Risk factors for non-reversal of diverting ileostomies: a retrospective analysis of 456 patients

Diverting ileostomies are routinely created during low rectal cancer surgery, yet 15-30% remain permanent. Understanding predictors of non-reversal is essential for informed patient counseling. This study investigated factors preventing ileostomy closure following colorectal surgery, primarily for rectal malignancy.

This retrospective cohort study analyzed prospectively collected data from patients undergoing diverting ileostomy creation (January 2015-December 2020). Exclusions included early postoperative mortality (within 30 days), follow-up less than 6 months, or missing primary outcome data. Demographics, surgical details, and reversal outcomes were analyzed. Multivariable logistic regression identified independent predictors of non-reversal.

Of 508 patients, 456 met inclusion criteria (mean age 58.9 ± 13.2 years, 63.8% male). Malignancy accounted for 96.7% of cases, with low anterior resection performed in 83.8%. Ileostomy closure was achieved in 364 patients (79.8%) at a median of 6 months (mean 7.4 ± 5.3). The non-reversal rate was 20.2% (92 patients). Main reasons included mortality (35.8%), metastatic disease (23.9%), and anastomotic complications (22.8%). Multivariable analysis identified ASA score 3-4 (OR 2.68, 95% CI 1.58-4.54, p < 0.001) and malignant pathology (OR 5.12, 95% CI 1.23-21.3, p = 0.025) as independent predictors of non-reversal. Age showed statistical but limited clinical significance.

One in five patients with diverting ileostomies will not undergo reversal. High ASA scores, malignant disease, mortality, metastatic progression, and anastomotic complications are primary barriers. These findings emphasize the need for realistic preoperative counseling regarding permanent stoma risk.