558 The Importance of Bowel Evaluation Before Reversing Ileostomy in Cancer Patients: A Single Centre Experience

Abstract Aim Water-soluble contrast enema (WSCE) is a well-recognized imaging modality to determine the feasibility of ileostomy reversal, giving a good baseline of anastomotic conditions, prior to reversal. The aim of this study was to evaluate the role of WSCE as a sole imaging modality to investigate anastomotic integrity prior to reversal. Method For this study a retrospective database was set including patients who underwent ileostomy for colorectal cancer in a single high-volume institution, between January 2016 and December 2022. Patients who had ileostomy for other reasons than cancer, were excluded. Primary outcomes assessed were reversal rate and overall survival. Secondary outcomes assessed were rate of WSCE imaging and complications. Results A total of 256 patients with colorectal cancer underwent resective surgery followed by a loop ileostomy. Median observed follow-up was 36 months (18.3-53.5). A total of 48 patients [men 33 (69.0%); mean age 68.4 years (SD 11.8)] were suitable for reversal, with an overall reversal rate of 18.7%. 30-day mortality after index procedure was 0%, with an overall survival of 93.8%. WSCE as a sole preoperative imaging was performed in 93.7% of the cases. Only two patients underwent additional colonoscopy or computed tomography (CT) prior to reversal. In terms of complications, 6/48 patients (8%) had parastomal hernia requiring further surgery. Conclusions Enema as a sole imaging modality prior to ileostomy reversal is associated with acceptable early and mid-term outcomes, making it an acceptable alternative to other imaging techniques. The incidence of postoperative complications is extremely low. Patients will still require rigorous oncological follow up.