title: Morbidities after closure of ileostomy: analysis of risk factors.
abstract: OBJECTIVE
  Low anterior resection is commonly performed for carcinoma of the distal rectum. Diverting ileostomy has been used to decrease the septic consequence of anastomotic leakage and to reduce the re-operation rate. Nevertheless, subsequent closure of ileostomy can be associated with considerable morbidities. This study aimed to evaluate the morbidities after closure of ileostomy and to identify possible risk factors associated with the morbidities.
  
  
  METHODS
  Data of patients who underwent closure of ileostomy, after a previous low anterior resection and defunctioning ileostomy for rectal cancer, was reviewed retrospectively. Patient's demographics, coexisting morbidities, operative details, and post-operative outcomes were analyzed.
  
  
  RESULTS
  From January 2000 to September 2012, 213 patients who underwent ileostomy closure were included. Thirty-five patients developed post-operative complications. The overall complication rate was 16.4 %. The majority of complications could be managed by conservative treatment. Only one patient required re-operation due to intestinal obstruction. There was no 30-day mortality. Age >80 years was an independent risk factor for post-operative complications. Age >80 years was also an independent risk factor for developing urinary retention (p = 0.001) and prolonged ileus (p = 0.02). Closure of ileostomy with hand-sewn techniques showed a higher incidence of post-operative intestinal obstruction (p = 0.049) compared to closure using stapler.
  
  
  CONCLUSIONS
  Closure of ileostomy following low anterior resection is associated with acceptable morbidities. Elderly patients tend to have a more complicated post-operative course and require more medical attention. The use of stapler is the preferred method for ileostomy closure as it is associated with less post-operative intestinal obstruction.
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Vivian Chi Mei
authors.initials: VC
authors.lastname: Man
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Hok Kwok
authors.initials: HK
authors.lastname: Choi
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong. lawwl@hkucc.hku.hk.
authors.forename: Wai Lun
authors.initials: WL
authors.lastname: Law
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Dominic Chi Chung
authors.initials: DC
authors.lastname: Foo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D045823:Ileus / Q000209:etiology; D007415:Intestinal Obstruction / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D016055:Urinary Retention / Q000209:etiology
keywords: Closure of ileostomy; Low anterior resection; Morbidities; Rectal cancer; Risk factors