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

doi:10.4292/wjgpt.v17.i2.120325

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Publication Name

World Journal of Gastrointestinal Pharmacology and Therapeutics

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2150-5349

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Pharmacol Ther. Jun 5, 2026; 17(2): 120325
Published online Jun 5, 2026. doi: 10.4292/wjgpt.v17.i2.120325

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

Rohit Sangwan, Himanshu Agrawal, Nitin Agarwal, Haleema Ather, Peeyush Kumar, Nikhil Gupta

Rohit Sangwan, Haleema Ather, Peeyush Kumar, Nikhil Gupta, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi 110001, Delhi, India

Himanshu Agrawal, Department of Surgery, University College of Medical Sciences (University of Delhi), GTB Hospital, Delhi 110095, India

Nitin Agarwal, Department of Surgical Disciplines, Postgraduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, Delhi 110001, India

Co-first authors: Rohit Sangwan and Himanshu Agrawal.

Co-corresponding authors: Nitin Agarwal and Nikhil Gupta.

Author contributions: Sangwan R contributed to conceptualization, data curation, formal analysis, investigation, methodology, writing-original draft preparation; Agrawal H contributed to conceptualization, supervision, methodology, validation, critical revision of the manuscript for important intellectual content, final approval of the version to be published; Agarwal N contributed to investigation, data acquisition, clinical oversight, resources, manuscript review and editing; Ather H contributed to data curation, statistical analysis support, manuscript drafting assistance; Kumar P contributed to methodology support, interpretation of data, manuscript review and editing; Gupta N contributed to supervision, project administration, critical revision of the manuscript, final approval of the manuscript; Sangwan R and Agrawal H have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper; Agarwal N and Gupta N have played important and indispensable roles in the manuscript preparation as the co-corresponding authors.

AI contribution statement: No AI tools such as ChatGPT, Grammarly, DeepL, or similar platforms were used to generate the scientific content of this manuscript. The authors used ChatGPT (OpenAI) for language refinement and editing without altering the manuscript's scientific content, interpretation, or conclusions. All scientific content and interpretation were developed and verified by the authors. No AI tool contributed to the study design, data analysis, or interpretation of results. All intellectual input and scientific decisions were made solely by the authors. No images, figures, or graphical content included in this manuscript were generated using AI.

Institutional review board statement: Institutional Review Board approval was obtained [No. TP (MD/MS) (177/2024)/IEC/ABVIMS/RMLH/177].

Clinical trial registration statement: This study was retrospectively registered in Thai clinical trial registry, TCTR ID: TCTR20260222005.

Informed consent statement: Written informed consent was obtained from all participants prior to enrollment in the study. Patients were informed about the purpose of the study, data collection procedures, and confidentiality safeguards. Participation was voluntary, and refusal to participate did not affect clinical care.

Conflict-of-interest statement: All authors declare that they have no conflicts of interest relevant to this manuscript.

CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.

Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. De-identified participant data may be shared in accordance with institutional policies and ethical regulations.

Corresponding author: Nitin Agarwal, Department of Surgical Disciplines, Postgraduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, Delhi 110001, India. drnitinagarwal72@gmail.com

Received: February 24, 2026
Revised: March 2, 2026
Accepted: April 7, 2026
Published online: June 5, 2026
Processing time: 93 Days and 2.7 Hours

Abstract

BACKGROUND

Stoma reversal is often considered a low-risk elective procedure; however, postoperative morbidity remains clinically significant. Evidence identifying predictors of meaningful complications, particularly from resource-limited settings, is limited.

AIM

To identify risk factors associated with Clavien-Dindo grade II and above complications following stoma reversal surgery.

METHODS

This prospective analytical study was conducted at a tertiary care center between February 2024 and June 2025. Adult patients undergoing elective stoma reversal were included and followed for 30 days postoperatively. Demographic, clinical, and operative variables-including age, etiology, type of index surgery, timing of reversal, type of anastomosis, and anastomosis time-were analyzed. Postoperative complications were graded using the Clavien-Dindo classification. Secondary outcomes included postoperative ileus and length of hospital stay.

RESULTS

Clinically significant complications were observed in a substantial proportion of patients. Advanced age and longer anastomosis time were significantly associated with Clavien-Dindo grade ≥ II complications, postoperative ileus, and prolonged hospital stay. In contrast, type of stoma and anastomotic technique were not independent predictors of high-grade complications.

CONCLUSION

Stoma reversal carries a measurable risk of morbidity and should not be regarded as a minor procedure. Patient-related factors and operative complexity play a greater role in determining outcomes than technical variations alone. Careful patient selection, preoperative optimization, and strategies to minimize anastomosis time are essential to improve postoperative outcomes.

Keywords: Stoma reversal; Ileostomy closure; Postoperative complications; Clavien-Dindo classification; Postoperative ileus

Core Tip: Stoma reversal is frequently perceived as a minor elective procedure, yet it carries a significant risk of postoperative morbidity. In this prospective study, advanced age and longer anastomosis time emerged as the strongest predictors of clinically significant (Clavien-Dindo grade ≥ II) complications, postoperative ileus, and prolonged hospital stay, whereas type of stoma and anastomotic technique were not independent risk factors. These findings emphasize that stoma reversal should be approached as a major abdominal operation, with careful patient selection, preoperative optimization, and operative strategies aimed at minimizing anastomosis time to improve outcomes.