The Risk Factors for Complications Following Intestinal Stoma Reversal

Background and objective  The restoration of bowel continuity after temporary intestinal stoma formation is a routine general surgical procedure. However, stoma reversal is associated with significant postoperative morbidity and mortality. Surgeons may face challenges such as dense adhesions, iatrogenic bowel injury, or even procedure abandonment, as well as postoperative complications such as surgical site infection (SSI), anastomotic leak, intra-abdominal sepsis, and death. This study aimed to identify common complications and their risk factors to facilitate strategies for optimizing surgical outcomes. Specifically, it sought to determine the incidence and pattern of early (within 30 days) postoperative complications, grade their severity using the Clavien-Dindo classification, and analyze the risk factors associated with complications following intestinal stoma reversal. Methods A prospective observational study was conducted in the Department of General Surgery at a tertiary care medical college hospital. All consenting adult patients undergoing reversal of a temporary intestinal stoma were included. Demographic, clinical, and operative variables - including age, sex, comorbidities, stoma type, indication, local pathology, interval between stoma creation and closure, preoperative chemo- or radiotherapy, hemoglobin, serum albumin, surgical technique, and use of postoperative nutritional support - were recorded. Outcome measures included intraoperative technical difficulty, iatrogenic bowel injury, postoperative complications, SSI, anastomotic leak, and mortality. Statistical analysis was performed using the Chi-square or Fisher's exact test for categorical data and the t-test for continuous data. A p-value <0.05 was considered statistically significant. Results Seventy patients undergoing stoma reversal were included. Technical difficulty and iatrogenic bowel injury occurred in 23 (32.8%) patients and were significantly associated with colostomy reversal (p=0.002) and end stoma reversal (p=0.0059). Postoperative complications occurred in 32 patients (45.7%). The most common complication was SSI in 26 (37.1%), followed by anastomotic leak in six (8.6% ), intra-abdominal abscess in four (5.7%), abdominal wall dehiscence in four (5.7%), and enterocutaneous fistula in three (4.2%). There were four deaths (5.7%), all due to sepsis following anastomotic leak in patients with comorbidities. Preoperative serum albumin <3.5 g/dL was significantly associated with mortality (p=0.0007), while postoperative nutritional support significantly reduced complications (p=0.001). Conclusions Stoma reversal is linked to considerable morbidity and mortality; hence, the decision to create a diverting stoma should be made judiciously. Ileostomy reversal is technically easier and safer than colostomy or Hartmann's reversal and may be preferred when diversion is indicated. Delayed reversal beyond three months, optimization of comorbidities, correction of hypoalbuminemia (>3.5 g/dL), and postoperative nutritional support are recommended to minimize complications and improve outcomes.