Diverting ileostomy reversal complications in patients with benign versus malignant conditions

Background: Reversal of ileostomy after surgery and chemoradiation creates a new group of patients with the potential for eventual postoperative complications. We aim to compare the postoperative morbidity of colorectal cancer patients with that of patients who underwent reversal of ileostomy for benign colorectal conditions. Methods: A retrospective analysis of patients undergoing ileostomy reversal was performed. Demographic, clinicopathologic features of patients, morbidity, initial diagnoses as well as rates of postoperative complications were analyzed. All complications after reversal of ileostomy were registered and classified according to Clavien-Dindo severity score. Results: 61 patients were divided in two groups; group A (21/61, 34.4%), included patients with benign colorectal diseases. The average time interval to reversal was 5.6±2.3 months and the in-hospital stay was 9.6±4.64 days. The overall complication rate was 33.3% (7/21) with wound infection rate at 14.3% (3/21). In group B (40/61, 65.6%), patients with malignancies maintained the ileostomy for an average of 8.2±3.3 months. In-hospital stay was 15.47±24 days and the overall complication rate was 65% (26/40). Wound infection was the most common complication with an incidence rate of 22.5%. The majority of complications in both groups was classified as Clavien-Dindo II and IIIa (14/61, 23%) while 9 patients (9/61,14.8%) had Clavien- Dindo score IIIb and IV. Conclusion: Reversal of ileostomy in cancer patients is correlated with a high complication rate. Wound infection and postoperative ileus were the most common complications. Cancer patients with reversal ileostomy had increased hospital in stay and delayed closure compared to patients with benign diseases.