Predictors of clinically significant complications after stoma reversal: A prospective analytical study

Table 7 Summary of studies on small intestinal perforation and ileostomy reversal

Ref.	Study design, number of cases	Objective	Results	Remarks
Kang et al[7], 2020	Retrospective multicenter cohort; 437 HP, 127 reversals	Evaluate rate of Hartmann’s reversal and predictors of post-reversal complications	35.9% post-reversal of Hartmann’s procedure complications. Interval > 6 months associated with lower complication rate. Age > 70, ASA III-IV, malignancy predicted non-reversal	Delay > 6 months may reduce complications; patient comorbidity critical
Pokorny et al[9], 2005	Retrospective cohort; 533 closures	Identify predictors of mortality and complications after stoma closure	Mortality 3%; complication rate 20%. Age predicted mortality; silicone drain use predicted complications	Age significant predictor; drain use associated with morbidity
Liang et al[21], 2013	Retrospective; 128 reversals	Identify predictors of SSI after stoma reversal	SSI rate 36%. Independent predictors: Fascial dehiscence (OR = 16.9), colostomy, thicker subcutaneous fat	Strong predictive model for SSI risk stratification
de Paula et al[12], 2020	ACS-NSQIP database analysis	Identify predictors of morbidity after elective ileostomy closure	Significant morbidity; operative time and patient factors predictive	Large database; risk-adjusted predictors identified
McCain et al[11], 2026	NSQIP database analysis	Identify predictors of major complications and mortality after colostomy reversal	Predictors: Age > 70, BMI ≥ 40, smoking, COPD, dependent status, steroid use, dialysis. Open approach ↑ complications (OR 1.67)	Robust national data; highlights modifiable risk factors
Lv et al[10], 2024	Retrospective; 439 patients	Identify predictors of overall and stoma-related complications after ileostomy reversal	Overall complications 11.4%. Low albumin → overall complications. High BMI and longer interval → stoma-related complications	Nutritional status and delay are key predictors
Khoo et al[16], 2021	Retrospective cohort; 251 patients	Assess impact of timing of reversal on outcomes	Early (< 6 months) reversal had lower POI (13.5% vs 38.1%) and fewer 30-day complications	Delay increases morbidity; supports early reversal
Rubio-Perez et al[18], 2014	Institutional retrospective study	Assess impact of delayed protective ileostomy closure	Delayed closure associated with increased postoperative complications	Timing is modifiable risk factor
Munshi et al[17], 2025	Multicenter retrospective cohort	Evaluate effect of delay on 90-day complications	Delayed reversal independently associated with higher complication rates	Multicenter validation of timing effect
Popazu et al[19], 2025	Retrospective; 148 HP reversals	Compare early vs delayed Hartmann reversal	Early (45-120 days) → fewer complications, shorter stay. Late reversal independently associated with complications	Supports early reversal when feasible
Oriel et al[22], 2017	Retrospective cohort; 114 reversals	Identify incidence and risk factors for hernias after stoma reversal	Incisional hernia 317%; risk factors: BMI, ASA ≥ 3, radiotherapy, deep SSI	Hernia risk stratification important for long-term outcomes
Tirelli et al[20], 2023	Retrospective; 126 patients	Identify predictors of Clostridium difficile infection after stoma reversal	CDI 4.8%; delayed reversal associated with higher CDI risk	Timing influences infectious morbidity
Peltrini et al[23], 2023	Retrospective; 145 patients	Evaluate postoperative morbidity after loop ileostomy reversal	Significant morbidity; risk influenced by urgency of primary surgery	Differentiates elective vs urgent index surgery
Abdulmohaymen[14], 2020	Prospective; 70 patients	Compare loop ileostomy vs loop colostomy complications including reversal	Higher reversal-related complications in ileostomy group (45.4% vs 13.5%)	Stoma type impacts reversal morbidity
Özcan et al[24], 2025	Retrospective cohort	Compare early vs late ileostomy closure complications	Evaluates complication rates based on timing	Adds evidence on timing-related morbidity

SSI: Surgical site infection; ACS-NSQIP: American College of Surgeons National Surgical Quality Improvement Program; COPD: Chronic obstructive pulmonary disease; BMI: Body mass index; ASA: American Society of Anesthesiologists; OR: Odds ratio; POI: Postoperative ileus; CDI: Clostridium difficile infection.