TO STUDY MORBIDITY AND MORTALITY RELATED TO ILEOSTOMY/COLOSTOMY CLOSURE AT TERTIARY CARE HOSPITAL
Main Article Content
Keywords
Stoma Closure, Ileostomy, Colostomy, Morbidity, Mortality.
Abstract
Background and Aim: Gastrointestinal stomas main function is to divert the flow away from a difficult anastomoses or intestinal obstruction. There is now a trend toward avoiding permanent stomas, and temporary loop stomas often used to protect anastomotic or distal bowel segments in high-risk patients. The present study aimed to determine the morbidity-mortality after ileostomy or colostomy closure.
Patients and Methods: This comparative observational study investigated 42 cases of ileostomy and colostomy closure in the Surgical Unit of Jinnah Hospital, Lahore from January 2020 to January 2024. Patients were divided into two groups; Group-I (Ileostomy closure) and Group-II (Colostomy closure). Demographic details such as age and gender, Clinical details such as indications, types of stoma technique used, and operative times, length of hospital stay, morbidity, and mortality recorded. SPSS version 26 was used for data analysis.
Results: The overall mean age was 46.8±6.52 years (15-75 years). Out of 42 cases, 28 (66.7%) underwent ileostomy and 14 (33.3%) underwent colostomy closure. The most prevalent indication for closure was protection of anastomosis in both stoma groups. The interval between creation and closure of stoma was shorter (117.8 days) in Group-I than Group-II (162.4 days). The incidence of hand sewing sutures and stapled technique was 32 (76.2%) and 10 (23.8%), respectively. The Group-II patients took 107.9±5.24 minutes as operative time which was significantly higher than 82.96±8.84 minutes in Group-I. The prevalence of morbidity in Group-I and Group-II was 10.7% (n=3) and 14.3% (n=2), respectively. Prolong hospital stay was required in Group-II. No mortality case reported in both stoma groups.
Conclusion: The present study observed that Stomatal closure well tolerated procedure, with low morbidity and mortality. The results suggest that ileostomy closure is a relatively simple procedure.
References
2. Angenete E, Thornell A, Burcharth J, Pommergaard HC, Skullman S, et al. Laparoscopic Lavage Is Feasible and Safe for the Treatment of Perforated Diverticulitis With Purulent Peritonitis: The First Results From the Randomized Controlled Trial DILALA. Ann Surg. 2016;263:117–122
3. Singh OP. Assessment of morbi-mortality related to ileostomy and colostomy closure. Cancer.;28:0-1.
4. Oliveira RAN, Oliveira PG, Nobrega dos Santos AC, de Sousa JB. Morbidade e mortalidade associadas ao fechamento de colostomias e ileostomias em alça acessadas pelo estoma intestinal. Rev Col Bras Cir 2012;39(05):389–393
5. Chow A, Tilney HS, Paraskeva P, Jeyarajah S, Zacharakis E, Purkayastha S. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis 2009;24(06):711–723
6. Poskus E, Kildusis E, Smolskas E, Ambrazevicius M, Strupas K. Complications after loop ileostomy closure: a retrospective analysis of 132 patients. Viszeralmedizin 2014;30(04):276–280
7. Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R. Increased postoperative complications after protective ileostomy closure delay: An institutional study. World J Gastrointest Surg 2014;6(09):169–174
8. Sharma A, Deeb AP, Rickles AS, Iannuzzi JC, Monson JRT, Fleming FJ. Closure of defunctioning loop ileostomy is associated with considerable morbidity. Colorectal Dis 2013;15(04):458–462
9. Holmgren K, Kverneng Hultberg D, Haapamäki MM, Matthiessen P, Rutegård J, Rutegård M. High stoma prevalence and stoma reversal complications following anterior resection for rectal cancer: a population-based multicentre study. Colorectal Dis 2017;19(12):1067–1075
10. Sharma B, Narendra NS. MORBI-MORTALITY RELATED TO ILEOSTOMY AND COLOSTOMY CLOSURE AT TERTIARY CARE HOSPITAL BIKANER. Cancer.;16:53-33.
11. Danielsen AK, Park J, Jansen JE, et al. Early closure of a temporary ileostomy in patients with rectal cancer – A multicenter randomized controlled trial. Ann Surg 2017;265(02):284–290
12. Löffler T, Rossion I, Gooßen K, et al. Hand suture versus stapler for closure of loop ileostomy–a systematic review and meta-analysis of randomized controlled trials. Langenbecks Arch Surg 2015;400 (02):193–205
13. Gong J, Guo Z, Li Y, et al. Stapled vs hand suture closure of loop ileostomy: a meta-analysis. Colorectal Dis 2013;15(10):e561–e568
14. Markides GA, Wijetunga IU, Brown SR, Anwar S. Meta-analysis of handsewn versus stapled reversal of loop ileostomy. ANZ J Surg 2015;85(04):217–224.
15. Waterland P, Goonetilleke K, Naumann DN, Sutcliff M, Soliman F. Defunctioning ileostomy reversal rates and reasons for delayed reversal: does delay impact on complications of ileostomy reversal? A study of 170 defunctioning ileostomies. J Clin Med Res 2015;7(09):685–689
16. Zhen L, Wang Y, Zhang Z, et al. Effectiveness between early and late temporary ileostomy closure in patients with rectal cancer: A prospective study. Curr Probl Cancer 2017;41(03):231–240
17. Antolovic D, Reissfelder C, Koch M, Mertens B, Schmidt J, et al. Surgical treatment of sigmoid diverticulitis--analysis of predictive risk factors for postoperative infections, surgical complications, and mortality. Int J Colorectal Dis. 2009;24:577–584
18. Mbelle PJ, Kizigina S, Mwashambwa M. Indications for Stoma Creation and Early Outcome Predictors of Stoma Closure at Universtiy of Dodoma Teaching Hospitals. Int J Biomed Res Prac. 2024;4(2):1-2.
19. Khan A, Haris M, Rehman M, et al. Early Postoperative Complications and Surgical Anatomy After Ileostomy Reversal Among the Population of Khyber Pakhtunkhwa, Pakistan. Cureus. 2021; 13: 17-22.
20. Mehboob A, Perveen S, Iqbal M, et al. Frequency and Complications of Ileostomy. Cureus. 2020; 12: 10-14.
21. Krishnamurty DM, Blatnik J, Mutch M. Stoma Complications. Clinics in Colon and Rectal Surgery. 2017; 30: 193-200.
22. Aktaş A, Kayaalp C, Ateş M, et al. Risk factors for postoperative ileus following loop ileostomy closure. Turk J Surg. 2020; 36: 333-339.
23. Poskus E, Kildusis E, Smolskas E, et al. Complications after loop ileostomy closure: A retrospective analysis of 132 patients. Viszeralmedizin. 2014; 30: 276-280.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Syeeda Saima Gilani
Nursing Instructor, College of Nursing AIMC, Jinnah Hospital, Lahore
Muhammad Shahzeb
General Internal Medicine, Shrewsbury and Telford NHS Trust
Dr Muhammad Salman
Assistant Professor, Jinnah Medical College, Peshawar
Muhammad Bilal
Rural Health Centre, Chellianwala Mandi Bahauddin, Pakistan
Bushra Safeer
Department of Medicine, Saidu Teaching Hospital, Swat, KPK
Joe Jacob Thomas
Royal College of Surgeons Ireland, School of Medicine & Surgery
Abdullah Almesri
Mubarak Al-Kabeer Hospital, Kuwait