AUTHOR=Werner Jens M. , Kupke Paul , Ertl Matthias , Opitz Sabine , Schlitt Hans J. , Hornung Matthias 

TITLE=Timing of Closure of a Protective Loop-Ileostomy Can Be Crucial for Restoration of a Functional Digestion

JOURNAL=Frontiers in Surgery

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.821509

DOI=10.3389/fsurg.2022.821509

ISSN=2296-875X

ABSTRACT=<sec><title>Introduction</title><p>Protective loop-ileostomy is one of the most common interventions in abdominal surgery to provide an alternative intestinal outlet until sufficient healing of a distal anastomosis has occurred. However, closure of a loop-ileostomy is also associated with complications. Thus, knowledge of the optimal time interval between primary and secondary surgery is crucial.</p></sec><sec><title>Methods</title><p>Data from 409 patients were retrospectively analyzed regarding complications and risk factors in closure-associated morbidity and mortality. A modified Clavien-Dindo classification of surgical complications was used to evaluate the severity of complications.</p></sec><sec><title>Results</title><p>A total of 96 (23.5%) patients suffered from postoperative complications after the closure of the loop-ileostomy. Early closure within 150 days from enterostomy (<italic>n</italic> = 229) was associated with less complications (<italic>p</italic> &lt; 0.001<sup>**</sup>). Looking at the severity of complications, there were significantly more (<italic>p</italic> = 0.014<sup>*</sup>) mild postoperative complications in the late closure group (&gt;150 days). Dysfunctional digestive problems—either (sub-) ileus (<italic>p</italic> = 0.004<sup>*</sup>), diarrhea or stool incontinence (<italic>p</italic> = 0.003<sup>*</sup>)—were the most frequent complications associated with late closure. Finally, we could validate in a multivariate analysis that “time to closure” (<italic>p</italic> = 0.002<sup>*</sup>) is independently associated with the development of complications after closure of a protective loop-ileostomy.</p></sec><sec><title>Conclusion</title><p>Late closure (&gt;150 days) of a loop-ileostomy is an independent risk factor in post-closure complications in a multivariate analysis. Nevertheless, circumstances of disease and therapy need to be considered when scheduling the closure procedure.</p></sec>