Stoma Complications: The Kaohsiung Veterans General Hospital Experience

Abstract

Purpose. A retrospective analysis of enteric stomas performed at Kaohsiung General Hospital was undertaken to evaluate stoma complications per stoma type and configuration and operating service. In addition, we attempted to identify factors predictive of increased enteric stoma complications. Methods. From Jan. 1991 to Dec. 2002, charts on 1048 patients with 1084 stomas were reviewed. Chart information included age, gender, early and late stoma complications, emergency status, operating service, type and configuration of the stoma, and whether the patient was seen preoperatively by an enteric stoma therapist. Data was then analyzed using a logistic regression model to identify those variables that influenced the rate of complications. Results. Of 1084 stomas, 781 were male and 303 female. Age distribution was from I day to 97 years with a median 67 years. 617 stomas were created emergently and 467 electively. Preoperative marking was given in 101 stomas. There were 276 (25.5%) complications. Among the total complications, 135 (12.5%) occurred early (＜ I month postoperative), and 141(13.0%) occurred late (＞ 1 month). The most common early complications were skin irritation (5.7%), stoma necrosis (2.3%), and prolapse (1.6%). The most common late complications were prolapse (6.4%), parastoma hernia (2.0%), and skin irritation (1.7%). The enteric stoma with the most complications was the loop ileostomy (38.6%). The enteric stoma with the least complications was the end descending colostomy (0%). The general surgery service had the most complications (39.8%), followed by gynecology (37.2%), trauma (26.4%), colorectal (23.6%), and pediatric surgery (19.6%). Operating service, enteric stoma type and configuration, and emergency status were found to be variables that influenced stoma complications. Conclusions. Complications from enteric stoma construction are common. Avoid the ileostomy, particularly in the loop configuration, and paying close attention to the emergency stoma construction can help minimize complications.