Trends in Stoma Creation, Complications and Closure in a Tertiary Centre: A Four-Year Retrospective Review
Abstract
The objective of this study is to examine current trends in intestinal stoma formation, stoma-related complications, hospital readmissions, and reversal outcomes in a tertiary colorectal surgery centre. This retrospective study included all patients undergoing intestinal stoma formation and closure from January 2022 to December 2025. Data on indications, operative approach, complications, readmissions, and reversal outcomes were obtained from the electronic medical record (BHIS). Patients with permanent end stomas and those who died before potential reversal were excluded from reversal analysis. A total of 339 patients underwent stoma formation, with an overall increase in annual case volume from 2022, peaking in 2024, followed by a decline in 2025. The most common indications were intestinal obstruction (n = 129, 38.1%), malignancy (n = 82, 24.2%), and diverting stoma for elective surgery (n = 68, 20.1%). Laparoscopic-assisted stoma creation increased from 23.8% to 41.8%. Complications occurred in 77 patients (22.7%), most commonly high-output stoma (n = 30/77, 39.0%), parastomal hernia (n = 14/77, 18.2%) and prolapse (n = 14/77, 18.2%). 55 (71.4%) patients with stoma-related complications were readmitted, most commonly for high-output stoma (28/55, 50.9%), which required multiple readmissions. High-output stoma was more frequent among ileostomies (26/145, 17.9%) than colostomies (4/194, 2.1%), while prolapse was more frequent among colostomies (12/194, 6.2%) than ileostomies (2/145, 1.4%). Among eligible patients, 39.3% (110/280) underwent closure, with a median time of 351 days (range 20–1110 days). Closure was achieved within 6 months in 36/110 patients (32.7%) and within 12 months in 57/110 patients (51.8%). Progressive malignancy was the most common reason for non-reversal (n = 57, 33.5%).
References
Gaikwad SP, Suhrid C, Pandya JS. Challenges of temporary stoma creation: An observational study from a tertiary care centre in Mumbai, India. Asian J Res Surg 2024; 7(1): 104-18.
Alam P, Khan RA, Ali M, et al. Trends of indications and complications of stoma in a tertiary care hospital. Pak J Med Health Sci 2022; 30: 16(11):387-9.
Mbelle PJ, Kizigina S, Mwashambwa M. Indications for stoma creation and early outcome predictors of stoma closure at University of Dodoma Teaching Hospitals. Int J Biomed Res Pract 2024; 30; 4(2): 1-12. https://doi.org/10.33425/2769-6294.1030
Elnaim ALK, Wong MPK, Sagap I. Intestinal stomas: Basics, complications and controversy—A systematic review. Acad Med Surg 2024; 1-12. https://doi.org/10.62186/001c.127121
Parini D, Bondurri A, Ferrara F, et al. Surgical management of ostomy complications: A MISSTO–WSES mapping review. World J Emerg Surg 2023; 18(1): 48. https://doi.org/10.1186/s13017-023-00516-5
Ge Z, Zhao X, Liu Z, et al. Complications of preventive loop ileostomy versus colostomy: A meta-analysis, trial sequential analysis, and systematic review. BMC Surg 2023; 23(1): 235. https://doi.org/10.1186/s12893-023-02129-w
Ashwath G, Manasijan EK, Rozario AP. Timing of the stoma reversal: What is the safe period? A retrospective observational study. Asian J Pharm Clin Res 2024; 17(5): 181. https://doi.org/10.22159/ajpcr.2024.v17i5.51172
Manterola C, Claros N. Early vs standard loop ileostomy closure: an unmatched case-control study. Int J Morphol 2023; 41(6): 1863. https://doi.org/10.4067/s0717-95022023000601863
Hsu C, Tsai W, Tsai TY, et al. Predictors for temporary stomas non-closure among non-metastatic rectal cancer patients undergoing curative resection: A retrospective analysis. World J Surg Oncol 2024; 22(1): 124. https://doi.org/10.1186/s12957-024-03403-8
Gustafsson CP, Gunnarsson U, Dahlstrand U, Lindforss U. Loop-ileostomy reversal-patient-related characteristics influencing time to closure. Int J Colorectal Dis 2018; 33(5): 593. https://doi.org/10.1007/s00384-018-2994-x
Sier M, Gelder LV, Ubbink DT, Bemelman WA, Oostenbroek RJ. Factors affecting timing of closure and non-reversal of temporary ileostomies. Int J Colorectal Dis 2015; 30(9): 1185. https://doi.org/10.1007/s00384-015-2253-3
Sherman KL, Wexner SD. Considerations in stoma reversal. Clin Colon Rectal Surg. 2017 30(3): 172. https://doi.org/10.1055/s-0037-1598157
Munshi E, Segelman J, Matthiessen P, et al. Increased risk of postoperative complications after delayed stoma reversal: a multicenter retrospective cohort study. Int J Colorectal Dis 2025; 40(1): 36. https://doi.org/10.1007/s00384-025-04831-y
Wiesler B, Hirt L, Guenin MO, et al. Stoma-associated complications after diverting loop ileostomy, end ileostomy or split stoma formation after right-sided colectomy. Tech Coloproctol 2024; 28(1): 68. https://doi.org/10.1007/s10151-024-02945-z
Saradar TK, Ganguly P, Pal J, Ghosh G, Ghosh BC. A clinical observational study of intestinal stoma and their complication from a tertiary care center in India. Asian J Med Sci. 2023; 14(3): 240. https://doi.org/10.3126/ajms.v14i3.49874
Wahab PA, Mohamed NMZN, Ismail N, Hassan II, Haryanto H. A descriptive analysis of patients with stoma attending a tertiary hospital on the east coast of Peninsular Malaysia. Int J Care Scholars 2024; 7(3): 4. https://doi.org/10.31436/ijcs.v7i3.365
Arai S, Yamaoka Y, Shiomi A, et al. Efficacy of laparoscopic surgery for loop colostomy: A propensity-score-matched analysis. Tech Coloproctol 2023; 27: 1319-26. https://doi.org/10.1007/s10151-023-02856-5
Wang YJ, Lin KH, Kang JC, Hu JM, Chen CY, Pu TW. Benefits of laparoscopy-assisted ileostomy in colorectal cancer patients with bowel obstruction. World J Clin Cases 2023; 11(24): 5660-5. https://doi.org/10.12998/wjcc.v11.i24.5660
Hayashi K, Kotake M, Hada M, et al. Laparoscopic versus open stoma creation: A retrospective analysis. J Anus Rectum Colon 2017; 1(3): 84-8. https://doi.org/10.23922/jarc.2016-014
Prakash K, Manna S, Halder D, De U. Indications for enteric stoma creation in emergency laparotomy for acute abdomen: A retrospective descriptive study. Indian J Surg 2024; 87(2): 324. https://doi.org/10.1007/s12262-024-04162-2
Seifarth C, Augustin LN, Lehmann KS, et al. Assessment of risk factors for the occurrence of a high-output ileostomy. Front Surg 2021; 8: 642288. https://doi.org/10.3389/fsurg.2021.642288
Takeda M, Takahashi H, Haraguchi N, et al. Factors predictive of high-output ileostomy: A retrospective single-center comparative study. Surg Today 2018; 49(6): 482. https://doi.org/10.1007/s00595-018-1756-2
Lee N, Lee SY, Kim CH, Kwak HD, Ju JK, Kim HR. The relationship between high-output stomas, postoperative ileus, and readmission after rectal cancer surgery with diverting ileostomy. Ann Coloproctol 2021; 37(1): 44-50. https://doi.org/10.3393/ac.2020.08.03
Boutté HJ, Poylin V. High ileostomy output: A practical review of pathophysiology, causes, and management. Semin Colon Rectal Surg 2023; 34(2): 100955. https://doi.org/10.1016/j.scrs.2023.100955
Toffaha A, Badr A, Al-Dhaheri M, et al. Risk factors for stoma outlet obstruction: systematic review and meta-analysis. Langenbecks Arch Surg 2025; 410(1): 317. https://doi.org/10.1007/s00423-025-03892-5
Harris D, Egbeare D, Jones S, Benjamin HB, Woodward A, Foster M. Complications and mortality following stoma formation. Ann R Coll Surg Engl 2005; 87(6): 427. https://doi.org/10.1308/003588405x60713
Boyer ME, Dhimal T, Hilty BK, et al. Assessing the pathway and timing for ileostomy reversal in rectal cancer: A retrospective cohort study. Surgery 2025; 185: 109507. https://doi.org/10.1016/j.surg.2025.109507
Metwally IH, Abdelkhalek M, Zuhdy M, Elbalka SS. Temporary stomas after rectal cancer resection: Predilection of being permanent and predictors of complications. J Coloproctol 2023; 43(3): 191-8. https://doi.org/10.1055/s-0043-1772786
Assaf D, Hazzan D, Ben-Yaacov A, Laks S, Zippel D, Segev L. Predisposing factors for high-output stoma in patients with diverting loop ileostomy after colorectal surgery. Ann Coloproctol. 2021; 39(2): 168. https://doi.org/10.3393/ac.2021.00241.0034
Bolckmans R, Jean-Baptiste C, Sandeep S, Stephen B, D’Hoore A, Albert W. Prospective evaluation of early complications after elective loop ileostomy: Need to optimise loperamide management? J Gastrointest Surg 2021; 26(3): 665. https://doi.org/10.1007/s11605-021-05148-1
DOI: http://dx.doi.org/10.17576/JSA.2026.1602.02
Refbacks
- There are currently no refbacks.
e-issn 2231-7481