Predictors of clinically significant complications after stoma reversal: A prospective analytical study

Stoma reversal is often considered a low-risk elective procedure; however, postoperative morbidity remains clinically significant. Evidence identifying predictors of meaningful complications, particularly from resource-limited settings, is limited.

To identify risk factors associated with Clavien-Dindo grade II and above complications following stoma reversal surgery.

This prospective analytical study was conducted at a tertiary care center between February 2024 and June 2025. Adult patients undergoing elective stoma reversal were included and followed for 30 days postoperatively. Demographic, clinical, and operative variables-including age, etiology, type of index surgery, timing of reversal, type of anastomosis, and anastomosis time-were analyzed. Postoperative complications were graded using the Clavien-Dindo classification. Secondary outcomes included postoperative ileus and length of hospital stay.

Clinically significant complications were observed in a substantial proportion of patients. Advanced age and longer anastomosis time were significantly associated with Clavien-Dindo grade ≥ II complications, postoperative ileus, and prolonged hospital stay. In contrast, type of stoma and anastomotic technique were not independent predictors of high-grade complications.

Stoma reversal carries a measurable risk of morbidity and should not be regarded as a minor procedure. Patient-related factors and operative complexity play a greater role in determining outcomes than technical variations alone. Careful patient selection, preoperative optimization, and strategies to minimize anastomosis time are essential to improve postoperative outcomes.