Authors: Peter James Mbelle, Simba Kizigina, Masumbuko Mwashambwa.
Background: In advanced and developing countries stomas are commonly applied to clients , which can either be colostomy or ileostomy. These stomas are associated with post operative complications which might be the causal factors for the morbidity and mortality to our surgical patients. This study focus and analyse the indications of stoma creation, it also explores early outcome predictors of stoma closure.
Objective: The aim of this study was to determine the indications for stoma creation and early outcome predictors of stoma closure.
Methodology: The study was prospective, descriptive cross-sectional done at BMH, DRRH and IRRH from June 2021 to August 2022. The structured questionnaire was used as a tool for data collection. The information was obtained from patients, case notes or register book. Convenient sampling technique was used to select clients. Clavien-Dindo tool was used for grading severity of post-operative complications, chi-square, binary and multivariate logistic regression were used to establish association between predictor and outcome variables. SPSS was used for analysis.
Results: A total of 194 subjects were enrolled in this study. There were 140 males (72.2%) and 54 females (27.8%) with male to female ratio of 3:1. Colostomy was the leading type of stoma created at 133 (68.6%) followed by ileostomy 61 (31.4%). Commonest indications for colostomy were sigmoid volvulus 75 (56.4%) and colo-rectal carcinoma 43 (32.3%). Ileostomy was commonly indicated in enteric perforation 24 (39.4%) and ileal trauma 20 (32.8%).
Overall post-stoma closure complications were noted in 78 (40.2%), colostomy contributed by 60 (30.9%) and ileostomy at 18 (9.3%). The noted post-operative complications were deep & organ/space SSI 52 (26.8%), AL & ECF 21 (10.8%) and IO 05 (2.6%). Clavien-Dindo tool showed 78 (40.2%) unfavorable and 08 (4.1%) favorable outcomes.
Binary logistic regression showed predictors of complications to be blood transfusion (p<0.001), hypo-albuminemia (p<0.001) and colostomy closure (p=0.041). Multivariate logistic regression showed hypo-albuminemia (p=0.002) a significant early outcome predictor of stoma closure.
Conclusion: Hypo-albuminemia was shown to be important prognostic indicator for complications following stoma closure. The stomas were commonly indicated in sigmoid volvulus and enteric ileal perforation, and predominant post stoma closure complications were surgical site infection (SSI).
Clavien-Dindo scoring system was also shown to be effective for grading severity of post-operative complications.
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