ORIGINAL ARTICLE   

Chirurgia 2022 August;35(4):202-7

DOI: 10.23736/S0394-9508.21.05335-3

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Incidence and evaluation of early complications affecting the stomal complex of ileostomy and their classification using the S.A.C.S instrument: a single-center retrospective analysis

Giorgia MORO ¹, Pier P. PRONTERA ², Ada ALOISI ¹, Francesco S. GROSSI ², Simona ANGELINI ², Attilio GUALANO ², Elsa VITALE ³ ✉

¹ San Camillo Forlanini Hospital, Rome, Italy; ² S.S. Annunziata Hospital, Taranto, Italy; ³ Mental Health Center Modugno, Department of Mental Health, Mental Health Center, ASL Bari, Modugno, Bari, Italy

BACKGROUND: The incidence of early complications of the stomal complex of ileostomy is not completely clear. Also, whether the incidence of early complications of ileostomy, and in particular of peristomal skin lesions (PSL), is affected by the type of ileostomy (permanent vs. temporary) and by the setting of the intervention (emergency vs. elective) has not been assessed. The primary endpoint of this study was therefore to assess the incidence of early complications of the stomal complex of ileostomy, with a particular regard to the peristomal skin lesions. Secondary end point was to establish whether early complications were more frequent in temporary vs. permanent or emergency vs. elective ileostomy, respectively.
METHODS: We studied retrospectively a large series of patients (n=477) who had undergone an ileostomy from 2011 to 2016. While surgery was performed in different General Hospital, the follow-up of all patients was performed by a single-center specialized in the management of the stoma complex. Postoperative complications, in particular early complications (i.e. developed within 30 days from surgery), surgical setting (emergency vs. elective) and type of ileostomy performed (temporary vs. permanent) were evaluated. Moreover, the peristomal Skin Lesion Assessment (S.A.C.S.) instrument was used for every patient presenting a peristomal skin lesion. Statistical analysis was performed using Microsoft Excel 2016 worksheet and Prism-GraphPad software.
RESULTS: 381/477 (80%) had at least one complication and 196/381 (41%) presented at least one early complication. PSLs were the most common postoperative early complication for patients who underwent ileostomy derivation in our series (31%), followed by decubitus on the stick (12%) used for the temporary ileostomy, and bowel retraction (12%). The least frequent early complication was peristomal hernia (0.2%). Early complications were significantly more frequent in temporary vs. permanent and in emergency vs. elective surgical intervention, respectively. The SACS instrument application allowed us to note that the 79% of PSL observed could be included in type 1 (23%), type 2 (30%) and type 3 (26%).
CONCLUSIONS: PSLs represent the most common early complications in patients with ileostomy. In particular, L1, L2 and L3 lesions, according to the S.A.C.S. classification system have emerged as the most common PSLs. Furthermore, this study shows that patients with temporary ileostomy and patients undergoing ileostomy under an emergency regimen have a higher risk of developing an early complication. Based on this study, the correct positioning of the stomal complex on the abdominal wall, performed by surgeons, as well as the correct management of the collection devices after surgery, seem to have a strong impact on the incidence of early complications of the ileostomy complex.

KEY WORDS: Complications; Ileostomy; Incidence