Delayed Loop Ileostomy Reversal Increases the Risk of Colitis and Clostridium difficile Infection
Yan S. Tan, S. Fujino, Marcus E. H. Chan, Johann W. Z. Leh, Asiri M. K. Arachchi, V. Narasimhan, Thomas S. Suhardja, Hanumant S. Chouhan, Pathirajage C. K. Saranasuriya, James T. Lim, Thang C. Nguyen, William M. K. Teoh, Yeng K. TayABSTRACT
Background
Temporary loop ileostomy formation is a routine procedure performed to protect distal colorectal anastomosis. Traditionally, the ideal timing of ileostomy reversal is believed to fall between 3 and 6 months. It has been suggested that delayed reversal increases the risk of complications. Our study looks to demonstrate the relationship between delayed reversal and its associated risks in a real‐world setting.
Methods
This is a retrospective cohort study conducted at Monash Health, analysing patients who underwent loop ileostomy reversal from May 2016 to December 2023. Main outcome measures include incidence of post‐reversal complications, including colitis,
Results
A total of 223 patients were included. The primary indications for initial surgery included cancer ( n = 134), inflammatory bowel disease ( n = 19) and diverticular disease ( n = 29). The median time between initial surgery and ileostomy reversal was 341 days (IQR = 211–530). Post‐reversal complications occurred in 65 patients (29.1%). Patients reversed after the pandemic experienced a delay between surgeries (median: 411, IQR = 276–660) compared with those prior (median: 294, IQR = 196–408, p < 0.0001). A statistically significant association was seen between delayed reversal and post‐operative complications (OR 1.11, p = 0.020, ROC AUC = 0.588). Ileostomy reversal occurring beyond 134 days (based on the Youden's Index with 90% sensitivity‐based cutoff) is associated with increased risk of complications.
Conclusion
Delayed loop ileostomy reversal is associated with post‐operative complications specifically colitis and