İleostomi Kapamanın Zamanlaması İleostomi Varlığında ve Kapanması Sonrasında Komplikasyonların Gelişimini Etkiler Mi? Tek Bir Kolorektal Merkeze Ait Retrospektif Bir Çalışma

Abstract

Bulgular: Çalışmada yaş ortalaması 59,9±13,0 yıl olan 62 hasta vardı. İleostomi kapama operasyonu için ortanca değer beş ay idi. İleostomiye bağlı komplikasyonlar 14 hastada (%22,6) gelişti. Ortalama yaş komplikasyon gelişen hastalarda anlamlı derecede daha yüksekti (p=0,027). Hastaların 24’ünde (%38,7) ileostomi kapama ile ilişkili komplikasyonlar tespit edildi. Daha yüksek vücut kitle indeksi ve daha fazla komorbid hastalığı olan yaşlı kadın hastalarda ileostomi kapatıldıktan sonra komplikasyon görülme olasılığı daha yüksekti (p<0,05). Komplikasyon gelişen hastalarda ileostomi süresi komplike olmayan hastalara göre daha kısa olmasına rağmen (beş aya karşı altı ay) anlamlı bir fark yoktu (p=0,535). İleostomi kapama zamanlamasına göre <6 ve ≥6 ay olarak yapılan gruplamanın komplikasyon gelişimine anlamlı bir etkisi yoktu (p>0,05). Sonuç: İleostomi kapamanın zamanlaması ileostomiye bağlı komplikasyonları ve postoperatif komplikasyonları etkilememiştir. Yaş, komplikasyonların gelişimi için önemli bir değişkendi. Kadın cinsiyet, obezite ve komorbidite sadece ileostomi kapamaya bağlı komplikasyonlarla ilişkili bulundu.

Keywords

• İleostomi
• Rektum Kanseri
• Postoperatif Komplikasyonlar

Does the Timing of Ileostomy Closure Does not Impact the Development of Complications During Ileostomy and After Its Reversal? A Retrospective Study in A Single Colorectal Center

Abstract

Objectives: A temporary diverting loop ileostomy is often performed with sphincter-preserving surgery for rectal cancer. However, optimal timing for the reversal of ileostomy is a challenging issue concerning the different cut-off periods. We aimed to evaluate the association between timing of closure and development of complications during ileostomy and after its closure. Materials and Methods: Between January 2016 and August 2020, patients who underwent ileostomy and ileostomy closure associated with the sphincter-preserving surgery for rectum adenocarcinoma were retrospectively analyzed. Ileostomy creation for rectovaginal fistula, restorative proctocolectomy, and emergent surgery for left-sided colonic tumors, and patients without ileostomy closure for any cause were excluded. Patient demographics and clinical variables were recorded. According to ileostomy closure time, the patients were divided into two groups as <6 and ≥6 months. Complications associated with ileostomy and postoperative complications after ileostomy reversal were analyzed regarding the closure time. Results: There were 62 patients with a mean age of 59.9±13.0 years. Ileostomy closure was performed within a median duration of five months. Ileostomy-related complications developed in 14 patients (22.6%). The mean age was significantly higher in patients with complications (p=0.027). In 24 patients (38.7%), there were ileostomy reversal-related complications. Elderly female patients with higher body mass index and more comorbid diseases were more likely to have complications following ileostomy closure (p<0.05). Although the duration of ileostomy in the complicated patients was lower than in the non-complicated patients (five vs. six months), there was no significant difference (p=0.535). There was no significant impact of the grouping based on the timing of ileostomy closure as <6 and ≥6 months on the development of complications (p>0.05). Conclusion: Timing of ileostomy closure did not influence the ileostomy-related complications and postoperative complications. Age was a significant variable for the development of complications. Female sex, obesity, and comorbidity were associated only with ileostomy reversal-related complications.

Keywords

• Ileostomy
• Rectum Cancer
• Postoperative Complications

References

1. 1. Poskus E, Kildusis E, Smolskas E, et al. Complications after Loop Ileostomy Closure: A Retrospective Analysis of 132 Patients. Viszeralmedizin. 2014;30:276-280.
2. 2. Choi YJ, Kwak JM, Ha N, et al. Clinical Outcomes of Ileostomy Closure According to Timing During Adjuvant Chemotherapy After Rectal Cancer Surgery. Ann Coloproctol. 2019;35:187-193.
3. 3. Copăescu C, Smeu B, Catanescu E, et al. Early Laparoscopic Ileostomy Reversal After Rectal Cancer Surgery - Technique and Outcomes. Chirurgia (Bucur). 2019;114:392-400.
4. 4. Li W, Ozuner G. Does the timing of loop ileostomy closure affect outcome: A case-matched study. Int J Surg. 2017;43:52-55.
5. 5. Chow A, Tilney HS, Paraskeva P, et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis. 2009;24:711-723.
6. 6. Sier MF, van Gelder L, Ubbink DT, et al. Factors affecting timing of closure and non-reversal of temporary ileostomies. Int J Colorectal Dis. 2015;30:1185-1192.
7. 7. Keane C, Park J, Öberg S, et al. Functional outcomes from a randomized trial of early closure of temporary ileostomy after rectal excision for cancer. Br J Surg. 2019;106:645-652.
8. 8. Gustafsson CP, Gunnarsson U, Dahlstrand U, et al. Loop-ileostomy reversalpatient- related characteristics influencing time to closure. Int J Colorectal Dis. 2018;33:593-600.

9. 9. Abdalla S, Scarpinata R. Early and Late Closure of Loop Ileostomies: A Retrospective Comparative Outcomes Analysis. Ostomy Wound Manage. 2018;64:30-35.
10. 10. Bausys A, Kuliavas J, Dulskas A, et al. Early versus standard closure of temporary ileostomy in patients with rectal cancer: A randomized controlled trial. J Surg Oncol. 2019;120:294-299.
11. 11. Bakx R, Busch OR, van Geldere D, et al. Feasibility of early closure of loop ileostomies: a pilot study. Dis Colon Rectum. 2003;46:1680-1684.
12. 12. Perez RO, Habr-Gama A, Seid VE, et al. Loop ileostomy morbidity: timing of closure matters. Dis Colon Rectum. 2006;49:1539-1545.
13. 13. Zhen L, Wang Y, Zhang Z, et al. Effectiveness between early and late temporary ileostomy closure in patients with rectal cancer: A prospective study. Curr Probl Cancer. 2017;41:231-240.
14. 14. Wang L, Chen X, Liao C, et al. Early versus late closure of temporary ileostomy after rectal cancer surgery: a meta-analysis. Surg Today. 2021;51:463-471.
15. 15. Robertson J, Linkhorn H, Vather R, et al. Cost analysis of early versus delayed loop ileostomy closure: a case-matched study. Dig Surg. 2015;32:166-172.
16. 16. Danielsen AK, Park J, Jansen JE, et al. Early Closure of a Temporary Ileostomy in Patients With Rectal Cancer: A Multicenter Randomized Controlled Trial. Ann Surg. 2017;265:284-290.
17. 17. Echazarreta-Gallego E, Elía-Guedea M, Córdoba-Díaz de Laspra E, et al. Defunctioning ileostomy. Is an early closure safe? Int J Colorectal Dis. 2016;31:771-773.
18. 18. Tulchinsky H, Shacham-Shmueli E, Klausner JM, et al. Should a loop ileostomy closure in rectal cancer patients be done during or after adjuvant chemotherapy? J Surg Oncol. 2014;109:266-269.
19. 19. Herrle F, Sandra-Petrescu F, Weiss C, et al. Quality of Life and Timing of Stoma Closure in Patients With Rectal Cancer Undergoing Low Anterior Resection With Diverting Stoma: A Multicenter Longitudinal Observational Study. Dis Colon Rectum. 2016;59:281-290.
20. 20. Memon S, Heriot AG, Atkin CE, et al. Facilitated early ileostomy closure after rectal cancer surgery: a case-matched study. Tech Coloproctol. 2012;16:285-290.
21. 21. Robertson JP, Puckett J, Vather R, et al. Early closure of temporary loop ileostomies: a systematic review. Ostomy Wound Manage. 2015;61:50-57.