title: Defunctioning Ileostomy Reversal Rates and Reasons for Delayed Reversal: Does Delay Impact on Complications of Ileostomy Reversal? A Study of 170 Defunctioning Ileostomies.
abstract: BACKGROUND
  Temporary defunctioning ileostomy can reduce the consequences of anastomotic leak following low anterior resection. However, some patients never have their ileostomy reversed and in other cases the time to reversal of ileostomy can be delayed. The aim of this study was to identify the ileostomy closure rate following anterior resection, time to closure of ileostomy, reasons for delay in reversal and whether delay was associated with an increased complication rate.
  
  
  METHODS
  Data were collected retrospectively on consecutive patients undergoing defunctioning ileostomy following anterior resection for rectal cancer, between January 2009 and August 2013. Data were collected on reversal of ileostomy rates, time to reversal, reasons for delayed reversal (defined as > 6 months) and complications following reversal.
  
  
  RESULTS
  One hundred seventy patients were studied (median age 69 years, range 41 - 90 years), of whom 117 (69%) were male. One hundred twenty-seven (75%) patients had their ileostomies reversed. Median time to reversal was 6 months (range 1 - 42). In 63 patients who had delayed reversal, reasons were adjuvant chemotherapy (22, 35%), medical illness (14, 22%), anastomotic leak (9, 14%), and others (4, 7%). Postoperative complications occurred in 33 patients (26%). There was no postoperative mortality. Univariate analysis showed that delayed reversal was associated with an increased rate of complications and longer length of hospital stay following reversal (P < 0.05).
  
  
  CONCLUSIONS
  One in four defunctioning ileostomies are not closed following anterior resection in our unit. Of those that are closed, approximately 50% have delayed closure beyond 6 months which is associated with increased risk of complications following their ileostomy reversal.
authors.affiliation: Department of Colorectal Surgery, Worcester Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Waterland
authors.affiliation: Department of General Surgery, Good Hope Hospital, Rectory Road, Sutton Coldfield, West Midlands B75 7RR, UK.
authors.forename: Kolitha
authors.initials: K
authors.lastname: Goonetilleke
authors.affiliation: Department of General Surgery, Good Hope Hospital, Rectory Road, Sutton Coldfield, West Midlands B75 7RR, UK.
authors.forename: David N
authors.initials: DN
authors.lastname: Naumann
authors.affiliation: Department of General Surgery, Good Hope Hospital, Rectory Road, Sutton Coldfield, West Midlands B75 7RR, UK.
authors.forename: Mathew
authors.initials: M
authors.lastname: Sutcliff
authors.affiliation: Department of General Surgery, Good Hope Hospital, Rectory Road, Sutton Coldfield, West Midlands B75 7RR, UK.
authors.forename: Faris
authors.initials: F
authors.lastname: Soliman
keywords: Anterior resection; Defunctioning; Ileostomy