Complicaciones del cierre de las ileostomías de protección y análisis de factores de riesgo asociados

Résumé

Protective ileostomies are used in a wide variety of surgical indications, both urgent and scheduled. Its creation and closure is not free of complications, sometimes serious, and even mortality. OBJECTIVE: Our main objective has been to evaluate the complications of the closure of protective ileostomies. The secondary objectives were the classification of complications according to the Clavien Dindo scale, the identification of possible associated risk factors and the theoretical cost - benefit analysis in clinical terms. MATERIALS AND METHODS: This is a retrospective study of a prospective database of all patients operated for closure of protective ileostomy in Morales Meseguer Hospital from 2006 to 2015. We have included variables of the initial surgery in which the protection ileostomy was created, the time between the creation and closure of the ileostomy and the closure of the protective ileostomy. RESULTS: Morbidity of ileostomy closure was 39.3% and mortality 1.2%. The most frequent postoperative complication was ileus (82.8%) and, secondly, infection of the surgical wound (9.8%). The Clavien Dindo complication rate was 14.7% (Grade I), 19.6% (Grade II), 3.1% (Grade III) and 3% (Grade IV). The univariate analysis shows that corticoid treatment, transfusion before, during or after the initial surgery, the appearance of complications in the first surgery and urgent indication of protective ileostomy are related to the appearance of complications in the closure of the ileostomy. Other variables studied have not shown any relationship with the complications of ileostomy closure. Transfusion during or after the initial surgery and the development of complications in that same surgery behave as independent risk factors for complications in the closure of ileostomies. We also have performed a theoretical approach with the published literature, about the necessary number (NNT) of protective ileostomies to prevent a leak after a low anterior resection. Our NNT to prevent a leak is 17.9 and to prevent a reoperation of 18.9. CONCLUSIONS: In our setting, closure of protective ileostomies represents a morbidity of 39.3% and a mortality of 1.2%, similar figures to the published literature. The classification of these complications according to Clavien Dindo allows a better comparison with other works and the ability to disseminate our results. The identification of risk factors such as transfusion during and after the initial surgery and the appearance of complications in that same surgery are new findings so far not found in the literature. The theoretical number of ileostomies to prevent a leak or reoperation allows to assess in clinical terms the usefulness of protective ileostomies.