The temporary  ileostomy was introduced to decrease the clinical consequences of an anastomotic leak and  shown to reduce the risk of anastomotic leakage as such.1 However, studies have shown complication rates up to 43% related to the temporary ileostomy,2 including readmissions, dehydration, and chronic renal failure.3 Most patients with a temporary ileostomy will keep their stoma at least 3 months, and it is not unusual that the stoma is left in place much longer, and for a few patients it becomes permanent.4

A temporary ileostomy may reduce the risk of pelvic sepsis after anastomotic dehiscence. However, the temporary ileostomy is afflicted with complications and requires a second surgical procedure (closure) with its own complications. Early closure of the temporary ileostomy could reduce complications. However, there is paucity of data on closure time thus this study aims to clarify any relation between the post-ileostomy closure complications rate and the time from its creation to the repair.

AIM:

to study ileostomy closure complications.

Hospital based study on 100 patients undergoing ileostomy closure following bowel surgery, for one year at Dept. of Surgery, S.P. M. C, Bikaner. Patients of any gender and age, temporary loop ileostomy and temporary double barrel ileostomy of any aetiology, medically and mentally fit to undergo early stoma closure were included. Patients with permanent stoma, anastomotic leak and/or wound dehiscence after index surgery, End ileostomy/colostomy were excluded from study.

Patients were subjected to stoma closure after valid written informed consent. Patient was subjected to routine investigations and distal loopogram (distal segment contrast), and undergo mechanical bowel preparation with polyethylene glycol. Closure of temporary stoma was performed under general or spinal anesthesia. Patients were followed up every week for first 6 weeks following closure and then at 12 weeks. The data was collected from under study population through a pretested and semi-structured questionnaire. The recorded data was compiled and entered in a spreadsheet computer program (Microsoft Excel 2007) and appropriate tests will be applied

Out of total 100 patients 70 males (70%) and 30 (30%) were females. Male to female ratio was 2.33:1 with mean age of 45.35±16.25.  Mean BMI was 20.96±1.5 kg/m².

Table 1: - Gender wise distribution of patients

7 (7%) had abdominal trauma, 51 (51%) patients had intestinal perforation, 30 (30%) patients had intestinal obstruction, 12 (12%) patients had malignancy as indication of stoma creation.

Fig. 1 indication of stoma creation in both groups

Mean time operative time for stoma closure was 73.35 ± 6.60.

Maximum 12 patients had electrolyte imbalance followed by 7 had wound infection, 8 patients had intra abdominal collection followed by 5 obstructions.

Table 2:- Comparison of post-operative complications among both groups

Mean time to stoma closure was 75.25±50.10 days. Mean hospital duration was 15±3 days.

Table 3: - Mean time to stoma closure

Out of total 100 patients 6 patients died and 94 patients were discharged home.

Fig1 : - Outcome

Out of total 100 patients 70 males (70%) and 30 (30%) were females. Male to female ratio was 2.33:1 with mean age of 45.35±16.25.  Mean BMI was 20.96±1.5 kg/m². Similarly, Uttam mandal et al 2022⁵ et al. found male predominance with male: female ratio of 1:3 and mean age of 45.84±12.82 yr. Also, Ian Fukudome et al 2021⁶ (n=47) observed similar sex distribution.

In our study, 7 (7%) had abdominal trauma, 51 (51%) patients had intestinal perforation, 30 (30%) patients had intestinal obstruction, 12 (12%) patients had malignancy as indication of stoma creation, similarly observed by Ian Fukudome et al 2021⁶.

In our study, mean time operative time for stoma closure was 73.35 ± 6.60. similarly, Uttam mondal et al 2022⁵ (n=100) found mean time of closure was 76.38+17.13 min.

In our study, maximum 12 patients had electrolyte imbalance followed by 7 had wound infection, 8 patients had intra abdominal collection followed by 5 obstructions.

Ian Fukudome et al 2021⁶ (n=47) observed more electrolyte imbalance in early closure. Similarly, Li Wang et al 2020⁷ (n=324) found 8.6% had intra abdominal collection. Also, Uttam mondal et al 2022⁵ (n=100) found that 7.5% had intestinal obstruction on closure. These infection rates are higher than   studies by Arvind kumar et al 2021⁸ (n=100), study by Gopal Sharma et al 2020⁹ (n=32)   ,and study by Augustinas Bausys et al 2019¹⁰  (n=86)

In our study, mean time to stoma closure was 75.25±50.10 days. Mean hospital duration was 15±3 days. Similarly, Gopal Sharma et al 2020⁹ (n=32) also seen hospital stay of 15.70+2.13 days. Creation of diversion stoma has its own complications which lead to prolonged hospital stay and increased health care expenditure and affects quality of life of patient.

Out of total 100 patients 6 patients died and 94 patients were discharged home. These results confirm our study with study conducted by Uttam mondal et al 2022⁵ (n=100) and study by Arvind kumar et al 2021⁸ (n=100).

Stoma creation subjects the patient to the risks associated with stoma closure surgery. The rate of complications associated with the stoma was non-negligible, so strict criteria should be applied when deciding whether to use a stoma and with its closure time. Delayed stoma closure did not show a significant advantage in reducing the incidence of postoperative anastomotic leakage, morbidity & mortality. Diversion stoma also comes at a cost in terms of stoma related complications (dermatitis, para stomal hernia, stoma retraction, stoma prolapse and electrolyte imbalance) which leads to increased hospital duration stay and prolonged time to get back to work, social stigma and affects quality of life of patients.

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