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Introduction: Diverting loop ileostomy is commonly used for a variety of indications in general surgery and is generally considered a safe technique. However, some patients develop ostomy-related complications necessitating revision surgery or early ostomy closure. The aim of this study was to better define the incidence and nature of early complications in relation to specific risk factors, and to recognize patients at risk in order to avoid preventable complications.
Methods: Single-center case-control study including all patients undergoing a protective loop ileostomy between 2001 and 2009. Complications were necrosis and retraction, peristomal infection, parastomal herniation, bowel obstruction, and individual problems related to postoperative ostomy care. Risk factors analyzed included age, gender, urgency of surgery, underlying pathology, body mass index, steroid use, diabetes mellitus, alcohol abuse, previous abdominal operations, dementia, renal insufficiency, inflammatory bowel disease (IBD), and chronic obstructive pulmonary disease (COPD). Univariate and subsequent multivariate analysis were performed using SPSS 18.0.
Results: 182 patients (43% female) were included, the majority of which (68%) were admitted for elective colorectal resections. Early complications were recorded in 16% of all cases (with 0% mortality), and occurred most frequently following emergency resections for obstructive colorectal cancer (44.4% complications) and perforated diverticulitis (18.7% complications). Median delay until ostomy closure was 74 (6-343) days in patients without and 51 (4-182) days in patients with complications. Problems with inadequate ostomy care (7.7%) were the main reason for early stoma closure. Parastomal herniation and peristomal infection occurred in 2.7% and 2.2%, respectively. Steroid use, diabetes mellitus, IBD, COPD and asthma were each associated with an increased risk for early ostomy complications and premature ostomy closure.
Conclusions: The incidence of early complications after ileostomy formation is high, indicating the need for well-defined indications for this procedure. Patients admitted for emergency surgery due to colonic obstruction are at greatest risk for ostomy-related morbidity, especially those suffering from comorbidities such as diabetes. The most frequent complication is an overwhelmed patient unable to deal safely and appropriately with his ostomy. Home support with trained ostomy nurses should be encouraged in all ostomy patients to avoid premature ostomy closure.