January 2005 and October 2009 at a single institution were prospectively collected. Nineteen independent clinical variables were examined by univariate and multivariate analyses.


RESULTS
Postoperative complications developed in 21 (16.8%) patients, including 20 (16%) wound infections, 1 (0.8%) ileus, and 1 (0.8%) anastomotic bleeding. There was no postoperative mortality. Risk factors for wound infection included male gender (odds ratio = 5.30; 95% confidence interval 1.14-24.8; p = 0.0339) and surgical site infection (SSI) after primary surgery (odds ratio = 5.00; 95% confidence interval 1.24-20.1; p = 0.0234). Mean length of postoperative hospital stay was significantly longer in patients with complications than in patients without them (14.0 versus 11.0 days; p = 0.0078).


CONCLUSIONS
The present study showed that most complications associated with ileostomy closure in a homogeneous group of patients with rectal tumor were wound infections. Male gender and SSI after primary surgery were independent risk factors for the development of wound infections. Surgeons should be aware of such high-risk patients, and techniques other than primary closure might need to be considered in high-risk patients to reduce wound infections.
Akiyoshi
Takashi
T
Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital, 3-10-6 Ariake, Koto-ku, Tokyo, 135-8550, Japan. takashi.akiyoshi@jfcr.or.jp
Fujimoto
Yoshiya
Y
Konishi
Tsuyoshi
T
Kuroyanagi
Hiroya
H
Ueno
Masashi
M
Oya
Masatoshi
M
Yamaguchi
Toshiharu
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D045823:Ileus / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012307:Risk Factors; D012737:Sex Factors; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome