Risk factors for postoperative ileus following loop ileostomy closure
Aydın Aktaş1, Cüneyt Kayaalp2, Mustafa Ateş3, Abuzer Dirican3
1Department of General Surgery, Karadeniz Technical University, School of Medicine, Trabzon, Turkey
2Department of Gastointestinal Surgery, İnönü University, School of Medicine, Malatya, Turkey
3Department of General Surgery, İnönü University, School of Medicine, Malatya, Turkey
Objective: The most common intra-abdominal complication following loop ileostomy closure (LIC) is postoperative ileus (POI). The aim of the study was to determine the risk factors of POI development following LIC and make recommendations for its prevention.
Material and Methods: In this study, patients having undergone LIC with peristomal incision following distal colorectal surgery were included. Clavien-Dindo classification was used to evaluate postoperative complications. POI and postoperative leakage were defined based on clinical and radiological criteria. The Centers for Disease Control and Prevention 2017 criteria were used to diagnose surgical site infection (SSI). Postoperative bleeding was diagnosed one day after surgery if there was a >2 g/dL or ≥15% decrease in the hemoglobin level.
Results: Seventy-nine patients were included into the study. In nine of the patients POI developed, six had SSI, five had postoperative bleeding, and two had anastomosis leakage. In the univariate analysis; age <60 years (p= 0.02), presence of comorbidity (p= 0.007), using an open technique in the first surgery (p= 0.02), performing total colectomy in the first surgery (p= 0.048), performing hand-sewn anastomosis of LIC (p= 0.01), and postoperative blood transfusion (p= 0.04) were found to be risk factors for POI. Performing hand-sewn anastomosis of LIC (p= 0.03) and using an open technique in the first surgery (p= 0.03) were found to be independent variables for POI risk.
Conclusion: Using an open technique in the first surgery and performing a hand-sewn anastomosis of LIC may increase POI.
Keywords: Ileostomy reversal, small bowel obstruction, colorectal surgery, hand-sewn anastomosis, laparoscopy
Cite this article as: Aktaş A, Kayaalp C, Ateş M, Dirican A. Risk factors for postoperative ileus following loop ileostomy closure. Turk J Surg 2020; 36 (4): 333-339.
The approval for this study was obtained from Inonu University Non-Interventional Clinical Research Ethics Committee (Decision No: 2017/26-2, Date: 05.12.2017).
Concept - A.A., C.K., M.A., A.D.; Design - A.A., C.K., M.A., A.D.; Supervision - C.K., M.A., A.D.; Data Collection and/or Processing-A.A., C.K.; Analysis and/or Interpretation -A.A., C.K., M.A., A.D.; Literature Review - A.A., C.K., M.A., A.D.; Writing Manuscript - A.A., C.K., M.A., A.D.; Critical Reviews - A.A., C.K., M.A., A.D.
The authors have no conflicts of interest to declare.
No financial support was used for this study.