WP5.17 - Stoma reversal after emergency surgery – an analysis of post-operative outcomes and the importance of timing

Abstract

Abstract Introduction Approximately 20,000 people in the UK undergo stoma formation annually(1), with 20% being emergency procedures(2). The reversal rate for these stomas is widely variable, with restoration of continuity being reported in 33-70% of patients(3). Previous research in the elective setting has demonstrated that delayed reversal leads to increased complications and reduced quality of life, but there is a lack of evidence in the emergency cohort. Aim To describe post-operative outcomes of stoma reversal after emergency formation, and to determine whether those reversed within a ‘standard’ timeframe have better outcomes than those with ‘delayed’ reversal. Methods A retrospective review of a prospectively maintained national emergency laparotomy database (ELLSA) from 4 hospitals over a 3-year period (Dec ’19 - ’22) was performed in Dec ’23. All patients undergoing stoma reversal by time of follow-up were included. Those reversed within 18 months of index procedure were classified as ‘standard’. Results 455 patients were identified (Median follow-up 31 months), 95 of whom had died and 34 had a pre-existing permanent stoma. Of the remaining 326, 34.4% underwent reversal (Median age 59; median time to reversal 458 days; 55% ileostomies). 56% of those underwent ‘standard’ reversal (62% ileostomies, p=0.08), and had reduced length of stay (6 days v 7 days, p=0.041) and reduced post-operative ileus rates (23.8% v 44.9%,p=0.019) than those undergoing ‘delayed’ reversal. Conclusion The majority of stomas formed in the emergency setting remain permanent. Prompt reversal of an emergency stoma should be undertaken to reduce complication profile and length of stay. Further work to identify risk factors associated with non-reversal should be undertaken.