title: Morbidity after closure of a defunctioning loop ileostomy.
abstract: OBJECTIVE
  A low pelvic anastomosis is associated with a substantial risk of leakage. A defunctioning stoma (DS) reduces the clinical anastomotic leak rate and the need for re-operation, but stoma closure has its own risk of morbidity and mortality. This study aims to audit morbidity and mortality after loop ileostomy (LI) closure.
  
  
  METHODS
  The medical records of 197 consecutive patients who underwent closure of a defunctioning LI between August 2003 and July 2008 were reviewed. Postoperative morbidity and mortality were recorded.
  
  
  RESULTS
  Transverse closure of the enterotomy was performed in 149 patients (75.6%), segmental enterectomy with hand-sewn end-to-end anastomosis in 26 (13.2%) and stapled side-to-side anastomosis in 22 (11.2%). Overall postoperative morbidity and mortality were 32.0% and 0.5%, respectively. The surgical complication rate was 30.5%, including prolonged ileus (11.2%), small bowel obstruction (4.1%), anastomotic leak (3.0%) and wound infection (4.6%). Surgical complications were more frequent in male patients (p = 0.005). Prolonged ileus was more frequent when the interval to stoma reversal exceeded 12 weeks (14.3% versus 3.5% ; p = 0.02). The incidence of complications was not influenced by the closure technique. Nineteen patients (9.6%) required re-operation for anastomotic leak (n = 8), wound infection (n = 1), small bowel obstruction (n = 3) and incisional herniation (n = 7).
  
  
  CONCLUSIONS
  LI closure is associated with clinically relevant morbidity and mortality. This association should be taken into account in the context of a routine DS policy and should be part of the patient's information.
authors.affiliation: Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: D'Haeninck
authors.forename: A M
authors.initials: AM
authors.lastname: Wolthuis
authors.forename: F
authors.initials: F
authors.lastname: Penninckx
authors.forename: M
authors.initials: M
authors.lastname: D'Hondt
authors.forename: A
authors.initials: A
authors.lastname: D'Hoore
mesh_terms: D057868:Anastomotic Leak / Q000453:epidemiology* / Q000601:surgery; D001530:Belgium / Q000453:epidemiology; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome