EP380 - Optimal Timing For Diverting Loop Ileostomy Reversal : A Single Centre Retrospective Review

Image or Table (Do Not add text here):

Purpose/Background: Diverting loop ileostomies (DLIs) are commonly performed to reduce the morbidity of colorectal anastomotic leaks after rectal cancer resections. Surgical closure of DLIs can result in a variety of complications such as bleeding, anastomotic leaks, prolonged ileus and mechanical bowel obstructions. The suggested time to closure of DLIs is three months after the rectal resection. However, the ideal timing and its effect on post-operative complications is unclear. In Northern Ontario (Canada), patients can wait upwards of a year for their stoma closure for various reasons including surgical resource scarcity. There is a growing body of evidence supporting early closure of DLIs, but literature on the impact of delayed reversals is notably scarce. This research gap underscores the pressing need for comprehensive investigations into the ramifications of delayed stoma reversal.

Methods/Interventions: This is a retrospective analysis of data collected from a tertiary care hospital in Northern Ontario, Canada. Data from patients who underwent surgical closure of DLI between January 2017 and December 2023 was collected and analyzed. The association between time to reversal and post-operative complications was evaluated using descriptive statistics, Chi-square or Fisher exact tests, and Kaplan-Meier analysis. Linear and logistic regression analyses were conducted on relevant clinical and pathologic variables to assess factors influencing time to reversal and post reversal complications.

Results/Outcomes: From January 2017 to December 2023, 121 patients underwent surgical closure of DLI: 26 within 6 months, 48 between 6 and 12 months, and 47 after 12 months of the initial stoma creation. Serious complications (Clavien-Dindo score ≥ 3) were observed in 12 patients, and these included anastomotic leaks, mechanical bowel obstructions and post-operative bleeds. The incidence of post-operative serious complications was null in patients waiting < 6 months for DLI closure, and significantly lower in the 6–12-month cohort when compared to the > 12-month cohort (0% vs 4.2% vs 21.3%, respectively, p=0.0050). The risk of serious complications increased by 15% for every additional month delay before DLI closure (OR 1.15 [95%CI, 1.05-1.25, p= 0.0219). Patients whose DLIs were closed after 12 months had a significantly higher risk of ICU admission (OR 9.65 [95%CI: 1.37-192.45], p=0.0461) and reoperation (OR 4.46 [95%CI: 1.26-18.04], p=0.0238) compared to patients reversed in < 12 months. Patients who received adjuvant chemotherapy underwent DLI closure 3.94 months later (95%CI, 1.74-6.14, p=0.00057) and were 2.31 times more likely to experience a serious complication (95%CI, 1.86-186.59, p=0.0299).

Conclusion/Discussion: Delays in surgical closure of DLIs are associated with increased risk of serious post-operative complications, including reoperation and ICU admission. Patients receiving adjuvant chemotherapy are at increased risk of delayed closure and post-operative complications. Our findings suggest that patients would benefit from DLI closure within 6 months of stoma creation. This data could be useful in advocating for earlier reversals in certain resource-scarce health care systems. These findings also suggest that the uptake of total neoadjuvant therapy (TNT) may lead to better patient outcomes post DLI reversal compared to traditional neoadjuvant/adjuvant protocols.