Nugroho PS, et al.
Preoperative and intraoperative predictive.
Preoperative and intraoperative predictive factors affecting to the time interval of stoma closure in patients at Dr.
Sardjito General Hospital.
Yogyakarta in 2018-2023 Pajar Sigit Nugroho1*.
Adeodatus Yuda Handaya2.
Anis Fuad3 Department Surgery Faculty Medicine Aisyiyah University of Yogyakarta.
Indonesia.
Department of Surgery Faculty of Medicine Universitas Gadjah Mada.
Yogyakarta.
Indonesia Department of Biostatistics.
Epidemiology, and Public Health Master of Public Health Science.
Universitas Gadjah Mada Yogyakarta.
Indonesia https://doi.
org/10.
22146/inajbcs.
ABSTRACT
Submitted: 2024-06-21 Ostomy procedures, frequently indicated for malignancies, significantly impact patient Accepted : 2025-01-30 well-being.
In certain instances, stoma closure becomes imperative.
Despite the lack of consensus regarding the optimal timeframe for temporary stoma closure, this study aimed to delineate predictors associated with the closure timing, thereby enhancing prognostic precision and augmenting patient care strategies.
A cross-sectional study was conducted at Dr.
Sardjito General Hospital.
Yogyakarta, analyzing medical records of patients who underwent primary stoma creation and subsequent closure between January 2018 and December 2023.
Factors, including preoperative, disease-related, and intraoperative variables, were analyzed using SPSS version 26.
Bivariate and multivariate analyses were performed to identify predictors for stoma closure duration.
In the colostomy group, body mass index (BMI), underlying disease, and complications were significantly associated with duration of stoma closure by bivariate analysis .
=0.
, and BMI and hemoglobin level associated with duration of closure by multivariate analysis .
=0.
Increasing BMI, disease stage, chemotherapy use, complications, and lower hemoglobin level predicted a longer closure duration, while chemotherapy reduced the risk.
In the ileostomy group, factors such as underlying disease, cancer stage, chemotherapy status, complications, and type of surgery were associated with duration of closure by bivariate analysis .
=0.
, with complications associated with duration of closure by multivariate analysis .
=0.
In conclusion.
BMI, underlying diseases, and complications are associated with stoma closure duration.
Understanding these factors can aid in risk stratification and optimizing patient management strategies during stoma closure surgeries.
ABSTRAK
Keywords:
predictive factor Prosedur ostomi, yang sering diindikasikan untuk keganasan, berpengaruh signifikan terhadap kesejahteraan pasien.
Pada kasus-kasus tertentu, penutupan stoma menjadi sangat penting.
Meskipun belum ada konsensus mengenai jangka waktu optimal untuk penutupan stoma sementara, penelitian ini bertujuan untuk menggambarkan prediktor yang mempengaruhi waktu penutupan, sehingga meningkatkan ketepatan prognosis dan menambah strategi perawatan pasien.
Sebuah studi cross sectional retrospektif dilakukan di RSUP Dr.
Sardjito.
Yogyakarta, dengan menganalisis rekam medis pasien yang menjalani pembuatan stoma primer dan penutupan stoma antara Januari 2018 dan Desember 2023.
Faktor-faktor yang meliputi variabel pra operasi, terkait penyakit, dan intra operasi dianalisis menggunakan SPSS versi 26.
Analisis bivariat dan multivariat dilakukan untuk mengidentifikasi faktor prediktif untuk durasi penutupan stoma.
Pada kelompok kolostomi, indeks massa tubuh (IMT), penyakit yang mendasari, dan komplikasi secara signifikan berhubungan dengan durasi penutupan stoma .
=0,016.
0,036.
dari hasil analisis bivariat, dengan IMT dan kadar hemoglobin berhubungan dengan durasi penutupan .
=0,010.
dari hasil analisis multivariat.
Peningkatan IMT, stadium penyakit, penggunaan kemoterapi, komplikasi, dan kadar hemoglobin yang lebih rendah memprediksi durasi penutupan yang lebih lama, sementara kemoterapi mengurangi risiko tersebut.
Pada kelompok ileostomi, faktor-faktor seperti penyakit yang mendasari, stadium kanker, status kemoterapi, komplikasi, dan jenis operasi berhubungan dengan durasi penutupan .
=0,010.
0,024.
0,002.
0,013.
dari hasil analisis bivariat, dengan komplikasi berhubungan dengan durasi penutupan dari hasil analisis multivariat.
Simpulan, faktor IMT, penyakit yang mendasari, dan komplikasi pasien mempengaruhi durasi penutupan stoma pasien.
Memahami faktor-faktor ini dapat membantu dalam stratifikasi risiko dan mengoptimalkan strategi manajemen pasien selama operasi penutupan stoma.
*corresponding author: sinupajarsigitnugroho@gmail.
InaJBCS.
Volume 57.
Number 1, 2025 January: 43-55
INTRODUCTION
An ostomy is a surgical procedure that involves creating an opening in a hollow organ connecting it to the bodyAos surface to facilitate the excretion of waste products.
An enterostomy refers specifically to an ostomy performed on the intestines, whether the small intestine .
or the large intestine .
The most common indication for an ostomy procedure is However, this procedure is a major surgery that can significantly impact the patientAos quality of life.
A systematic review of 18 randomized controlled trial (RCT.
found that ostomy procedure complications range from 2.
1%, primarily involving peristomal skin and hernia.
2 Among 616 patients with temporary ostomies, 19% became permanent, with delays in closure linked to advanced age, secondary stomas, end stoma colostomy or ileostomy, and postoperative complications.
3 Metaanalyses indicate that permanent stomas are associated with advanced age (>65 y.
, severe comorbidities .
haracterized as American Society of Anesthesiologists (ASA) >.
, complications, anastomotic insufficiency, and advanced malignancy.
Currently, there is no consensus on the optimal timing for temporary stoma closure.
One study suggests that closure can be performed after 8-12 wk, by which time inflammation resolution, postoperative recovery, and adhesion softening are expected.
The study by Guo et al.
5 indicates that stoma closure can be performed as early as 4 wk postcolorectal resection, although there is a higher incidence of surgical wound complications compared to routine closure procedures performed around the 8th week post-colorectal resection.
contrast, a study by Krebs et al.
6 suggests that temporary stoma closure performed less than 8 mo post-surgery has fewer conducted in India, examining 102 patients who underwent temporary stoma creation, found that 77 patients underwent reversal on day 74.
47 on average, while 25 patients could not undergo reversal.
Fifty-one patients received reversal only after a second surgery .
econdary operatio.
Factors contributing to the delay include loop intra-abdominal sample collection, and secondary stoma creation.
Given these considerations, it would be highly beneficial to identify predictors that clarify the prognosis for stoma closure timing.
This could lead to the development of tools to guide predictions and provide patient education on stoma .
olostomy/ileostom.
Therefore, this study aims to determine the factors associated with the timing of stoma closure.
MATERIALS AND METHODS
Design and subjects This retrospective cohort study was conducted at Dr.
Sardjito General Hospital in Yogyakarta.
Indonesia utilizing medical records.
The study included patients who underwent primary stoma creation and subsequent closure between January 2018 and December 2023.
Patients over 18 yo with complete medical records, excluding those with primary surgeries at other hospitals, deceased before stoma closure, or had permanent stomas, were analyzed.
The minimum number of samples required based on the rule of thumb calculation with the sample size is 10 times larger than the research variable (Roscoe, 1.
, so the required sample is 14 variables multiplied by 10 is 140 subjects.
Data collection The analyzed factors included preoperative variables .
ge, sex.
BMI.
American Society of Anesthesiologists (ASA) status, chemotherapy statu.
Nugroho PS, et al.
Preoperative and intraoperative predictive.
disease-related variables .
omorbidities, etiology, cancer stag.
, and intraoperative variables .
peration duration, hospital stay length, stoma creation urgency, postoperative complication.
These factors were assessed before the stoma closure as the cohort nature of this Stoma closure intervals were considered as dependent variable and categorized using the median and analyzed separately for each colostomy and ileostomy groups.
Statistical analysis Data were analyzed using SPSS for Windows version 26.
Descriptive statistics, including means, standard percentages, were used to summarize the Normality tests were performed, and stoma closure intervals were analyzed using chi-square.
Bivariate analysis identified predictor factors with odds ratios (OR) and 95% confidence intervals (CI).
Variables with p<0.
in bivariate analysis were included in multivariate analysis, with significance set at p<0.
05, to identify predictive factors using logistic regression, indicated by OR RESULTS Univariate analysis results This study involved 140 patients, with a mean age of 50.
03A13.
9 yr, evenly distributed between sex.
Comorbidities were present in 33 patients, with the majority having malignant diseases .
3%).
Patients were divided into colostomy and ileostomy groups, each consisting of 70 samples.
Stoma creation typically lasted 4 hr, with 107 elective procedures .
4%) and 33 emergent procedures .
6%).
Detailed patient characteristics are provided in the accompanying TABLE 1.
In this study, patients had a mean postoperative hospital stay of 7.
edian 7 .
Complications occurred in 23 patients post-stoma creation.
Among them, 17 patients experienced Clavien-Dindo classification (CDC) grade 2 complications, including septic shock .
, wound dehiscence .
, and stoma prolapse .
Additionally, 16 patients had CDC grade 3 complications, such as anastomotic leakage with severe adhesions .
, cecal leakage .
, and relaparotomy .
The mean stoma closure interval was 270A193 d with a median of 236 d.
Among all variables, only ASA status differed significantly between patients undergoing colostomy and ileostomy.
However, other variables showed no significant differences between the two groups.
In the colostomy group, the median age was 51.
5 yr (IQR 41-.
, with the majority being male .
Most patients had normal BMI .
1%) and a single comorbidity .
6%).
Malignant diseases primarily drove colostomy procedures, with the majority being in stage i .
9%) and receiving .
6%).
Elective procedures predominated .
4%) with a median stoma creation duration of 4 hr (IQR 4-.
After colostomy, the median hospital stay was 8 d (IQR 7-.
Complications occurred in 17 patients, mainly CDC grade 2 .
and grade 3 .
The median closure interval for colostomy was 284 d (IQR 208.
Conversely, in the ileostomy group, the median age was also 51.
5 yr (IQR 43-.
, with the majority being female .
Most patients had a normal BMI .
%) and no comorbidities .
6%).
Malignant diseases also predominated .
6%), mainly in stage i .
6%) and receiving chemotherapy .
7%).
Elective procedures were common .
with a median stoma creation duration of 4 hr (IQR 3-.
After ileostomy, the median hospital stay was 6 d (IQR 5-.
Complications occurred in 16 patients, primarily CDC grade 2 .
and grade 3 .
The median closure interval for ileostomy was 176 d (IQR 101-.
Notably, closure intervals were shorter in patients with non-malignant underlying diseases compared to those with malignant diseases.
InaJBCS.
Volume 57.
Number 1, 2025 January: 43-55 TABLE 1.
Characteristics of study subjects Overall Variable Intervention Colostomy Ileostomy BMI
A Underweight
A Normal
A Overweight
A Obese
ASA status
A ASA I
A ASA II
A ASA i Chemotherapy status
A No A Yes
Comorbidity A None
A Single A Multiple Underlying disease A Non malignant A Malignant Stadium
A 0
A I
A II
A i A IV Sex A Male A Female Age .
A O 51
A >51
Stoma creation time .
A O4
A >4
Type of surgery A Elective A Emergencies Length of hospitalization .
A O7
A >7
Complications A None
A CDC 2
A CDC 3
Stoma closure interval .
A O236
A >236
Abbreviations: American Society of Anesthesiologists (ASA).
body mass index (BMI).
Clavien-Dindo classification (CDC) Nugroho PS, et al.
Preoperative and intraoperative predictive.
TABLE 2.
Results of bivariate analysis between variables with stoma closure interval Variable Colostomy closure O284 d >284 d Sex
A Male
A Female BMI
A Underweight
A Normal
A Overweight
A Obese
Comorbid
A None
A Single A Multiple Underlying disease A Non malignant A Malignant Stadium
A 0
A I
A II
A i A IV
Status ASA
A ASA I
A ASA II
A ASA i Chemotherapy Status A No A Yes Age .
A O 51
A >51
Length of hospitalization .
A O6/7 A >6/7 Complications A None
A CDC 2
A CDC 3
Stoma creation time
A O4
A >4
Type of surgery A Elective A Emergencies Albumin A O4.
A >4.
Hemoglobin .
/dL) A O12.
A >12.
Ileostomy closure O284 d >284 d p<0.
05 was statistically significant.
variables with p<0.
25 were underwent to multivariate InaJBCS.
Volume 57.
Number 1, 2025 January: 43-55 Bivariate and multivariate analysis The results indicate that BMI, underlying disease, and complications are associated with the duration of colostomy closure interval .
=0.
040, respectivel.
Similarly, in the ileostomy group, bivariate analysis was conducted to examine the relationship between closure interval duration and several predictor factors (TABLE .
The findings reveal that underlying disease, cancer stage, chemotherapy status, complications, and type of surgery are associated with the duration of stoma closure interval .
=0.
034, respectivel.
Variables that show a p <0.
25 in the bivariate analysis then proceed to multivariate analysis (TABLE .
In the colostomy group, significant predictors included BMI, underlying disease, chemotherapy status, complications, and hemoglobin levels, with BMI and hemoglobin levels associated with closure duration .
= 0.
010 and 0.
For ileostomy, significant disease, cancer stage, chemotherapy status, operation duration, surgery type, complications, and patient albumin levels, with only complications was associated with closure duration .
= Overall, an increase in disease stage, chemotherapy use, operation duration, and albumin levels increased the risk of prolonged ileostomy closure, while non-malignant underlying diseases and elective surgery types reduced this TABLE 3.
Results of multivariate analysis between variables with stoma closure interval Variable Sig.
95% CI
Lower
Upper
Colostomy group
BMI
Underlying disease Chemotherapy status Complication Hemoglobin level Constant Ileostomy group Underlying disease Malignancy stadium Chemotherapy status Duration of surgery Complication Type of surgery Albumin Constant p<0.
05 is considered as significant Nugroho PS, et al.
Preoperative and intraoperative predictive.
DISCUSSION
Many patients undergo temporary ostomy formation for conditions like inflammatory bowel disease, colorectal cancer, and diverticular disease.
8 The primary goals are to improve quality of life, treat pathological conditions, or prevent postoperative complications like anastomotic leakage.
9 Closure of a temporary stoma should be delayed until surrounding edema and induration subside and the bowel appears normal.
Patency of the distal anastomosis must be confirmed with fluoroscopy.
Ostomy closure can be scheduled when the intestinal anastomosis or ileoanal pouch has healed, acute inflammation has subsided, and post-resection edema has The timing was also affected by the patientAos psychological and physical recovery from the initial surgery.
Typically, stoma closure occurs after eight to twelve weeks, but it carries a risk of complications.
10,11
This study identified risk factors and predictors affecting ostomy closure time were identified in the colostomy and ileostomy groups.
In this study, 70 colostomy and 70 ileostomy procedures were performed, with a mean patient age of 50.
03 A 13.
9 yr.
The patient cohort consisted of 70 males .
%) and 70 females .
%), resulting in a maleto-female ratio of 1:1.
The majority of patients had a normal BMI.
ASA status II.
In our cohort, over 50% of the patients had cancer as the primary etiology, with a malignancy-to-nonmalignancy ratio of 7:3.
Consequently, most patients received chemotherapy.
This aligns with the common indication of malignancy among ostomy recipients.
More than 50% of patients presented at cancer stage 0 and had no comorbidities.
The majority of ostomy procedures were elective, with stoma creation times of O4 hr, and most patients had hospital stays of O7 d.
Additionally, more than 76.
4% of patients experienced no complications.
The mean duration for stoma closure in this study was 270 A 193 d.
Cancer and related complications are the most common indications for ostomy, followed by diverticular disease, inflammatory bowel disease, trauma, gastrointestinal perforation, radiation effects, distal anastomosis protection, and management of anastomotic leaks.
Colorectal cancer is the leading cause of both colostomy and ileostomy in this study, followed by other cancers such as ovarian and cervical cancer.
The overall cancer morbidity and mortality ratio by sex is 1:1.
13 These findings are consistent with previous studies.
Colorectal cancer is the third most common cancer globally .
80 million case.
, the second most common in women .
79 million case.
, and the third most common in men .
98 million case.
Its incidence increases by 1% annually among those aged 50-64 yr.
In Indonesia, colorectal cancer predominantly occurs in individuals over 50 yo.
14 In this study, the mean age of patients was above 50 Between colostomy and ileostomy procedures, the only differing variable was ASA status.
The colostomy group had a higher prevalence of ASA II and ASA i status .
% vs.
73%).
No other variables differed between the two groups.
Inflammation associated with cancer development External inflammation can be triggered by factors like infections, autoimmune diseases, obesity, smoking, asbestos exposure, and excessive alcohol consumption, all raising cancer risk.
Conversely, cancerinduced inflammation results from cancer-triggering malignancy by activating inflammatory This impacts patient cancer stages, clinical conditions, and ASA status, which predicts surgical risk.
15,16
In this study, colostomy was observed in 49 out of 70 patients with malignancies, with a mean cancer stage of i.
42 of InaJBCS.
Volume 57.
Number 1, 2025 January: 43-55 these patients exhibited ASA II/i status.
Among non-malignancy recipients, trauma was identified as the etiology in 21 patients, presenting with a spectrum of conditions including sigmoid perforation, rectovaginal fistula, intestinal tuberculosis, obstructive ileus, sigmoid volvulus, proctitis, diverticulosis, anal stricture, colitis.
Fournier gangrene, retroperitoneal mass, peritonitis, sigmoid perforation, descending sigmoid colon necrosis, ileocolic intussusception, and iatrogenic rectal laceration.
Of the nonmalignancy patients, 14 had ASA II status and 1 had ASA i, indicating a higher prevalence of ASA II/i among cancer patients compared to non-malignancy In the ileostomy cohort, 48 out of 70 patients had malignancies, with 8 classified as ASA I and 40 as ASA II.
None of the cancer patients receiving ileostomy exhibited ASA i, suggesting a milder clinical presentation.
Nonmalignancy ileostomy patients presented with conditions such as rectovesical fistula, ileal perforation peritonitis, sigmoid perforation peritonitis, cecal perforation peritonitis, abscess, trauma, diverticulum perforation, appendicitis.
Fournier gangrene, and obstructive Among these patients, 5 had ASA II status and 17 had ASA I.
Similarly, cancer patients showed a higher prevalence of ASA II compared to non-malignancy Ostomy predominantly elective, with stoma creation taking O4 hr, and most patients had hospital stays of O7 d.
Moreover, 4% of patients experienced no Among those who did, 17 patients were classified as CD II and 16 as CD i.
In a study by Krebs .
, out of 218 stoma patients, 75.
2% had no complications, while the remaining cases were classified as CD I .
CD II .
CD i .
CD IV .
, and CD V .
Meanwhile, post-ostomy creation complications in the study by Nassif et 8 occurred in only 35.
6% of patients, with an average hospital stay duration 9 d.
8 The average duration for stoma closure overall is 270A193 d, with a median of 236 d.
In the study by Nassif et al.
,8 the median time for stoma closure 5 d .
nterquartile range.
IQR, 122-.
Analysis of significant variables of colostomy group Bivariate associations between BMI, underlying disease, complications, and stoma closure duration .
< 0.
Variables that meet p<0.
25 will undergo multivariate BMI and hemoglobin levels associated with closure duration .
= 0.
010 and 0.
044, respectivel.
in multivariate analysis.
Subgroup analysis of cancer patients in the study by Nassif et al.
8 revealed that overall complications post-primary surgery (OR:127.
95%CI:17.
06 - 237.
p = 0.
, and receiving adjuvant therapy (OR:173.
95%CI:48.
56 - 298.
p = 0.
were significant predictors for longer closure time in multivariate In a study conducted by Lertsithichai et al.
,17 complications were compared between patients undergoing colostomy and ileostomy.
The results indicated that temporary colostomy significantly increased the likelihood of stoma complications in colorectal cancer patients undergoing elective resection and also led to more infectious and wound Conversely, temporary ileostomy tended to result in more postclosure surgical complications.
17 In this study, the most common complications were relaparotomy, adhesions, and colon resection in 10 patients, followed by septic shock in 6 patients and depression in 1 patient.
Obesity in patients correlates with a higher incidence of wound infections, increased risk of wound dehiscence.
Nugroho PS, et al.
Preoperative and intraoperative predictive.
and anastomotic leakage.
Moreover, obese patients are more prone to stoma-related complications such as parastomal hernias, mucosal separation, stoma retraction, and stoma prolapse.
Studies by Saito et al.
19 have linked BMI with prolonged stoma closure intervals, which associated with postoperative Higher BMI values were identified as significant risk factors for postoperative complications, with a BMI of 24 kg/m2 serving as a threshold, above which the incidence of complications significantly rises.
Obesity is linked to increased systemic inflammation, disrupting wound healing processes and extending the time needed for stoma Similarly, low hemoglobin levels or anemia are associated with post-stoma creation complications, particularly anastomotic leakage, which can heighten the risk of ischemia.
Ischemia has been described as a risk factor for leakage.
therefore, adequate blood flow is prioritized during anastomosis creation.
Currently, this assessment relies on subjective evaluations based on tissue characteristics and blood loss, without considering factors such as hemoglobin concentration or tissue oxygenation.
Although this relationship is not fully elucidated, intraoperative blood loss can be considered a surrogate measure for decreased hemoglobin levels.
Analysis of significant ileostomy group In the ileostomy group, the median time for stoma closure interval is 176 d (IQR 101-.
However, several surgical experts concur in the literature that ileostomy closure should ideally occur no sooner than 60 to 90 d postpreserving sphincter proctectomy.
This timeframe represents an optimal period where patients have recovered from the primary surgery, intra-abdominal adhesions are more manageable, and stoma inflammation and edema have subsided, making it the Ausweet spotAy for 21 But time extensions can occur due to several factors.
The results indicate that underlying disease, cancer stage, chemotherapy status, complications, and type of surgery are associated with the duration of stoma Similar findings were observed in a study by Chau et al.
22 involving rectal cancer patients, where chemotherapy administration correlated with the duration of stoma closure .
=0.
In Barenboim et al.
23 factors associated with stoma non-closure in multivariate analysis included pathological stage 3 .
%) vs 51 .
2%).
p = 0.
, disease recurrence .
%) vs 40 .
9%).
, hospital stay > 10 d .
= 0.
and anastomotic leakage with ClavienDindo score > 2 or reoperation .
%) vs 13 .
1%).
p = 0.
Underlying chemotherapy may weaken the immune system and slow tissue regeneration, delaying wound healing.
The mechanisms governing wound healing can promote the growth of malignant cells, while chronic inflammation is associated with malignant transformation and The microenvironment resembles chronic wounds, where infiltrating immune cells stimulate tumor growth and invasion.
Environmental stimuli, like hypoxia and DNA damage, prompt tumor cells to release chemokines, recruiting protumor inflammatory cells and fostering pro-tumor Chemotherapy often causes skin toxicity like rashes and dryness due to its effects on cell metabolism and division.
It also inhibits inflammation and angiogenesis, slowing wound healing by reducing collagen production and impairing the immune system, increasing infection In multivariate analysis, only the complication variable was associated with duration of stoma closure .
= 0.
InaJBCS.
Volume 57.
Number 1, 2025 January: 43-55 A study in Sweden explored ileostomy reversal timing post-proctectomy, citing reasons for delay.
Of 106 patients, 79% underwent reversal, with 19% within 4 mo post-low anterior resection, while 81% were delayed beyond 4 mo.
Delay reasons included low medical priority .
%), non-surgical complications .
%), symptomatic anastomotic leaks .
%), and postoperative chemotherapy .
%).
Risk factors for permanent ileostomy diversion were stage IV cancer .
<0.
and symptomatic anastomotic leaks .
<0.
26 Another study evaluated 27 patients, with 9 .
%) experiencing postoperative complications and delayed closure, while 18 .
%) underwent early loop ileostomy closure at an average of 11 d .
-21 .
after the initial procedure.
This aligns with our findings, where complications such as septic shock, stoma prolapse, anastomotic leaks, cecal leaks, and wound dehiscence were observed.
Common early complications poststoma creation includes leakage and skin irritation, high output leading to fluid and electrolyte imbalances, or stoma necrosis.
advanced complications encompass parastomal hernia, stoma prolapse, and stoma stenosis.
These complications may arise due to surgical factors or patient-related factors.
Redirecting inflammation, muscle atrophy, and bacteremia and postoperative ileus.
Despite restoration attempts, hidden histological changes and altered enteric nervous system function may persist longer than anticipated, maintaining inflammation and bowel dysfunction for years post-surgery.
28 Research conducted by Whitney et al.
29 revealed thirtyseven cases of small bowel obstruction or partial small bowel obstruction (SBO or pSBO, 9.
79%), 5 cases of anastomotic leakage in ileoileostomy .
4%), and 4 cases of pouch leakage .
9%).
Eight patients experienced systemic inflammatory response syndrome (SIRS) within the first 5 d post-operation without an identified intra-abdominal source following extensive examination.
Surgical anastomotic dehiscence, small bowel obstruction, and incisional .
Evaluating prevention and complications is best done through Eighteen such trials have explored various approaches to stoma either temporary loop colostomy or loop ileostomy and monitoring for The analysis reveals that the only significant difference between the two stoma sites is the increased risk of stoma prolapse associated with loop 30i However, this study did not specifically analyze the type of surgery, as well as stoma placement.
Limitation and future directions This study has limitations as its retrospective design using medical records may yield incomplete or insufficiently detailed data, affecting analysis outcomes.
ThereAos a risk of selection bias as medical records might not fully represent the general population, limiting findingsAo generalizability.
Small sample size compromises statistical power and generalization, while varied clinical conditions and backgrounds may impact results.
Clinical variables like BMI, hemoglobin levels, and complications may suffer from measurement errors.
Unidentified confounding factors and complex interactions between variables may affect the results.
Additionally, technology might affect data collected over time.
For future studies, a scoring system based on multivariate analysis can be developed by conducting a study with a larger sample size that will be more Nugroho PS, et al.
Preoperative and intraoperative predictive.
representative of the population.
This scoring can help predict the right time to close the stoma based on the predictor factors found in patients.
In addition, a prospective cohort study design can further strengthen the relationship between predictive factors and the patient stoma closure interval.
Studies on the pathophysiological mechanisms of stoma closure from each predictive factor can also increase our knowledge about stoma closure intervals.
REFERENCES
CONCLUSION
The findings indicate that in the colostomy group.
BMI, underlying disease, and complications associated with stoma closure duration.
Multivariate analysis revealed that both BMI and hemoglobin levels are independently associated with closure duration.
Specifically, increased BMI, advanced disease stage, chemotherapy use, complications, and lower hemoglobin levels predicted a longer duration until stoma closure.
Conversely, chemotherapy appeared to reduce the risk of prolonged stoma closure in this group.
In the ileostomy group, underlying disease, cancer stage, chemotherapy status, complications, and surgery type were associated with closure duration Multivariate analysis showed that associated with closure duration.
Furthermore, advancing disease stage, chemotherapy, longer surgery duration, and lower albumin levels seemed to increase the risk of prolonged closure in the ileostomy group, while nonmalignant diseases and elective surgery appeared to reduce this risk.
ACKNOWLEDGMENT