Impact of timing of reversal of loop ileostomy on patient outcomes: a retrospective cohort study

Abstract

Background: Diverting loop ileostomies (DLIs) are ideally reversed 6–12 weeks after the index operation. However, reversal surgery is frequently delayed in a real-world setting, with potential implications on patient’s quality of life and postoperative complications. The aim of this study was to investigate the impact of timing of the reversal on patient outcomes at a tertiary referral hospital. Methods: Consecutive patients who underwent elective reversal of loop ileostomy (RLI) between January 2007 and January 2019 were included. The primary outcomes were incidence of postoperative ileus (POI) and 30-day postoperative complications. Results: Of 251 eligible patients, 158 (63%) were men, the median age was 64 years (range 23–88 years), and the most common index operation was an ultra-low anterior resection in 106 (42%). The median time to reversal for the entire cohort was 7.4 months (range 1–28). RLI was performed within 6 months after the index surgery in 89 patients (35%, early group), 6–12 months in 120 (48%, middle group) and after more than 12 months in 42 (17%, late group) patients. A significantly lower incidence of postoperative ileus (13.5% vs. 25.8% vs. 38.1%, p = 0.006), and 30-day postoperative complications (29.2% vs 41.7% vs. 57.1%, p = 0.011) were seen in the early group compared to the middle and late groups, respectively. There was no difference in the return to theater, length of hospital stay, and readmission rate between groups. Conclusion: Delayed RLI is associated with increased risk of postoperative complications.