Risk factors for stoma outlet obstruction after colorectal cancer surgery with diverting loop ileostomy: A retrospective single-center study.

PURPOSE: Stoma outlet obstruction (SOO) is a notable complication following diverting loop ileostomy (DLI) for colorectal cancer. However, no definitive risk factors for SOO have been identified. This study aimed to determine the risk factors associated with SOO.

METHODS

This retrospective study included 167 consecutive patients who underwent elective colorectal cancer surgery with DLI at Chiba University Hospital between January 2010 and October 2024. We evaluated the patient, tumor, and surgical factors along with the computed tomography-based anatomical measurements. These included rectus abdominis muscle (RAM) thickness, subcutaneous adipose tissue (SAT) thickness, stoma penetration angles, penetration site through the RAM, and proximal limb orientation measurements.

RESULTS

SOO occurred in 21 (12.6%) patients. A univariate analysis demonstrated that central penetration of the RAM (P = 0.01) and caudal orientation of the proximal limb (P = 0.02) were significantly associated with SOO length. A multivariable logistic regression analysis indicated that stoma penetration through the central portion of the RAM was an independent risk factor for SOO (odds ratio, 3.38; 95% CI], 1.26-10.1; P = 0.02).

CONCLUSION

Central RAM penetration was an independent risk factor for SOO. As the penetration site is a modifiable technical factor, avoiding the central RAM when creating the DLI may reduce the risk of SOO.