Complications associated with loop ileostomy: analysis of risk factors

Abstract Purpose: Loop ileostomy is a common surgical procedure but is associated with complications such as outlet obstruction (OO), parastomal hernia (PH), and high-output stoma (HOS). This study aimed to identify risk factors for these complications and their causal relationships.Methods: The study included 188 consecutive patients who underwent loop ileostomy between April 2016 and September 2021. Clinical factors and postoperative stoma-related complications (OO, HOS, and PH) were analyzed retrospectively. Stoma-related factors were evaluated by computed tomography (CT). The incidence, clinical course, and risk factors for the stoma-related complications were investigated.Results: OO was diagnosed in 28 cases (15.7%), PH in 57 (32%), and HOS in 57 (31.8%). A small longitudinal stoma diameter at the rectus abdominis level on CT and a right-sided stoma were significantly associated with OO. Creation of an ileostomy for anastomotic leakage was independently associated with HOS. Higher body weight and a large longitudinal stoma diameter at the rectus abdominis level on CT were significantly associated with PH. There was a significant relationship between occurrence of OO and occurrence of HOS; however, the association of occurrence of OO with that of PH was marginal.Conclusion: This study identified key risk factors for OO, HOS, and PH as complications of loop ileostomy and their causal relationships. Our findings may contribute to prevention and management of complications related to loop ileostomy.