title: Morbidity related to defunctioning loop ileostomy in low anterior resection.
abstract: OBJECTIVE
  A defunctioning loop ileostomy in low anterior resection reduces the incidence and morbidity of an anastomotic leakage, but complications related to the stoma may occur. We explored stoma-associated complications during the stoma period and after stoma reversal.
  
  
  METHODS
  A retrospective analysis of rectal cancer patients operated with low anterior resection and a defunctioning loop ileostomy at Helsingborg Hospital and Malmö University Hospital from January 2007 to June 2009 was undertaken.
  
  
  RESULTS
  Ninety-two patients were included, of whom 82 (89 %) underwent stoma reversal. The median stoma period was 6.2 ± 3.2 months. Sixty-six percent of the patients suffered from minor or major stoma-associated morbidity. The complication rate was significantly related to the stoma time (p < 0.01). Twenty-nine percent (27/92) had at least one episode of dehydration, leading to readmittance in half of the cases. Elderly patients were more prone to develop dehydration. Dehydration most commonly occurred early in the postoperative period (mean, 5.8 weeks). The mean hospital stay for stoma reversal was 6.5 ± 4.0 days. Forty percent (33/82) had some complication associated with the reversal.
  
  
  CONCLUSIONS
  This study indicates high morbidity associated with defunctioning loop ileostomy. Our data suggest that the stoma time should be limited to reduce complications. Monitoring and early stoma reversal should be considered in elderly patients. Furthermore, stoma reversal is not uneventful, and more studies are needed to address how to minimize complications.
authors.affiliation: Colorectal Unit, Department of Surgery, Helsingborg Hospital, 251 87, Helsingborg, Sweden.
authors.forename: Oscar
authors.initials: O
authors.lastname: Åkesson
authors.forename: Ingvar
authors.initials: I
authors.lastname: Syk
authors.forename: Gudrun
authors.initials: G
authors.lastname: Lindmark
authors.forename: Pamela
authors.initials: P
authors.lastname: Buchwald
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects* / Q000706:statistics & numerical data*; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012004:Rectal Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D054047:Surgical Stomas / Q000009:adverse effects / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology