Underwent Loop Ileostomy Closure Research Articles

Development of a novel nomogram for the prediction of surgical site infection risk after loop ileostomy closure

BackgroundA postoperative surgical site infection (SSI) is a prevalent complication after loop ileostomy closure. There are few studies on the risk factors and the development of predictive models for postoperative SSIs. The aim of this study was to develop and validate a nomogram model capable of accurately predicting the occurrence of postoperative SSIs.MethodsThis retrospective analysis examined the clinical data of 369 patients who underwent loop ileostomy closure at a local hospital from January 2015 to March 2022. A logistic regression model was used to identify the potential risk factors for a postoperative SSI after loop ileostomy closure. A nomogram was established using independent risk factors, and the prediction performance of the model was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC).ResultsForty-eight (13.0%) developed postoperative SSIs after loop ileostomy closure. Multivariate logistic regression analysis revealed that a body mass index (BMI) > 25 kg/m2, diabetes, linear skin closure (LSC), and a prolonged operative time were independent risk factors for SSIs, whereas the presence of a subcutaneous drainage tube was identified as an independent protective factor. The nomogram models constructed using these variables achieved AUCs of 0.833 and 0.823 on the training set and validation set, respectively. The calibration curves demonstrated excellent consistency.ConclusionThe nomogram developed using clinical data from patients who underwent loop ileostomy closure demonstrates a robust predictive capability, offering valuable guidance to clinicians in assessing the risk of postoperative SSIs.

Complications associated with loop ileostomy reversal delayed greater than twelve months.

Diverting loop ileostomy is performed after colectomy to allow for anastomotic healing, and prevention of pelvic sepsis when an anastomotic leak occurs. There is no consensus on the optimal timing of ileostomy closure, and there is limited data on complications associated with ileostomy closure greater than 12 months after creation. The aim of this study is to investigate outcomes of delayed loop ileostomy closure greater than 12 months after creation. Patients undergoing loop ileostomy closure between 2013 and 2023 at Carilion Medical Center, in Roanoke, VA were reviewed. Cohorts compared were defined as Control Group (closure < 4 months) and Delayed Group (closure > 12 months). Demographics and outcomes were compared. Statistical comparisons were performed using either Wilcoxon rank sum test, Pearson's Chi-squared test or Fisher's exact test. Statistical modeling included binary logistic regression for 30-day readmissions and a generalized linear modeling for days till bowel function returns. Adjusted odds ratios, confidence intervals, and p-values were calculated. There were 135 patients in the Control Group and 19 patients in the Delayed Group. Demographics were similar between the groups except for a higher percentage of patients with diabetes, renal failure and history of cancer in Delayed Group (all p < 0.05). Operative time was longer for Delayed loop ileostomy closure (p < 0.05). Patients in the Delayed Group demonstrated a higher hospital readmission rate within 30 days (p < 0.05). Both groups had similar return of bowel function on post-operative day 2, similar length of stay, and similar rates of postoperative ileus (p = NS). Delayed loop ileostomy closure more than 12 months after creation does not delay return of bowel function but may lead to higher hospital readmission rates within 30 days.

Can inflammatory markers such as lymphocyte to C-reactive protein ratio and hemoglobin, albumin, lymphocyte, and platelet score predict complications after loop ileostomy closure?

Aim: This study aims to investigate whether inflammatory biochemical markers such as hemoglobin, albumin, lymphocyte, platelet scores (HALP), and lymphocyte-C-reactive protein ratio (LCR) can predict complications after ileostomy closure. Methods: Eighty-five patients who underwent loop ileostomy closure were included in this retrospective study. Alongside the patient’s demographic data, surgical data, histopathology results, and biochemistry data were recorded. Complications that occurred within the first 30 days after surgery were evaluated using the Clavien-Dindo classification. Inflammation markers such as HALP and LCR were obtained using biochemical parameters. Results: The rate of mild complications (Clavien-Dindo I and II) was 27%, while the rate of severe complications (Clavien-Dindo III and IV) was 12.94%. A statistically significant correlation was found between the development of early complications and levels of albumin, lymphocyte, neutrophil, and C-reactive protein (CRP) (p

Prophylactic effect of retromuscular mesh placement during loop ileostomy closure on incisional hernia incidence—a multicentre randomised patient- and observer-blind trial (P.E.L.I.O.N trial)

BackgroundIncisional hernia is a frequent complication following loop ileostomy reversal. Incisional hernias are associated with morbidity, loss of health-related quality of life and costs and warrant the investigation of prophylactic measures. Prophylactic mesh implantation at the time of surgical stoma reversal has shown to be a promising and safe method to prevent incisional hernias in this setting. However, the efficacy of this method has not yet been investigated in a large multicentre randomised-controlled trial (RCT) with adequate external validity. The P.E.L.I.O.N. trial will evaluate the efficacy of prophylactic mesh reinforcement after loop ileostomy closure in decreasing the rate of incisional hernia versus standard closure alone.MethodsP.E.L.I.O.N. is a multicentre, patient- and observer-blind RCT. Patients undergoing loop ileostomy closure will undergo intraoperative 1:1 randomisation into either abdominal wall closure with a continuous slowly absorbable suture in small-stitch technique without mesh reinforcement (control group) or abdominal wall closure with an additional reinforcement with a retromuscular non-absorbable, macro-pore (pore size ≥ 1000 μm or effective porosity >0%) light-weight monofilament or mixed structure mesh. A total of 304 patients (152 per group) will need to be randomised in the study. Based on inclusion and exclusion criteria, 1,014 patients are expected to be screened for eligibility in order to recruit the necessary number of patients. The primary endpoint will be the frequency of incision hernias within 24 months according to the European Hernia Society definition. Secondary endpoints will be the frequency of surgical site occurrences (including surgical site infections, wound seromas and hematomas, and enterocutaneous fistulas), postoperative pain, the number of revision surgeries and health-related quality of life. Safety will be assessed by measuring postoperative complications ≥ grade 3 according to the Dindo-Clavien classification.DiscussionDepending on the results of the P.E.L.I.O.N. trial, prophylactic mesh implantation could become the new standard for loop ileostomy reversal.Trial registrationDRKS00027921, U1111-1273-4657

A PROSPECTIVE CASE STUDY: ASSOCIATION OF LOW SERUM ALBUMIN LEVEL AND LONGER INTERVAL TO CLOSURE WITH COMPLICATIONS RATE AFTER ILEOSTOMY CLOSURE

Background: A loop ileostomy is the stoma most constantly used to defunction an empty colon in order to safeguard a vulnerable distal anastomosis. Some cases have a trouble-free stoma, while others have recurring problems that may need another surgery. A temporary stoma, which has secured an anastomosis, may be closed as soon as the anastomosis is soundly healed. Early takedown, at around 2 weeks, is exercised by some surgeons but is technically more tough at this stage. A holdup of 6 – 8 weeks allows the stoma to mature and the planes around the stoma to become more dened. The further delay will also allow the case to get back nutritious and immunological status after a major operation, and will also reduce the danger of thromboembolic complications. However, the case has to learn to manage the stoma in order to return home. nonetheless, the morbidity and mortality associated with ileostomy reversal can not be overlooked. We assessed the possible danger factors for complications following ileostomy reversal. All patients who underwent loop ileostomy closure between November 2019 andMaterials and methods: December 2021 at Krishna Rajendra Hospital, Mysore where identied. Medical records on patient characteristics, preoperative management, surgical techniques, postoperative management, chemotherapy/radiotherapy, and complications were retrospectively analyzed in a prospectively collected database. A total of 84 patients underwent loop ileostomy closure. The overall complication rate was 25 % and one patient died.Results: The two most common complications were wound infection (18%) and small bowel obstruction (3.9%). In univariable and multivariable analyses, closure technique or chemotherapy did not affect the outcome, but low serum albumin &lt;3.5 g/dL and longerinterval to ileostomy closure were independent contributingfactors for morbidities of ileostomy closure. Closure approach or chemotherapy didn't affect theConclusion: complication of ileostomy closure. Nevertheless, serum albumin &lt;3.5 g/dL and a longer interval to ileostomy closure were identied as risk factors for morbidity of ileostomy closure. These two factors should be corrected and planned before ileostomy closure.

The impact of prolonged delay to loop ileostomy closure on postoperative morbidity and hospital stay: A retrospective cohort study.

AimThere is increasing evidence that delayed loop ileostomy closure is associated with an increase in postoperative morbidity. In the context of a publicly funded health service with constrained theatre access, we review the impact of delay in loop ileostomy closure.MethodA retrospective cohort study of patients undergoing loop ileostomy closure at the Dunedin Public Hospital between 2000–2017 was performed. Cases and complications were identified from the prospectively maintained Otago Clinical Audit database. Patient demographics, ASA score, indications for ileostomy, reasons for delay in closure, length of stay (LOS) after ileostomy closure and complications were collected. LOS and overall complication rate were assessed using univariable and multivariable analyses.ResultsA total of 292 patients were included in the study, of whom 74 (25.3%) were waiting for longer than 12 months for ileostomy closure. The overall complication rate was 21.5%. This was 8% up to 90 days, 20% between 90–360 days, 28% between 360–720 days and 54% after 720 days. Delay was associated with an increased risk of any complication (RR 1.06 for every 30 days with stoma, p < 0.001), including Ileus (OR [95% CI] 1.06 [1.00–1.11], p = 0.024). Overall mean LOS was 5.9 days (range 1–63), being 4.6 days up to 180 days, 5.6 between 180–720 days and 8.7 after 720 days. LOS significantly increased with increasing stoma duration (p = 0.04).ConclusionIncreasing time with loop ileostomy is detrimental for patients, being associated with an increase in complication rates, and is detrimental for hospitals due to increased length of stay. Resources should be allocated for timely closure of loop ileostomies.

Predisposing factors for high output stoma in patients with a diverting loop ileostomy after colorectal surgeries.

One of the most common ileostomy-related complications is high output stoma (HOS) which causes significant fluids and electrolytes disturbances. We aimed to analyze the incidence, severity, and risk factors for readmission for HOS. We reviewed all patients who underwent loop ileostomy closure in a single institution between 2010 and 2020. Patients that were readmitted for dehydration due to HOS during the time interval between the creation and the closure of the stoma were identified and divided into a study (HOS) group. The remaining patients constructed the control group. A total of 307 patients were included in this study, out of which, 41 patients were readmitted 73 times (23.7% readmission rate) for the HOS group, and the remaining 266 patients constructed the control group. Multivariate analysis identified; advanced American Society of Anesthesiologists (ASA) physical status (PS) classification, elevated baseline creatinine, and open surgery as risk factors for HOS. Renal function worsened among the entire cohort between the construction of the stoma to its closure (mean creatinine of 0.82 vs. 0.96, P<0.0001). Loop ileostomy formation is associated with a substantial readmission rate for dehydration as a result of HOS, and increasing the risk for renal impairment during the duration of the diversion. We identified advanced ASA PS classification, open surgery, and elevated baseline creatinine as predictors for HOS.

The Impact of an Enhanced Recovery Program on Loop Ileostomy Closure.

The implementation of enhanced recovery after surgery (ERAS) protocols has decreased the length of stay (LOS) and complications in colorectal procedures. However, little data has been published on the subset of patients undergoing loop ileostomy closure. We investigated the outcomes of loop ileostomy reversals prior to and after initiation of an ERAS protocol. Patients undergoing ileostomy reversal over a 5-year period by 4 colorectal surgeons were studied and divided into pre-ERAS patients and ERAS patients in a retrospective, case-control study. Patient demographics, comorbidities, LOS, underlying disease process, index intra-abdominal procedure, readmission rate, and complications were evaluated. Overall, 208 patients were analyzed 149 pre-ERAS and 59 ERAS-with median LOS significantly lower in the ERAS group than the pre-ERAS group (50.8hours vs. 96.1hours, P < .0001). In subgroup analysis, the LOS was significantly lower if the index procedure performed was laparoscopic when comparing ERAS to pre-ERAS (49.9hours vs. 96.6hours, P < .001). ERAS did not confer a significant decrease in the LOS during ileostomy reversal with open index procedures (72.9hours vs. 95.5hours, P = .05). Utilizing an ERAS protocol is safe and effective for loop ileostomy closure with a shorter LOS and no difference in complication rates or 30-day readmission rates.

Protective Loop Ileostomy Closure Techniques: Comparison of Three Different Surgical Techniques

ObjectiveAnastomotic leaks can be very dangerous in colorectal cancers. Protective loop ileostomy is life-saving in low anterior rectal tumors to prevent pelvic sepsis. The aim of this study is to compare early morbidities for stapled, handsewn closure (end to end) or handsewn closure (anterior wall only) of loop ileostomy, and to further assess efficacy and safety for each technique. MethodsPatients who underwent loop ileostomy closure from January 2014 and December 2019 retrospectively were analyzed. Multivariate logistic regression was used to determine the effect of the potential risk factors on the rate of each complication. The patients were divided into three groups based on the anastomoses. The first group included patients who had handsewn anterior closure; the second group included patients who had side-to-side anastomosis using linear stapler, and the third group included patients who had end-to-end handsewn anastomosis. The primary endpoint of the study was the postoperative 30 days. IBM Statistical Package for the Social Sciences (SPSS), version 22.0 (SPSS Inc., Chicago, IL) was used for statistical analysis.ResultsA total of 198 patients underwent reversal. There was a statistical difference between the handsewn anterior wall and stapler anastomosis in terms of postoperative ileus and wound infection. The handsewn group was superior to anastomosis with stapler (p: 0.027 and p: 0.042, respectively). A statistical difference was found between handsewn anterior wall closure and handsewn end-to-end anastomosis in terms of postoperative ileus, wound infection, and postoperative hospital stay (p: 0.013, p: 0.037, and p: 0.046, respectively). When stapled anastomosis and handsewn end-to-end anastomosis techniques were compared, a statistical difference was found in terms of postoperative ileus risk (p: 0.043), but no significant difference was found in terms of postoperative wound infection and hospital stay.ConclusionsThere was no significant difference in the rate of anastomotic leakage between the handsewn and stapled techniques. The rate of small-bowel obstruction was higher in the handsewn group. As a result, in this study, it was revealed that the handsewn anterior wall closure technique is the best among all ileostomy closure techniques.

Low albumin level and longer interval to closure increase the early complications after ileostomy closure

BackgroundLoop ileostomy has an important role in mitigating the serious effects of anastomotic leakage in colorectal surgery. However, the morbidity and mortality associated with ileostomy reversal cannot be overlooked. We investigated the possible risk factors for complications following ileostomy reversal. MethodsAll patients who underwent loop ileostomy closure between 2008 and 2017 at Inje University Busan Paik Hospital were identified. Medical records on patient characteristics, preoperative management, surgical techniques, postoperative management, chemotherapy/radiotherapy, and complications were retrospectively analyzed in a prospectively collected database. ResultsA total of 354 patients underwent loop ileostomy closure. The overall complication rate was 23.7%, with Clavien-Dindo grade I as the most common (15.8%), 5.6% in grade II, 2.2% in grade III–V, and three patients died. The two most common complications were wound infection (11.6%) and small bowel obstruction (4.8%). In univariable and multivariable analyses, closure technique or chemotherapy did not affect the outcome, but low serum albumin <3.5 g/dL (OR 7.248, CI 2.416–22.838, p < 0.001) and longer interval to ileostomy closure (OR 1.977, CI 1.167–3.350, p = 0.0113) were independent contributing factors for morbidities of ileostomy closure. ConclusionsClosure technique or chemotherapy did not affect the complication of ileostomy closure. However, serum albumin <3.5 g/dL and a longer interval to ileostomy closure were identified as risk factors for morbidity of ileostomy closure. These two factors should be corrected and planned before ileostomy closure.

A combination of subcuticular sutures and subcutaneous closed-suction drainage reduces the risk of incisional surgical site infection in loop ileostomy closure.

The purpose of this study was to evaluate the effectiveness of a wound closure method using a combination of subcuticular sutures and subcutaneous closed-suction drainage (SS closure) for preventing incisional surgical site infection (SSI) in loop ileostomy closure. A total of 178 consecutive patients who underwent loop ileostomy closure at Nara Medical University Hospital between 2004 and 2018 were retrospectively assessed. The patients were divided into 2 groups: the conventional skin closure (CC) group from 2004 to 2009 (75 patients) and the SS closure (SS) group from 2010 to 2018 (103 patients). The incidence of incisional SSI was compared between the two groups, and the factors associated with incisional SSI were examined by univariate and multivariate analyses. Incisional SSI occurred in 7 cases (9.3%) in the CC group but was significantly reduced to only 1 case (0.9%) in the SS group (p = 0.034). In the univariate analysis, the hemoglobin levels, serum creatinine levels, and SS closure were associated with incisional SSI. SS closure was the only independent preventive factor for incisional SSI according to the multivariate analysis (hazard ratio = 0.24, p = 0.011). The combination of subcuticular sutures and subcutaneous closed-suction drainage may be a promising way of preventing incisional SSI in loop ileostomy closure.

Predictors of hernia after loop ileostomy closure: a single-center retrospective review.

Our aims were to determine the rate of incisional hernia after closure of a loop ileostomy (LI) and to identify any perioperative risk factors that may be associated with hernia development. We performed an IRB-approved retrospective review that included consecutive patients who underwent LI closure from January 1, 2012, to December 31, 2014. The primary outcome was identification of hernia on physical exam or by abdominal imaging. A stepwise logistic regression analysis was used to determine predictors of ileostomy site hernia. A total of 243 consecutive patients had LI closure during the study timeframe. The overall rate of hernia formation was 11.9% (29/243). The median time to discovery of the hernia was 16.4 (range, 2.2-55.9) months with a median follow-up time of 49 months. Although LI performed in conjunction with sigmoidectomy for diverticulitis consisted of only 19% of ileostomy cases, 62% of hernias were (18/29) identified in this cohort. Rates of hernia formation increased with respect to body mass index (underweight 0%; normal 4.6%; overweight 13.8%; obese 21%). The multivariable model identified increased BMI (underweight/normal weight versus overweight: OR 4.13, 95% CI 1.06-16.04; underweight/normal weight versus obese: OR 8.74, 95% CI 2.17-35.23) and surgical indication (reference variable: diverticulitis; rectal cancer: OR 0.21, 95% CI 0.06-0.76; Crohn's/ulcerative colitis: OR 0.06, 95% CI 0.01-0.53; other: OR 0.15, 95% CI 0.04-0.64) as significant predictors of ileostomy site hernia. The development of a hernia at the site of LI closure was influenced mostly by BMI, surgical indication, and operative time.

Prediction model and web-based risk calculator for postoperative ileus after loop ileostomy closure.

Postoperative ileus (POI) is a significant complication after loop ileostomy closure given both its frequency and impact on the patient. The purpose of this study was to develop and externally validate a prediction model for POI after loop ileostomy closure. The model was developed and validated according to the TRIPOD checklist for prediction model development and validation. The development cohort included consecutive patients who underwent loop ileostomy closure in two teaching hospitals in Montreal, Canada. Candidate variables considered for inclusion in the model were chosen a priori based on subject knowledge. The final prediction model, which modelled the 30-day cumulative incidence of POI using logistic regression, was selected using the highest area under the receiver operating characteristic curve (AUC) criterion. Model calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test. The model was then validated externally in an independent cohort of similar patients from the University of British Columbia. The development cohort included 531 patients, in whom the incidence of POI was 16·8 per cent. The final model included five variables: age, ASA fitness grade, underlying pathology/treatment, interval between ileostomy creation and closure, and duration of surgery for ileostomy closure (AUC 0·68, 95 per cent c.i. 0·61 to 0·74). The model demonstrated good calibration (P= 0·142). The validation cohort consisted of 216 patients, and the incidence of POI was 15·7 per cent. On external validation, the model maintained good discrimination (AUC 0·72, 0·63 to 0·81) and calibration (P= 0·538). A prediction model was developed for POI after loop ileostomy closure and included five variables. The model maintained good performance on external validation.

Multivariate analysis of risk factors for complications after loop ileostomy closure.

Despite the advantages of diverting loop ileostomy construction, it is related to complications. The aim of the study was to determine the risk factors for complications after loop ileostomy closure. Patients who underwent loop ileostomy closure from January 2010 to March 2018 were retrospectively analyzed. Multivariate logistic regression was used to determine the effect of the potential risk factors on the rate of each complication. A total of 136 patients underwent reversal. Indications for the initial operation were colorectal cancer (39.7%), diverticulitis (25.7%), idiopathic chronic ulcerative colitis (ICUC) (8.1%), familial adenomatous polyposis (FAP) (7.4%), and others (19.1%). Multivariate analysis identified the following risk factors: type of incision (midline laparotomy) (odds ratio [OR] = 6.5) for wound infection; treatment with immunomodulator (OR = 12.5) for anastomotic leak; history of FAP (OR = 9.8) for intestinal obstruction; previous use of immunomodulator (OR = 10.0) and performing reversal through midline incision (OR = 18.9) for reoperation; and ≥ 65 years old (OR = 3.5) for medical complications. The rate of incisional hernia was 11%, and the risk factors were time to closure < 3 months (OR = 6.4) and parastomal hernia (OR = 13.2). Several patient-related and surgical technique factors should be considered at the time of loop ileostomy closure to reduce post-operative morbidity.

Incidence and predictors of postoperative ileus after loop ileostomy closure: a systematic review and meta-analysis.

Postoperative ileus (POI) is regarded as the most clinically significant morbidity following loop ileostomy closure; however, its incidence remains poorly understood. Our objective was therefore to determine the pooled incidence of POI after loop ileostomy closure and identify risk factors associated with its development. We systematically searched MEDLINE (via Ovid and PubMed), Embase, the Cochrane Library, Biosis Previews, and Scopus to identify studies reporting the incidence of POI in patients who underwent loop ileostomy closure. Two independent reviewers extracted data and appraised study quality. Cumulative incidence proportions were pooled across studies using a random-effects meta-analytic model. Sixty-seven studies, including 9528 patients, met our inclusion criteria. The pooled estimate of POI was 8.0% (95% CI 6.9-9.3%; I2 = 74%). The estimated incidence varied by POI definition: studies with a robust definition of POI (n = 8) demonstrated the highest estimate of POI (12.4%, 95% CI 9.2-16.5%; I2 = 79%) while studies that did not report an explicit POI definition (n = 38) demonstrated the lowest estimate (6.7%, 95% CI 5.3-8.3%; I2 = 61%). Small bowel anastomosis technique (hand-sewn) and interval time from ileostomy creation to closure (longer time) were the factors most commonly associated with POI after loop ileostomy closure. However, most comparative studies were not powered to examine risk factors for POI. POI is an important complication after loop ileostomy closure, and its incidence is dependent on its definition. More research aimed at studying this complication is required to better understand risk factors for POI after loop ileostomy closure.

The Effectiveness of Contralateral Drainage in Reducing Superficial Incisional Surgical Site Infection in Loop Ileostomy Closure: Prospective, Randomized Controlled Trial

Loop ileostomy reduces the rates of morbidity due to colorectal anastomotic dehiscence. For its part, ileostomy closure is associated with low mortality (0-4%) but substantial morbidity (11-37%). Incisional surgical site infection (SSI) is one of the most frequent complications (2-40%). A single-center, prospective, randomized controlled clinical trial of two study groups: control (conventional primary skin closure) and experimental (primary skin closure with a contralateral Penrose® drain). Seventy patients undergoing loop ileostomy closure between April 2013 and June 2017 were included (35 per branch). Four were later removed from the study. Six of the remaining 66 patients (per protocol analysis) were diagnosed with incisional SSI (9.1%); there were no statistically significant differences between the two groups (control group: 9.7%; experimental group: 8.6%) or between the risk factors associated with incisional SSI. Rates of overall and relevant morbidity (Clavien ≥ III) were considerable (28.1% and 9.1%, respectively), and there were no statistically significant differences between the two groups. No patients died. Contralateral drainage does not significantly affect the results of primary ileostomy closure. The rate of incisional SSI was similar in the drainage and non-drainage groups, and the overall rate of 9.1% was in the low range of those reported in the literature. The absence of mortality (0%) and the non-negligible rates of overall and relevant morbidity (28.1% and 9.1%, respectively) in our series suggest that loop ileostomy is a safe procedure. However, the bowel reconstruction involves risks that must be borne in mind. The study was registered and approved by the clinical research ethics committee of the study center (reference number 2012076). Clinical trial was registered in ClinicalTrial.gov (identification number NCT02574702 and reference: ILEOS-ISS_2013).

Incisional hernia following closure of loop ileostomy: The main predictor is the patient, not the surgeon

BackgroundIncisional hernia at the ileostomy site occurs in 0–48% of patients undergoing loop ileostomy closure. Risk factors for ileostomy-site hernia are not currently well understood. We explored the predictive value of patient and clinical factors for ileostomy-site hernias. MethodLoop ileostomy reversals undertaken between 1st January 2009 and 31st December 2013 were retrospectively evaluated. Preoperative patient data (BMI, age, gender, blood pressure, diabetes), surgical variables (preoperative ileostomy marking, intraoperative management (suture type, closure method), postoperative complications (≤30 days), approach, urgency, and chemotherapy, hospital stay, stoma closure interval, follow-up duration) were collected. Patients were followed up by clinical examination and postoperative imaging. Results193 loop ileostomy reversals were identified. Operative indications included: colorectal cancer (n = 102, 52.8%); inflammatory bowel disease (n = 47, 24.3%); diverticulosis (n = 20, 10.4%); assorted indications (n = 19, 9.8%); and inflammatory fistulae (n = 5, 2.6%). Median duration of clinical follow-up was 20.5 months (0–69). Hernia occurred in 26 patients (13.5%), detected at a median of eight months post-reversal. Radiological follow-up occurred in 72% of patients and, as a reference standard, in 100% of patients diagnosed with a hernia. Concordance between clinical and radiological findings was 88.5%. Postoperative complications predicted higher hernia risk. BMI and preoperative blood pressure were significant hernia predictors. Differences in the type of suture material to close the defect (absorbable vs. non-absorbable) and stoma skin closure method (primary vs. secondary intention healing) were non-predictive of hernia. ConclusionWhilst BMI and patient comorbidity are the major hernia predictors, variability in surgical practice does not constitute a significant risk factor for ileostomy-site incisional hernia.

PWE-395 Patient and clinical risk factors for incisional hernia following reversal of loop ileostomy

<h3>Introduction</h3> Loop ileostomy reversal is commonly performed, with reported rates of ileostomy-site incisional hernia between 0–48%. Risk factors of patients developing post-reversal hernias are poorly understood. <h3>Method</h3> We performed a retrospective study of patients undergoing loop ileostomy reversal during five years 1^stJanuary 2009 to 31^stDecember 2013. The primary outcome was ileostomy-site incisional hernia, detected clinically and, as a gold standard, by computed tomography scans or ultrasonography. Data were extracted on preoperative factors (age, BMI, smoking, preoperative marking, surgical indication), intraoperative decisions (rectus sheath suture, skin suture, closure method) and postoperative events (complication (&lt;30days), followup duration). Data were analysed with SPSS version 21. Statistics are median (IQR) and correlations Spearman’s rho. P &lt; 0.05 was considered statistically significant. <h3>Results</h3> In total, 180 patients underwent loop ileostomy closure. Baseline demographics were as follows: age (66 years (26), BMI 25kg/m²(5.8) and 28 patients (16%) were smokers. Indication for ileostomy was rectal cancer (n = 98; 54.4%), followed by inflammatory bowel disease (n = 40; 22.2%), diverticulosis (n = 19; 10.6%), inflammatory fistulae (n = 4; 2.2%), and assorted indications (n = 16; 8.9%). Overall incidence of ileostomy-site incisional hernia was 19%, occurring at a median of 8 months (IQR 15). Overall duration of postoperative follow up was 20 months (IQR 28). Clinical detection of hernia compared to CT/US was 88% and all clinically-evident cases were identified radiologically. Four cases not evident clinically were detected by radiology alone. 64% of hernias required reoperation. Surgical indication was a significant hernia determinant (χ²p &lt; 0.001) with a higher incidence in cancer patients. 66% of patients were marked preoperatively. Post-closure complications occurred in 22% of patients and predicted higher hernia risk (χ²p &lt; 0.001). BMI was a major risk factor for ileostomy-site hernia (Mann Whitney P = 0.04; R=.236; P = 0.002). Patients with higher blood pressure at closure had a higher incidence of hernias (Mann Whitney P = 0.009). Age and smoking were not significant factors (R = -0.018 and 0.005 respectively; P &gt; 0.05 for both). Choice of suture material for rectus sheath (PDS vs. Prolene) or skin (Monocryl vs. Maxon) did not predict hernia (R=-0.113 and -0.041 respectively; both P &gt; 0.05). Healing by secondary intention was not associated with higher hernia incidence (R = 0.004; P &gt; 0.05). <h3>Conclusion</h3> Ileostomy-site hernia occurs in approximately one fifth of patients. Patient factors such as BMI and preoperative co-morbidity remain the greatest predictors of hernia. Variability in operative practice such as choice of suture material and the method of skin closure does not impact hernia risk. <h3>Disclosure of interest</h3> None Declared.

Ileostomy Closure in a Colorectal Surgery Unit. Comparative Analysis of Different Techniques

IntroductionThe objective of this study is to assess whether the results of loop ileostomy closure in terms of morbidity and hospital stay are influenced by the type of anastomosis and suture used. MethodAll patients who underwent loop ileostomy closure were reviewed. A retrospective cohort study comparing morbidity and hospital stay according to the type of anastomosis (TT/LL) and the type of suture (hand sewn/mechanical) was performed. ResultsFrom January 2003 to November 2011 a total of 167 loop ileostomy closures were analysed. The groups were: type of anastomosis (TT 95/LL 72) and type of suture (manual 105/stapled 62). In 76% of the observed population the underlying disease was cancer. Mortality occurred in one case. The stratified morbidity analysis by type of complications showed no significant differences between the groups in terms of local (7.4% TT, LL 8.3%, 6.7% hand sewn, stapled 9.7%), general (TT 9.5%, 16.7% LL, hand sewn 6.7%, 6.5% stapled) and surgical (TT 15.8%, 19.4% LL, hand sewn 17.1%, 17.7% stapled) complications, nor in the rate of reoperations (TT 6.3%, 6.9% LL, hand sewn 6.7%, 6.5% stapled) and hospital stay in days (TT 7.8, 8 LL, hand sewn 8.6, stapled 6.7). ConclusionsClosure of loop ileostomy can be performed regardless of the type of suture or anastomosis used, with the same rate of morbidity and hospital stay.

Evolución del cierre de ileostomía en una unidad de cirugía colorrectal. Análisis comparativo según la técnica

IntroductionThe objective of this study is to assess whether the results of loop ileostomy closure in terms of morbidity and hospital stay are influenced by the type of anastomosis and suture used. MethodAll patients who underwent loop ileostomy closure were reviewed. A retrospective cohort study comparing morbidity and hospital stay according to the type of anastomosis (TT/LL) and the type of suture (hand sewn/mechanical) was performed. ResultsFrom January 2003 to November 2011 a total of 167 loop ileostomy closures were analized. The groups were: type of anastomosis (TT 95/LL 72) and type of suture (manual 105/stapled 62). In 76% of the observed population the underlying disease was cancer. Mortality occurred in one case. The stratified morbidity analysis by type of complications showed no significant differences between the groups in terms of local (7.4% TT, LL 8.3%, 6.7% hand sewn, stapled 9.7%), general (TT 9.5%, 16.7% LL, hand sewn 6.7%, 6.5% stapled) and surgical (TT 15.8%, 19.4% LL, hand sewn 17.1%, 17.7% stapled) complications, nor in the rate of reoperations (TT 6.3%, 6.9% LL, hand sewn 6.7%, 6.5% stapled) and hospital stay in days (TT 7.8, 8 LL, hand sewn 8.6, stapled 6.7) ConclusionsClosure of loop ileostomy can be performed regardless of the type of suture or anastomosis used, with the same rate of morbidity and hospital stay.