Early closure of ileostomy is associated with less postoperative nausea and vomiting.
OBJECTIVE
Temporary loop ileostomy is increasingly used in colorectal surgery but necessitates secondary closure. We evaluated postoperative complications, particularly nausea and vomiting, in patients with early, intermediate, or late elective ileostomy closure.


METHODS
We included all patients undergoing ileostomy closure from 2001 to 2008. Time from ileostomy construction to closure was classified as early (EC, <12 weeks), intermediate (IC, 12-18 weeks), and late (LC, >18 weeks). Using multivariable logistic regression, we compared the frequency of postoperative complications between the groups.


RESULTS
We included 134 patients (87 males; median age 71 years, range 29-91). Carcinoma of the rectum (n = 67, 50%) was the main reason for ileostomy construction. The median time to ileostomy closure was 103 days (range 8-461). Among patients with EC, IC, and LC, postoperative nausea occurred in 50.0, 73.1, and 78.6%, respectively (p = 0.006), and postoperative vomiting in 22.5, 57.7, and 59.5%, respectively (p = 0.001). Adjusting for important covariates, the odds ratio for postoperative nausea was 2.0 (95% CI 0.76-5.1) for IC and 4.1 (95% CI 1.2-14.3) for LC compared to EC (p = 0.069). For postoperative vomiting, adjusted odds ratios were 3.8 (95% CI 1.4-10.4) for IC and 4.6 (95% CI 1.4-15.5) for LC (p = 0.012). Other complications did not differ between the groups.


CONCLUSIONS
These findings suggest that early ileostomy closure might reduce postoperative nausea and vomiting.
Department of Visceral Surgery and Medicine, University of Bern, Bern, Switzerland.
Mathias
M
Worni
André
A
Witschi
Beat
B
Gloor
Daniel
D
Candinas
Urban T
UT
Laffer
Claudia E
CE
Kuehni
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects / Q000379:methods*; D007082:Ileum / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology*; D016017:Odds Ratio; D013997:Time Factors; D014839:Vomiting / Q000209:etiology*