title: Morbidity related to defunctioning ileostomy closure after ileal pouch-anal anastomosis and low colonic anastomosis.
abstract: OBJECTIVE
  Defunctioning ileostomies are widely performed in order to prevent or treat anastomotic leakage after colorectal surgery. The aim of the present study was to determine morbidity related to stoma closure and to identify predictive factors of a complicated postoperative course.
  
  
  METHODS
  A consecutive series of 138 patients were retrospectively analyzed after stoma reversal. Data collection included general demographics and surgery-related aspects. Morbidity related to stoma closure was retrieved from our prospectively collected registry of complications.
  
  
  RESULTS
  In 74 of 138 patients, defunctioning ileostomy was performed after restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA). The remaining ileostomies (n = 64) were constructed after a low colorectal or coloanal anastomosis. A total of 46 complications were recorded in 28 patients resulting in an overall complication rate of 20.3%. Anastomotic leakage rate was 4.3%, and reoperation rate was 8.0%. The number of complications according to the Clavien-Dindo classification was 5 for grade I (10.9%), 26 for grade II (56.5%), 13 for grade III (28.3%), 1 for grade IV (2.2%), and 1 for grade V (2.2%). Multivariate analysis revealed a significantly higher ASA score in the complicated group (P = 0.015, odds ratio 2.6, 95% confidence interval 1.2-5.6).
  
  
  CONCLUSIONS
  Closure of a defunctioning ileostomy is associated with 20% morbidity and a reoperation rate of 8%. There is an urgent need for criteria on which a more selective use of a defunctioning ileostomy after low colonic anastomosis or IPAA can be based given its associated morbidity.
authors.affiliation: Department of Surgery, Academic Medical Center, Postbox 22660, 1100 DD, Amsterdam, The Netherlands. e.van.westreenen@antoniusziekenhuis.nl
authors.forename: Henderik L
authors.initials: HL
authors.lastname: van Westreenen
authors.forename: Annelies
authors.initials: A
authors.lastname: Visser
authors.forename: Pieter J
authors.initials: PJ
authors.lastname: Tanis
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
mesh_terms: D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D039021:Colonic Pouches / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors