<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec id="j_raon-2019-0037_s_006">
<h3>Background</h3>
<p>Diverting stoma is often performed in rectal cancer surgery for reducing the consequences of possible anastomotic failure. Closing of stoma follows in most cases after a few months. The aim of our study was to evaluate morbidity and mortality after diverting stoma closure and to identify risk factors for complications of this procedure.</p>
</sec>
<sec id="j_raon-2019-0037_s_007">
<h3>Patients and methods</h3>
<p>At our department, we have performed a retrospective cohort analysis of data for 260 patients with diverting stoma closure from 2003 to 2015. Age, stoma type, patient’s preoperative ASA score, surgical technique and time to stoma closure were investigated as factors which could influence the complication rate.</p>
</sec>
<sec id="j_raon-2019-0037_s_008">
<h3>Results</h3>
<p>218 patients were eligible for investigation. Postoperative complications developed in 54 patients (24.8%). Most common complications were postoperative ileus (10%) and wound infection (5%). Four patients died (1.8%). There was no effect on complication rate regarding type of stoma, closing technique, patient’s ASA status and patient age. The only factor influencing the complication rate was the time to stoma closure. We found that patients which had the stoma closed prior to 8 months after primary surgery had lower overall complication rate (p&lt;0. 05).</p>
</sec>
<sec id="j_raon-2019-0037_s_009">
<h3>Conclusions</h3>
<p>To reduce overall complication rate, our data suggest a shorter period than 8 months after primary surgery before closure of diverting stoma. As diverting stoma closure is not a simple operation, all strategies should be taken to reduce significant morbidity and mortality rate.</p>
</sec>
</abstract>

Background
Diverting stoma is often performed in rectal cancer surgery for reducing the consequences of possible anastomotic failure. Closing of stoma follows in most cases after a few months. The aim of our study was to evaluate morbidity and mortality after diverting stoma closure and to identify risk factors for complications of this procedure.


Patients and methods
At our department, we have performed a retrospective cohort analysis of data for 260 patients with diverting stoma closure from 2003 to 2015. Age, stoma type, patient’s preoperative ASA score, surgical technique and time to stoma closure were investigated as factors which could influence the complication rate.


Results
218 patients were eligible for investigation. Postoperative complications developed in 54 patients (24.8%). Most common complications were postoperative ileus (10%) and wound infection (5%). Four patients died (1.8%). There was no effect on complication rate regarding type of stoma, closing technique, patient’s ASA status and patient age. The only factor influencing the complication rate was the time to stoma closure. We found that patients which had the stoma closed prior to 8 months after primary surgery had lower overall complication rate (p<0. 05).


Conclusions
To reduce overall complication rate, our data suggest a shorter period than 8 months after primary surgery before closure of diverting stoma. As diverting stoma closure is not a simple operation, all strategies should be taken to reduce significant morbidity and mortality rate.

Factors affecting the morbidity and mortality of diverting stoma closure: retrospective cohort analysis of twelve-year period

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Background
Diverting stoma is often performed in rectal cancer surgery for reducing the consequences of possible anastomotic failure. Closing of stoma follows...

Clavien- Dindo	n (%)
0	164 (75.2)
1	20 (9.2)
2	18 (8.3)
3b	9 (4.1)
4a	3 (1.4)
5	4 (1.8)

	Anterior Wall Sutures	Resection With Anastomosis	Together
Ileostomy	7 (7%)	95 (93%)	102
Colostomy	69 (59%)	47 (41%)	116
Together	76 (35%)	142 (65%)	218

N = 218
Age	64.6 years (26 – 90)
Sex
Male	136 (62%)
Female	82 (38%)
ASA score
1	60 (27%)
2	102 (47%)
3	26 (12%)
4	1 (0.5%)
Time to closure	248 days (30 – 911)

Type of closure	AWS	RWA	p
All complications	16 (7.3%)	38 (17.4%)	> 0.05
Severe complications	5 (2.2%)	11 (5%)	> 0.05
Age	< 65 years	> 65 years	p
All complications	23 (10.5%)	31 (14.2%)	> 0.05
Severe complications	4 (1.8%)	12 (5.5%)	> 0.05
ASA status	ASA 1 & 2	ASA 3 & 4	p
All complications	38 (17.4%)	6 (3%)	> 0.05
Severe complications	13 (6%)	3 (1.3%)	> 0.05
Type of stoma	Ileostomy	Colostomy	p
All complications	27 (12.4%)	27 (12.4%)	> 0.05
Severe complications	9 (4.1%)	7 (3.2%)	> 0.05
Time to closure	<240 days	>240 days	p
All complications	14 (6.4%)	40 (18%)	= 0.044
Severe complications	4 (1.8%)	12 (5.5%)	> 0.05

Grade	Explanation
	Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic
1	and radiological interventions. Acceptable therapeutic regimens are: drugs as antiemetics, antipyretics, analgetics, diuretics and
	electrolytes, and physiotherapy. This grade also includes wound infections opened at the bedside.
2	Requiring pharmacological treatment with drugs other than such allowed for grade I complications. Blood transfusions, antibiotics and total parenteral nutrition are also included.
3	Requiring surgical, endoscopic or radiological intervention.
a	Intervention under regional/local anesthesia.
b	Intervention under general anesthesia.
4	Life-threatening complication requiring intensive care/intensive care unit management.
a	Single organ dysfunction.
b	Multi-organ dysfunction.
5	Patient demise.

Factors affecting the morbidity and mortality of diverting stoma closure: retrospective cohort analysis of twelve-year period

Article Category: Research Article

Published Online: Sep 24, 2019

Page range: 331 - 336

Received: Mar 21, 2019

Accepted: Jul 15, 2019

DOI: https://doi.org/10.2478/raon-2019-0037

© 2019 Bojan Krebs, Arpad Ivanecz, Stojan Potrc, Matjaz Horvat, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Complications according to Clavien-Dindo

Type of stoma and closure technique

Clinical characteristics

The effect of different variables on complication rate

Clavien-Dindo classification