Background: Diverting stoma is often performed in rectal cancer surgery for reducing the consequences of possible anastomotic failure. Closing of stoma follows in most cases after a few months. The aim of our study was to evaluate morbidity and mortality after diverting stoma closure and to identify risk factors for complications of this procedure. Patients and methods: At our department, we have performed a retrospective cohort analysis of data for 260 patients with diverting stoma closure from 2003 to 2015. Age, stoma type, patient’s preoperative ASA score, surgical technique and time to stoma closure were investigated as factors which could influence the complication rate. Results: 218 patients were eligible for investigation. Postoperative complications developed in 54 patients (24.8%). Most common complications were postoperative ileus (10%) and wound infection (5%). Four patients died (1.8%). There was no effect on complication rate regarding type of stoma, closing technique, patient’s ASA status and patient age. The only factor influencing the complication rate was the time to stoma closure. We found that patients which had the stoma closed prior to 8 months after primary surgery had lower overall complication rate (p<0. 05). Conclusions: To reduce overall complication rate, our data suggest a shorter period than 8 months after primary surgery before closure of diverting stoma. As diverting stoma closure is not a simple operation, all strategies should be taken to reduce significant morbidity and mortality rate.

Background: Pro- and anti-inflammatory cytokines play an important role in abdominal sepsis. Studies suggest that the anti-inflammatory response is more detrimental to the patient with abdominal sepsis than the initial pro-inflammatory response. We therefore studied the serum levels of pro-inflammatory and anti-inflammatory interleukins in patients with abdominal sepsis treated by abbreviated laparotomy. Methods: We performed a prospective study of 42 patients treated by abbreviated laparotomy. The patients were divided into a high-risk (more than two procedures before abdominal closure) group (24 patients) and a low-risk (two or fewer procedures) group (18 patients). The differences and correlations between the serum levels of pro-inflammatory and anti-inflammatory cytokines on days one and ten after the initial procedure were assessed. Results: The mortality was significantly higher in the high-risk group (41.7% vs. 5.6% in the low-risk group; p = 0.012). IL-10 serum levels were significantly higher in the high-risk group (22.5 pg/mL (IQR 5.25)) compared to the low-risk group (12.15 pg/mL (IQR 6.725)) (p = 0.012). Age was significantly correlated with mortality (p = 0.007). The logarithmic value of IL-10 serum levels on day one (HR: 2.5; 95% CI: 1.109–5.638; p = 0.027) and the IL-10 cut-off value (HR: 3.816; 95% CI: 1.047–13.910; p = 0.042) were significantly correlated with worse disease course in multivariate analysis. Conclusions: Patients who exhibit a greater anti-inflammatory response on day one are at increased risk of a protracted course and higher mortality. IL-10 serum levels on day one after surgery predict a worse disease course in these patients and could be a useful marker of abdominal sepsis.