Risk factors for non-reversal of diverting ileostomies: a retrospective analysis of 456 patients

Q: Why do some diverting ileostomies remain unreversed after colorectal surgery?

Non-reversal is influenced by factors such as mortality, metastatic disease, and anastomotic complications. The study emphasizes that these barriers prevent closure in a substantial minority of patients.

Q: How many patients achieved ileostomy closure in this study?

Among 456 included patients, 364 achieved ileostomy closure, corresponding to a 79.8% closure rate.

Q: Which independent predictors were associated with non-reversal?

Multivariable analysis identified ASA score 3–4 and malignant pathology as independent predictors of non-reversal, with significant odds ratios reported in the results.

Sep 30, 2026

Uploaded by Kyle

Diverting ileostomies are commonly created during low rectal cancer surgery, yet 15–30% never undergo reversal, leaving patients with permanent stomas. This retrospective cohort study evaluated factors that prevent ileostomy closure after colorectal surgery. Using prospectively collected data from January 2015 to December 2020, 456 eligible patients were analyzed with multivariable logistic regression. Non-reversal occurred in 20.2%, mainly linked to mortality, metastatic disease, and anastomotic complications. Independent predictors included ASA score 3–4 and malignant pathology, highlighting the need for realistic preoperative counseling.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

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Abstract

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Introduction

International Journal of Colorectal Disease (2026) 41:21 [https://doi.org/10.1007/s00384-025-05059-6](https://doi.org/10.1007/s00384-025-05059-6) Risk factors for non‑reversal of diverting ileostomies: a retrospective analysis of 456 patients Osman Civil1 · Nevin Sakoglu1 · Atif Tekin1 · Metin Kement2 Received: 13 July 2025 / Accepted: 7 December 2025 © The Author(s) 2026 Abstract Purpose Diverting ileostomies are routinely created during low rectal cancer surgery, yet 15–30% remain permanent. Understanding predictors of non-reversal is essential for informed patient counseling. This study investigated factors preventing ileostomy closure following colorectal surgery, primarily for rectal malignancy. Methods This retrospective cohort study analyzed prospectively collected data from patients undergoing diverting ileostomy creation (January 2015–December 2020). Exclusions included early postoperative mortality (within 30 days), follow-up less than 6 months, or missing primary outcome data. Demographics, surgical details, and reversal outcomes were analyzed. Multivariable logistic regression identified independent predictors of non-reversal. Results Of 508 patients, 456 met inclusion criteria (mean age 58.9 ± 13.2 years, 63.8% male) . Malignancy accounted for 96.7% of cases, with low anterior resection performed in 83.8% . Ileostomy closure was achieved in 364 patients (79.8%) at a median of 6 months (mean 7.4 ± 5.3) . The non-reversal rate was 20.2%(92 patients) . Main reasons included mortality (35.8%), metastatic disease (23.9%), and anastomotic complications (22.8%) . Multivariable analysis identified ASA score 3–4 (OR 2.68, 95% CI 1.58–4.54, p < 0.001) and malignant pathology (OR 5.12, 95% CI 1.23–21.3, p = 0.025) as independent predictors of non-reversal. Age showed statistical but limited clinical significance. Conclusion One in five patients with diverting ileostomies will not undergo reversal. High ASA scores, malignant disease, mortality, metastatic progression, and anastomotic complications are primary barriers. These findings emphasize the need for realistic preoperative counseling regarding permanent stoma risk. Keywords Ileostomy closure · Rectal cancer surgery · Permanent ileostomy · Anastomotic complications · Predictive factors * Osman Civil [dr.civil@hotmail.com](dr.civil@hotmail.com) Nevin Sakoglu [nsakoglu@medipol.edu.tr](nsakoglu@medipol.edu.tr) Atif Tekin [atiftekin@medipol.edu.tr](atiftekin@medipol.edu.tr) Metin Kement [mkement@yahoo.com](mkement@yahoo.com) 1 Department of General Surgery, Faculty of Medicine, Istanbul Medipol University, Cobancesme Mahallesi, Fatih Caddesi No: 1/8, Istanbul, Turkey 34197 2 Department of General Surgery, Faculty of Medicine, Istanbul Bahcesehir University, Istanbul, Turkey Introduction Diverting ileostomies are frequently created during colorectal surgery to protect distal anastomoses, divert fecal stream in emergency settings, or facilitate healing in complex cases [1–3]. These diversionary procedures have become an integral component of modern colorectal surgical practice, particularly in rectal cancer surgery where low anastomoses carry increased risk of complications. While defunctioning stomas decrease symptomatic leak rates from 10–15% to 5–8% and reduce the need for reoperation [1 , 3], they impose substantial burdens including dehydration requiring readmission in 15–20% of patients [4], acute kidney injury, electrolyte disturbances, highoutput syndrome, stoma-related complications (prolapse, retraction, parastomal hernia in 15–35% of cases) [5 , 6], significant psychological distress, body image concerns, and reduced quality of life scores by 20–30% compared to patients without stomas [5 , 6] . The creation of diverting ileostomies involves careful consideration of multiple factors including patient risk profile, disease characteristics, surgical complexity, and anticipated healing conditions. In rectal cancer surgery, p

FAQs

Why do some diverting ileostomies remain unreversed after colorectal surgery?

Non-reversal is influenced by factors such as mortality, metastatic disease, and anastomotic complications. The study emphasizes that these barriers prevent closure in a substantial minority of patients.

How many patients achieved ileostomy closure in this study?

Among 456 included patients, 364 achieved ileostomy closure, corresponding to a 79.8% closure rate.

Which independent predictors were associated with non-reversal?

Multivariable analysis identified ASA score 3–4 and malignant pathology as independent predictors of non-reversal, with significant odds ratios reported in the results.

Sep 30, 2026

Uploaded by Kyle