U. H. Bhatti1, S. B. Chauhan1, K. S. Ahmed1, M. A. Khan1, K. Inam Pal1 1Aga Khan University Medical College,General Surgery,Karachi, Sindh, Pakistan
Introduction:
Stoma creation is a common part of elective and emergency abdominal surgery. There are multiple Pakistani studies on stoma indications and complications, but none actually deal with the proportion of those that underwent eventual stoma reversal.
Methods:
Medical records of all patients undergoing ileostomy or colostomy creation between January 2000 – December 2015 were reviewed for demographic and study details. Stoma type, reversal status, and time to reversal were recorded in addition to surgical details.
Results:
1532 patients underwent an ileostomy or colostomy either alone or as part of another procedure during the study period (704 ileostomies, 819 colostomies). Mean age was 47.4 years (SD 16.9), 62.4% were men. 844 (55.4) emergency procedures were performed, 250 of them related to abdominal trauma (16.4% overall). 515 (33.8%) patients had an active GI malignancy at the time of stoma creation. In total, 466 (30.6%) of stomas were reversed during the follow-up period, with a median (IQR) of 126 days to reversal (IQR 81-250 days). Median follow-up duration was 241 days (IQR 41-1036). On binary logistic regression, surgery for abdominal trauma (OR 0.45 (95% .33-.60)), outpatient compliations after stoma creation (OR 0.75 (95% CI .57-.98)) predicted lower odds of reversal, wheres surgery for active malignancy was found to be predictive of reversal (OR 1.68 (95% CI 1.27-2.22). A Kaplan-Meier Survival curve of time to stoma reversal by stoma type is shown (Figure 1), with no significant difference in reversal time between ileostomies and colostomies (log-rank p= 0.49).
Conclusion:
Overall stoma reversal rate remains low, though this does not account for patients who succumed to their trauma or primary malignancy. The type of stoma did not impact the chance of reversal, and neither did emergency procedure status, possibly because patients in this group succumbed to injuries before their stomas could be reversed. Overall time to reversal was higher than reported contemporary literature. Key study limitation remains patients lost to follow-up, with 25% of patients following up less than 41 days.
