Visceral fat-to-muscle ratio is associated with inflammatory ileus after excision of intestinal fistula with severe abdominal adhesions.

BACKGROUND: Postoperative inflammatory ileus (PII) is characterised by long-term re-obstruction, following temporary defecation. An intestinal fistula excision (IFE) with severe abdominal adhesions could increase the risk of PII in patients with sarcopenia. On the other hand, the postoperative outcomes are negatively impacted owing to chronic preoperative inflammation, as measured by the visceral fat area (VFA) and the total abdominal muscle area index (TAMAI) ratio. This study aims to evaluate the predictability of VFA/TAMAI for postoperative PII after IFE. METHODS: Four tertiary centres participated in this retrospective cohort study. Patients with sarcopenia who underwent IFE between January 2018 and October 2022 were enrolled. VFA/TAMAI was evaluated as a risk factor for PII. RESULTS: We included 177 eligible patients (102 [57.6%] males) with a median age of 51 years (interquartile range [IQR]: 38-61 years) in this study. PII occurred in 16.9% of patients (n = 30), with an interval of four days (IQR: 3-5 days) between IFE and temporary defecation. The duration of the re-obstruction after temporary defecation was 23 days (IQR: 21-30 days), following temporary defecation that lasted for one days (IQR: 1-2 days). The adjusted logistic regression revealed that VFA/TAMAI was associated with PII (odds ratio = 1.51, 95% confidence interval: 1.02-2.19; p = 0.03). CONCLUSION: VFA/TAMAI was associated with inflammatory ileus after IFE with severe abdominal adhesions in patients with sarcopenia.