Risk factors for postoperative ileus following loop ileostomy closure

Abstract

Objective: The most common intra-abdominal complication following loop ileostomy closure (LIC) is postoperative ileus (POI). The aim of the study was to determine the risk factors of POI development following LIC and make recommendations for its prevention.

Material and Methods: In this study, patients having undergone LIC with peristomal incision following distal colorectal surgery were included. Clavien-Dindo classification was used to evaluate postoperative complications. POI and postoperative leakage were defined based on clinical and radiological criteria. The Centers for Disease Control and Prevention 2017 criteria were used to diagnose surgical site infection (SSI). Postoperative bleeding was diagnosed one day after surgery if there was a >2 g/dL or >= 15% decrease in the hemoglobin level.

Results: Seventy-nine patients were included into the study. In nine of the patients POI developed, six had SSI, five had postoperative bleeding, and two had anastomosis leakage. In the univariate analysis; age <60 years (p=0.02), presence of comorbidity (p=0.007), using an open technique in the first surgery (p=0.02), performing total colectomy in the first surgery (p=0.048), performing hand-sewn anastomosis of LIC (p=0.01), and postoperative blood transfusion (p=0.04) were found to be risk factors for POI. Performing hand-sewn anastomosis of LIC (p=0.03) and using an open technique in the first surgery (p=0.03) were found to be independent variables for POI risk.

Conclusion: Using an open technique in the first surgery and performing a hand-sewn anastomosis of LIC may increase POI.

C1 [Aktas, Aydin] Karadeniz Tech Univ, Sch Med, Dept Gen Surg, Trabzon, Turkey.

[Kayaalp, Cuneyt] Inonu Univ, Sch Med, Dept Gastointestinal Surg, Malatya, Turkey.

[Ates, Mustafa; Dirican, Abuzer] Inonu Univ, Sch Med, Dept Gen Surg, Malatya, Turkey.