Outcome of Restorative Surgery of Fecal Diversion, a Prospective Observational Study of 50 Cases in a Teaching Hospital

Background: An intestinal stoma is a planned opening made in the intestine to divert feces and flatus to the abdominal wall where they can be collected in external appliances. Either colostomy or ileostomy, most of the time acts as the best lifesaving surgical procedure for certain emergencies as well as routine small intestinal and colorectal surgery. Objective: To see the outcome of intestinal stoma closure surgery and the factors that influence the outcome of surgery. Study Design: This is a descriptive type of-cross sectional study. Department of Surgery, Bangabandhu Sheikh Mujib Medical University Hospital (BSMMUH), Dhaka, Bangladesh, which were done over a period of twelve months from April, 2012 to March, 2013. Results: 50 patients with intestinal stoma were admitted in different surgical wards of BSMMUH, Dhaka for intestinal stoma closure surgery. Out of 50 patients 30 patients presented with ileostomy & 20 patients presented with colostomy. After restoration of bowel continuity, in case of ileostomy closure, out of 30 patients 23(77%) patients were recovered uneventfully & 7(23%) patients recovered with some complications. Out of complicated cases, 2(7%) patients developed febrile illness, 2(7%) patients’ intestinal obstruction, 1(3.33%) patient developed anastomotic leakage, 1(3.33%) urinary retention & 1(3.33%) patient post-operative ileus. In case of colostomy closure, out of 20 patients 14(70%) patients were recovered uneventfully & 6(30%) recovered with some events; 3(15%) patients developed wound infection, 1(5%) patient post-operative ileus, 1(5%) patient diarrhea & 1(5%) patient febrile illness. Over all Out of 50 patients, post-operative recovery of 37 (74%) patients were uneventful & 13(26%) patients were recovered with complications. 3(6%) patients developed febrile illness, 3(6%) patients wound infection, 2 (4%) patients’ adhesive obstruction, 2(4%) patients post-operative ileus, 1(2%) patient developed anastomotic leakage, 1(2%) patient urinary retention & 1(2%) patient developed diarrhoea. Conclusion: Complications of Intestinal stoma reversal surgery is associated with nutritional status of the patients, anaemia, electrolyte imbalance, acquired complications in stoma site, duration of stoma, nature of operation and last of all surgical skill. So Intestinal stoma closure surgery should be performed after adequate nutritional build up, correction of anaemia, correction of electrolyte imbalance, stoma with adequate duration and by a surgeon who is technically skilled and experienced to minimize the incidence of post-operative complication.