Analysis of risk factors for complications after protective ileostomy reconstruction in patients operated on for rectal cancer.

Abstract

Objective: To estimate the incidence of complications following ileostomy reversal and to identify associated risk factors.

Patients and methods: A retrospective cohort study was conducted, including patients who underwent rectal cancer surgery with a protective ileostomy. The minimum follow-up period was one year. A univariate analysis was performed to identify potential risk factors for complications, and variables with P<0.1 were included in a multivariate analysis.

Results: Between January 1, 2015, and December 31, 2023, a total of 220 patients underwent surgery. Thirteen percent did not undergo ileostomy reversal. Thus, 193 patients were included in the final analysis. The median time to ileostomy reversal was 292 days. Postoperative complications occurred in approximately 27.5% of cases. Among the potential risk factors, albumin levels <4g/dl, open surgical approach for rectal pathology, absence of efferent loop stimulation, and side-to-side anastomosis were associated with P<.1 in univariate analysis. In the multivariate analysis, only low albumin levels and the open surgical approach for rectal pathology remained significantly associated with an increased risk of complications.

Conclusion: Modifiable factors such as the use of a laparoscopic approach for rectal surgery, stimulation of the efferent loop, and optimization of preoperative nutritional status may help reduce the incidence of postoperative complications.