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Comparison of postoperative complication rates between a novel endoluminal balloon-assisted drainage and diverting stoma after low rectal cancer. Clin Transl Oncol 2022; 24:1347-1353. [PMID: 35029803 DOI: 10.1007/s12094-021-02775-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
AIM To introduce a novel endo-luminal balloon-assisted drainage (EBAD) and compare postoperative complication rates between EBAD and diverting stoma (DS) groups. METHODS The single center prospective non-random cohort study included a total of 163 patients in convenience patients with rectal cancer between January 2019 and January 2021. Out of 163 patients, 83 underwent DS and 80 EBAD. Primary endpoints were postoperative complication rate. RESULTS The total number of complications was 28 in the DS group vs. 22 in the EBAD group (P = 0.388). 18 patients (21.7%) in the DS group and 14 patients (17.5%) in the EBAD group developed postoperative complication (P = 0.501). There were no differences identified for anastomotic leak rates between the two groups (P = 0.677). The rate of the pelvic abscess was lower in the EBAD group (1/80, 1.3%) than in the DS group (4/83, 4.8%) but with no statistical significance (P = 0.386). Compared with the DS group, the median operative time was shorter in the EBAD group (225 vs. 173.5 min, P < 0.001). Regarding incomplete small bowel obstruction, a higher prevalence was observed in the DS group compared to the EBAD group (7.2% vs 2.5%, P = 0.301). 7 patients (11.3%) in the DS group developed a para-stomal hernia, while no patient suffered a catheter-related complication. The median postoperative hospital stay was shorter in the DS groups than in the EBAD group (7 vs 8 days, P = 0.009). The median residence time of endo-luminal balloon-assisted drainage was 5.41 days. The median average and total volume of drainage were 51.57 ml/day and 255 ml, respectively. CONCLUSION EBAD is feasible and safe with similar postoperative complications when compared with a DS. EBAD may replace DS after rectum resection.
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Yane Y, Hida JI, Chiba Y, Makutani Y, Ushijima H, Yoshioka Y, Iwamoto M, Wada T, Daito K, Tokoro T, Ueda K, Kawamura J. Effectiveness of negative pressure wound therapy with instillation and dwelling after stoma closure: a retrospective and propensity score matching analysis. Sci Rep 2022; 12:916. [PMID: 35042963 PMCID: PMC8766549 DOI: 10.1038/s41598-022-05016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 01/04/2022] [Indexed: 11/09/2022] Open
Abstract
The use of temporary diverting stoma has become more common in low colorectal anastomosis to reduce anastomotic complications. Surgical site infection (SSI) at the stoma closure site has been one of the most frequent postoperative complications. The aim of this study was to compare the short-term outcomes between conventional primary suture closure and negative pressure wound therapy with instillation and dwelling (NPWTi-d) therapy following purse-string suturing, using propensity score matching analysis. We retrospectively evaluated the medical records of 107 patients who underwent stoma closure between January 2016 and October 2020. The primary outcome was the proportion of SSI. The secondary outcome was the day of postoperative length of stay. Propensity score matching with one-to-one match was performed for reducing treatment selection bias. Of a total of 107 patients, 67 patients had been treated with conventional primary closure and 40 with NPWTi-d therapy. The propensity score matching derived 37 pairs. The respective SSI proportions were 0% and 16.2% in the groups with NPWTi-d and primary closure (P = 0.025). The respective median days of postoperative hospital stay were 9.0 and 10.0 in the groups with NPWTi-d and primary closure (P = 0.453). NPWTi-d therapy with purse-string suturing was effective in reducing SSI after stoma closure.
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Affiliation(s)
- Yoshinori Yane
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Jin-Ichi Hida
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Yasutaka Chiba
- Division of Biostatistics, Clinical Research Center, Faculty of Medicine, Kindai University, Osaka-sayama, Osaka, Japan
| | - Yusuke Makutani
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Hokuto Ushijima
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Yasumasa Yoshioka
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Masayoshi Iwamoto
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Toshiaki Wada
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Koji Daito
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Tadao Tokoro
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Kazuki Ueda
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Junichiro Kawamura
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osaka-sayama, Osaka, 589-8511, Japan.
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Jafari MD, Halabi WJ, Jafari F, Nguyen VQ, Stamos MJ, Carmichael JC, Mills SD, Pigazzi A. Morbidity of Diverting Ileostomy for Rectal Cancer: Analysis of the American College of Surgeons National Surgical Quality Improvement Program. Am Surg 2020. [DOI: 10.1177/000313481307901016] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
There is controversy regarding the potential benefits of diverting ileostomy after low anterior resection (LAR). This study aims to examine the morbidity associated with diverting ileostomy in rectal cancer. A retrospective review of LAR cases was performed using the American College of Surgeons National Surgical Quality Improvement Program (2005 to 2011). Patients who underwent LAR with and without diversion were selected. Demographics, intraoperative events, and postoperative complications were reviewed. Among the 6337 cases sampled, 991 (16%) received a diverting ileostomy. Patients who were diverted were younger (60 vs 63 years), predominantly male (64 vs 53%), and more likely to have received pre-operative radiation (39 vs 12%). There was no significant difference in steroid use, weight loss, or intraoperative transfusion. Postoperatively, there was no significant difference in length of stay, rate of septic complications, wound infections, and mortality. The rate of reoperation was lower in the diverted group (4.5 vs 6.9%). Diversion was associated with a higher risk-adjusted rate of acute renal failure (OR 2.4; 95% CI (1.2, 4.6); P < 0.05). The use of diverting ileostomy reduces the rate of reoperation but is associated with an increased risk of acute renal insufficiency. These findings emphasize the need for refinement of patient selection and close follow-up to limit morbidity.
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Affiliation(s)
- Mehraneh D. Jafari
- Department of Surgery, University of California, Irvine School of Medicine, Orange, California
| | - Wissam J. Halabi
- Department of Surgery, University of California, Irvine School of Medicine, Orange, California
| | - Fariba Jafari
- Department of Surgery, University of California, Irvine School of Medicine, Orange, California
| | - Vinh Q. Nguyen
- Department of Statistics, University of California Irvine, Irvine, California
| | - Michael J. Stamos
- Department of Surgery, University of California, Irvine School of Medicine, Orange, California
| | - Joseph C. Carmichael
- Department of Surgery, University of California, Irvine School of Medicine, Orange, California
| | - Steven D. Mills
- Department of Surgery, University of California, Irvine School of Medicine, Orange, California
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine School of Medicine, Orange, California
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Behuria N, Banerjee JK, Ghosh SR, Kulkarni SV, Saranga Bharathi R. Evidence-based adoption of purse-string skin closure for stoma wounds. Med J Armed Forces India 2020; 76:185-191. [PMID: 32476717 DOI: 10.1016/j.mjafi.2019.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 02/22/2019] [Indexed: 02/05/2023] Open
Abstract
Background Opinion is divided on the optimal technique of skin closure after stoma reversal as most conventional techniques compromise either on speed/neatness of wound apposition or on the incidence of surgical site infection (SSI). Evidence suggests that purse-string skin closure (PSSC) may achieve both objectives. This study aims to compare conventional primary closure (PC) with PSSC to determine the efficacious technique for stoma wound closure. Methods Patients undergoing stoma reversal between April 2015 and September 2017 were prospectively studied. Patients were divided into two groups based on the technique of skin closure (PC or PSSC). The following parameters were assessed: SSI, hospital stay, additional outpatient visit, wound healing time and patient satisfaction based on a standardised questionnaire. Results Forty one patients underwent stoma reversal (20 PSSC vs 21 PC). Wound infection, need for wound care, length of hospital stay, healing time and scar size were significantly less, whereas average patient wound satisfaction scores were significantly more in the PSSC group. Conclusion Purse-string skin closure (PSSC) proves efficacious and hence merits adoption as the technique of choice for closure of stoma wounds.
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Affiliation(s)
- Nilotpal Behuria
- Graded Specialist (Surgery & Gastro-intestinal Surgery), INS Patanjali, Karwar, India
| | - Jayant Kumar Banerjee
- Professor (Gastro-intestinal Surgery), Bharati Vidyapeeth Medical College, Pune, India
| | - Sita Ram Ghosh
- Consultant (Surgery), Command Hospital (Southern Command), Pune 411040, India
| | - Shrirang Vasant Kulkarni
- Classified Specialist ( (Surgery) & Gastro-intestinal Surgeon), Command Hospital (Central Command), Lucknow, India
| | - Ramanathan Saranga Bharathi
- Classified Specialist ( (Surgery) & Gastro-intestinal Surgeon), Command Hospital (Central Command), Lucknow, India
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Chung CTY, Baek SJ, Kwak JM, Kim J, Kim SH. Anastomotic Sinus That Developed From Leakage After a Rectal Cancer Resection: Should We Wait for Closure of the Stoma Until the Complete Resolution of the Sinus? Ann Coloproctol 2019; 35:30-35. [PMID: 30727707 PMCID: PMC6425247 DOI: 10.3393/ac.2018.08.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/13/2018] [Indexed: 12/17/2022] Open
Abstract
Purpose The aims of this study were to identify the clinical characteristics of an anastomotic sinus and to assess the validity of delaying stoma closure in patients until the complete resolution of an anastomotic sinus. Methods The subject patients are those who had undergone a resection of rectal cancer from 2011 to 2017, who had a diversion ileostomy protectively or therapeutically and who developed a sinus as a sequelae of anastomotic leakage. The primary outcomes that were measured were the incidence, management and outcomes of an anastomotic sinus. Results Of the 876 patients who had undergone a low anterior resection, 14 (1.6%) were found to have had an anastomotic sinus on sigmoidoscopy or a gastrografin enema before their ileostomy closure. In the 14 patients with a sinus, 7 underwent ileostomy closure as scheduled, with a mean closure time of 4.1 months. The remaining 7 patients underwent ileostomy repair, but it was delayed until after the follow-up for the widening of the sinus opening by using digital dilation, with a mean closure time of 6.9 months. Four of those remaining seven patients underwent stoma closure even though their sinus condition had not yet been completely resolved. No pelvic septic complications occurred after closure in any of the 14 patients with an anastomotic sinus, but 2 of the 14 needed a rediversion due to a severe anastomotic stricture. Conclusion Patients with an anastomotic sinus who had been carefully selected underwent successful ileostomy closure without delay.
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Affiliation(s)
| | - Se-Jin Baek
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jung-Myun Kwak
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jin Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seon-Hahn Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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Hajibandeh S, Hajibandeh S, Kennedy-Dalby A, Rehman S, Zadeh RA. Purse-string skin closure versus linear skin closure techniques in stoma closure: a comprehensive meta-analysis with trial sequential analysis of randomised trials. Int J Colorectal Dis 2018; 33:1319-1332. [PMID: 30074070 DOI: 10.1007/s00384-018-3139-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To compare purse-string skin closure (PSC) and linear skin closure (LSC) techniques in patients undergoing stoma closure METHODS: We conducted a systematic review of literature and meta-analysis of outcomes according to PRISMA statement standards to compare PSC and LSC techniques in stoma closure. Trial sequential analysis (TSA) was performed to assess the possibility of type I or II error and compute the information size required for conclusive meta-analysis. RESULTS We identified six randomised controlled trials (RCTs) and eight observational studies, enrolling a total of 1102 patients. The included populations in the PSC and LSC groups were comparable in terms of baseline characteristics. The risk of surgical site infection (SSI) was significantly lower in the PSC group (OR 0.10; 95% CI 0.06, 0.18; P < 0.00001). There was no difference between the two groups in terms of operative time (MD 1.80; 95% CI - 1.35, 4.96; P = 0.26), anastomotic leak (OR 0.73; 95% CI 0.21, 2.48; P = 0.61), incisional hernia (OR 0.59; 95% CI 0.25, 1.37; P = 0.22), small bowel obstruction (OR 0.96, 95% CI 0.50, 1.86; P = 0.91), and length of hospital stay (MD - 0.04; 95% CI - 0.51, 0.42; P = 0.86). Patient satisfaction was higher in the PSC group. TSA showed that the risk of type 1 error was minimal and meta-analysis was conclusive. CONCLUSIONS PSC is associated with significantly lower risk of SSI and better patient satisfaction compared with LSC in closure of stomas and should be the closure technique of choice. The current available evidence is robust and conclusive highlighting that the results of the current study should be incorporated into clinical practice without a need for further trial data.
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Affiliation(s)
- Shahab Hajibandeh
- Department of General Surgery, Royal Bolton Hospital, Bolton, UK. .,Department of General Surgery, North Manchester General Hospital, Manchester, UK.
| | - Shahin Hajibandeh
- Department of General Surgery, Stepping Hill Hospital, Stockport, UK
| | | | - Sheik Rehman
- Department of General Surgery, Royal Bolton Hospital, Bolton, UK
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Kalogera E, Nitschmann C, Dowdy S, Cliby W, Langstraat C. A prospective algorithm to reduce anastomotic leaks after rectosigmoid resection for gynecologic malignancies. Gynecol Oncol 2017; 144:343-347. [DOI: 10.1016/j.ygyno.2016.11.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/09/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
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Prospective analysis of indications and early complications of emergency temporary loop ileostomies for perforation peritonitis. Ann Gastroenterol 2015; 28:135-140. [PMID: 25609137 PMCID: PMC4289987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/21/2014] [Indexed: 11/07/2022] Open
Abstract
Background To determine the indications, nature, and rate of early complications of temporary loop ileostomy created in emergency for benign diseases, their management, and to find out the associated risk factors. Methods A total of 630 patients undergoing temporary loop ileostomy for benign diseases were studied prospectively over a period of 6 years. Stoma-related early complications occurring within 6-8 weeks were analyzed. Only emergency cases were included in this study. Descriptive statistics were used to summarize the data and statistical significance was evaluated by applying the Pearson’s chi-square test. Results Typhoid perforation (n=402) was the most commonpathology, followed by tuberculosis (n=106); trauma (n=81); and intestinal obstruction with gangrenous bowel (n=41). 299 patients had no stoma-related complications. Skin excoriation was the most commonstoma-related complication. Age more than 50 years; shock at presentation; delay in presentation; delay in surgery; presence of comorbidities; and surgery done out of working hours, were associated with increased complications. Conclusion Temporary loop ileostomy for perforation peritonitis due to benign systemic diseases like typhoid fever and tuberculosis confers a very high morbidity.
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Mennigen R, Sewald W, Senninger N, Rijcken E. Morbidity of loop ileostomy closure after restorative proctocolectomy for ulcerative colitis and familial adenomatous polyposis: a systematic review. J Gastrointest Surg 2014; 18:2192-200. [PMID: 25231081 DOI: 10.1007/s11605-014-2660-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 09/03/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Temporary loop ileostomy is a routine procedure to reduce the morbidity of restorative proctocolectomy. However, morbidity of ileostomy closure could reduce the benefit of this concept. The objective of this systematic review was to assess the risks of ileostomy closure after restorative proctocolectomy for ulcerative colitis or familial adenomatous polyposis. MATERIALS AND METHODS Publications in English or German language reporting morbidity of ileostomy closure after restorative proctocolectomy were identified by Medline search. Two hundred thirty-two publications were screened, 143 were assessed in full-text, and finally 26 studies (reporting 2146 ileostomy closures) fulfilled the eligibility criteria. Weighted means for overall morbidity and mortality of ileostomy closure, rate of redo operations, anastomotic dehiscence, bowel obstruction, wound infection, and late complications were calculated. RESULTS Overall morbidity of ileostomy closure was 16.5 %, there was no mortality. Redo operations for complications were necessary in 3.0 %. Anastomotic dehiscence occurred in 2.0 %. Postoperative bowel obstruction developed in 7.6 %, with 2.9 % of patients requiring laparotomy for this complication. Wound infection rate was 4.0 %. Hernia or bowel obstruction as late complications developed in 1.9 and 9.4 %, respectively. CONCLUSION The considerable morbidity of ileostomy reversal reduces the overall benefit of temporary fecal diversion. However, ileostomy creation is still recommended, as it effectively reduces the risk of pouch-related septic complications.
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Affiliation(s)
- Rudolf Mennigen
- Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Geb. W1, 48149, Muenster, Germany,
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Lee JT, Marquez TT, Clerc D, Gie O, Demartines N, Madoff RD, Rothenberger DA, Christoforidis D. Pursestring closure of the stoma site leads to fewer wound infections: results from a multicenter randomized controlled trial. Dis Colon Rectum 2014; 57:1282-9. [PMID: 25285695 DOI: 10.1097/dcr.0000000000000209] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Surgical site infection after stoma reversal is common. The optimal skin closure technique after stoma reversal has been widely debated in the literature. OBJECTIVE We hypothesized that pursestring near-complete closure of the stoma site would lead to fewer surgical site infections compared with conventional primary closure. DESIGN This study was a parallel prospective multicenter randomized controlled trial. SETTINGS This study was conducted at 2 university medical centers. PATIENTS Patients (N = 122) presenting for elective colostomy or ileostomy reversal were selected. INTERVENTIONS Pursestring versus conventional primary closure of stoma sites were compared. MAIN OUTCOME MEASURES Stoma site surgical site infection within 30 days of surgery, overall surgical site infection, delayed healing (open wound for >30 days), time to wound epithelialization, and patient satisfaction were the primary outcomes measured. RESULTS The pursestring group had a significantly lower stoma site infection rate (2% vs 15%, p = 0.01). There was no difference in delayed healing or patient satisfaction between groups. Time to epithelialization was measured in only 51 patients but was significantly longer in the pursestring group (34.6 ± 20 days vs 24.1 ± 17 days, p = 0.02). LIMITATIONS This study was limited by the variability in procedures and surgeons, the limited follow-up after 30 days, and the inability to perform blinding. CONCLUSION Pursestring closure after stoma reversal has a lower risk of stoma site surgical site infection than conventional primary closure, although wounds may take longer to heal with the use of this approach. REGISTRATION NUMBER NCT01713452 (www.clinicaltrials.gov).
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Affiliation(s)
- Janet T Lee
- 1Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 2Department of Surgery, Mercy Clinic, Saint Louis, Missouri 3Division of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Klink CD, Wünschmann M, Binnebösel M, Alizai HP, Lambertz A, Boehm G, Neumann UP, Krones CJ. Influence of skin closure technique on surgical site infection after loop ileostomy reversal: retrospective cohort study. Int J Surg 2013; 11:1123-5. [PMID: 24035923 DOI: 10.1016/j.ijsu.2013.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/28/2013] [Accepted: 09/02/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intestinal stoma closure is associated with high risk of surgical site infection (SSI) at stoma reversal site. The aim of this retrospective cohort study was to determine the outcome of purse string approximation (PSA) compared to primary linear closure (PLC) of the skin after loop ileostomy reversal. METHODS Data of 140 patients operated between 2005 and 2012 were analyzed in this two-center-study to determine the outcome of patients with either PSA (n = 44) or PLC (n = 96) after loop ileostomy reversal. RESULTS Patients in the PSA group were significantly older than in the PLC group (64 ± 15 vs. 57 ± 18; p = 0.026). Cardiac diseases were significantly more present in the PSA group in comparison to the PLC group (59% vs. 38%; p = 0.017). Stoma creation was significantly more often due to malignancy in the PSA group in comparison to the PLC group (68% vs. 50%; p = 0.044). SSI occurred significantly more often in the PLC group in comparison to the PSA group (17% vs. 5%; p = 0.047). CONCLUSIONS The risk for SSI is lower in patients with PSA in comparison to patients with PLC. In order to diminish SSI we recommend performing a PSA in patients with loop ileostomy reversal.
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Affiliation(s)
- C D Klink
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Germany.
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Dusch N, Goranova D, Herrle F, Niedergethmann M, Kienle P. Randomized controlled trial: comparison of two surgical techniques for closing the wound following ileostomy closure: purse string vs direct suture. Colorectal Dis 2013; 15:1033-40. [PMID: 23634717 DOI: 10.1111/codi.12211] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/04/2012] [Indexed: 02/08/2023]
Abstract
AIM Surgical site infection (SSI) is a common complication following ileostomy closure with a frequency of up to 40%. This prospective randomized controlled trial was initiated to compare two surgical techniques - direct suture (DS) and purse-string suture (PSS) - used to close the wound following ileostomy closure. The primary end-point was the SSI rate. Secondary end-points were cosmetic outcome [using two validated scales: the Patient and Observer Scar Assessment Scale (POSAS) and the Body Image Questionnaire (BIQ)] and the influence of other factors on the SSI rate. METHOD Of a total of 99 patients screened, 84 were included in this study. Forty-three patients were randomized into the PSS group and 41 were randomized into the DS group. Follow up was performed within 3 days after surgery, at discharge, and 30 days and 6 months after the operation. RESULTS In the PSS group there were no cases of SSI compared with 10 (24%) cases in the DS group (P = 0.0004). There were no statistically significant differences in cosmetic outcome between the two groups. No other statistically significant factors influencing the incidence of SSI could be identified. CONCLUSION The rate of SSI is significantly lower following PSS than following DS, and both techniques have a similar cosmetic outcome. PSS closure should be considered as standard of care for wound closure after ileostomy reversal.
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Affiliation(s)
- N Dusch
- Department of Surgery, University of Heidelberg, Mannheim, Germany
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Kalogera E, Dowdy SC, Mariani A, Weaver AL, Aletti G, Bakkum-Gamez JN, Cliby WA. Multiple large bowel resections: potential risk factor for anastomotic leak. Gynecol Oncol 2013; 130:213-8. [PMID: 23578541 PMCID: PMC3686884 DOI: 10.1016/j.ygyno.2013.04.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 03/27/2013] [Accepted: 04/02/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Identify risk factors of anastomotic leak (AL) after large bowel resection (LBR) for ovarian cancer (OC) and compare outcomes between AL and no AL. METHODS All cases of AL after LBR for OC between 01/01/1994 and 05/20/2011 were identified and matched 1:2 with controls for age (±5 years), sub-stage (IIIA/IIIB; IIIC; IV), and date of surgery (±4 years). Patient-specific and intraoperative risk factors, use of protective stomas, and outcomes were abstracted. A stratified conditional logistic regression model was fit to determine the association between each factor and AL. RESULTS 42 AL cases were evaluable and matched with 84 controls. Two-thirds of the AL had stage IIIC disease and >90% of both cases and controls were cytoreduced to <1cm residual disease. No patient-specific risk factors were associated with AL (pre-operative albumin was not available for most patients). Rectosigmoid resection coupled with additional LBR was associated with AL (OR=2.73, 95% CI 1.13-6.59, P=0.025), and protective stomas were associated with decreased risk of AL (0% vs. 10.7%, P=0.024). AL patients had longer length of stay (P<0.001), were less likely to start chemotherapy (P=0.020), and had longer time to chemotherapy (P=0.007). Cases tended to have higher 90-day mortality (P=0.061) and were more likely to have poorer overall survival (HR=2.05, 95% CI 1.18-3.57, P=0.011). CONCLUSIONS Multiple LBRs appear to be associated with increased risk of AL and protective stomas with decreased risk. Since AL after OC cytoreduction significantly delays chemotherapy and negatively impacts survival, surgeons should strongly consider temporary diversion in selected patients (poor nutritional status, multiple LBRs, previous pelvic radiation, very low anterior resection, steroid use).
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Affiliation(s)
| | - Sean C. Dowdy
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrea Mariani
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Amy L. Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | - William A. Cliby
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
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McCartan DP, Burke JP, Walsh SR, Coffey JC. Purse-string approximation is superior to primary skin closure following stoma reversal: a systematic review and meta-analysis. Tech Coloproctol 2013; 17:345-51. [DOI: 10.1007/s10151-012-0970-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/27/2012] [Indexed: 12/20/2022]
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15
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Åkesson O, Syk I, Lindmark G, Buchwald P. Morbidity related to defunctioning loop ileostomy in low anterior resection. Int J Colorectal Dis 2012; 27:1619-23. [PMID: 22576906 DOI: 10.1007/s00384-012-1490-y] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2012] [Indexed: 02/04/2023]
Abstract
AIM A defunctioning loop ileostomy in low anterior resection reduces the incidence and morbidity of an anastomotic leakage, but complications related to the stoma may occur. We explored stoma-associated complications during the stoma period and after stoma reversal. METHODS A retrospective analysis of rectal cancer patients operated with low anterior resection and a defunctioning loop ileostomy at Helsingborg Hospital and Malmö University Hospital from January 2007 to June 2009 was undertaken. RESULTS Ninety-two patients were included, of whom 82 (89 %) underwent stoma reversal. The median stoma period was 6.2 ± 3.2 months. Sixty-six percent of the patients suffered from minor or major stoma-associated morbidity. The complication rate was significantly related to the stoma time (p < 0.01). Twenty-nine percent (27/92) had at least one episode of dehydration, leading to readmittance in half of the cases. Elderly patients were more prone to develop dehydration. Dehydration most commonly occurred early in the postoperative period (mean, 5.8 weeks). The mean hospital stay for stoma reversal was 6.5 ± 4.0 days. Forty percent (33/82) had some complication associated with the reversal. CONCLUSION This study indicates high morbidity associated with defunctioning loop ileostomy. Our data suggest that the stoma time should be limited to reduce complications. Monitoring and early stoma reversal should be considered in elderly patients. Furthermore, stoma reversal is not uneventful, and more studies are needed to address how to minimize complications.
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Affiliation(s)
- Oscar Åkesson
- Colorectal Unit, Department of Surgery, Helsingborg Hospital, 251 87, Helsingborg, Sweden
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Gustavsson K, Gunnarsson U, Jestin P. Postoperative complications after closure of a diverting ileostoma--differences according to closure technique. Int J Colorectal Dis 2012; 27:55-8. [PMID: 21845418 DOI: 10.1007/s00384-011-1287-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to compare three methods for closure of a diverting ileostoma according to development of postoperative small-bowel obstruction (SBO) and anastomotic leakage (AL). METHODS Complications arising within 30 days after closure of a defunctioning loop ileostomy in 351 patients during the period 1999-2006 were studied retrospectively by evaluation of case records. The techniques employed were: hand-sewn anastomosis without bowel resection, hand-sewn anastomosis with bowel resection and stapled anastomosis. RESULTS Of the 351 patients, 149 had a hand-sewn anastomosis without bowel resection (HS), 70 had a hand-sewn anastomosis with bowel resection (HSR) and 132 patients had a stapled anastomosis (S). The total number of SBOs was 44 patients (12.5%). In the two hand-sewn groups, 15.5% (34 patients) suffered postoperative SBO compared to 7.6% (10 patients) in the stapled group (p = 0.029). No difference in AL could be found between the groups, where the overall frequency was 2.8% (10 patients). Median hospital stay was 6 days in the HS group, 5 days in the HSR group and 4 days in the S group (p = 0.001). CONCLUSION In the present study, stapled anastomosis was associated with a lower frequency of postoperative SBO and a shorter hospital stay compared to sutured anastomosis (either with or without a short small-bowel resection) after closure of a diverting ileostoma.
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Affiliation(s)
- Kajsa Gustavsson
- Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Karolinska Institutet, 141 85, Stockholm, Sweden.
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Closure of loop ileostomy: potentially a daycase procedure? Tech Coloproctol 2011; 15:431-7. [PMID: 22033543 DOI: 10.1007/s10151-011-0781-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 10/09/2011] [Indexed: 01/26/2023]
Abstract
BACKGROUND Four thousand four hundred and twenty-seven ileostomy closures were performed in the UK in 2008-2009, (35,432 bed days). None were recorded as being performed as a daycase procedure. Our aim is to evaluate the morbidity and mortality associated with this procedure and to investigate whether daycase surgery is feasible. METHOD Patients having closure of loop ileostomy were identified retrospectively from May 2005 to July 2010. The primary surgery, method of ileostomy closure, length of hospital stay and early (≤30 days) or late (>30 days) complications were recorded. RESULTS A total of 138 patients were evaluated. The median age was 63 (17-83) years and 64% were male patients. The primary surgery was predominantly anterior resection (74%). Median time from initial surgery to reversal was 37 (1-117) weeks. The median length of hospital stay was 4 (1-39) days. Applying a 23-h discharge protocol to our results excluded 18 patients categorised as ASA3. Ninety-six patients (80%) met the discharge criteria for a potential 23-h hospital stay. The expected readmission rate within 30 days of surgery was 12% (n = 14). 85 patients (71%) did not suffer an early complication. There were 35 early complications (30%), 10 general and 25 specific to the procedure, but serious only in 5%. There were no deaths in the eligible patients. CONCLUSION Closure of loop ileostomy in our series is safe, with a low serious morbidity rate. It may be feasible to perform reversal of ileostomy as a daycase/23-h stay. We intend to implement a 23-h stay for reversal of ileostomy.
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Beck-Kaltenbach N, Voigt K, Rumstadt B. Renal impairment caused by temporary loop ileostomy. Int J Colorectal Dis 2011; 26:623-6. [PMID: 21184086 DOI: 10.1007/s00384-010-1086-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2010] [Indexed: 02/04/2023]
Abstract
PURPOSE Creation of a temporary loop ileostomy is a standard surgical procedure. This study was undertaken to determine whether dehydration associated with the ileostomy causes renal impairment. METHODS The prospective data from 107 consecutive patients undergoing temporary loop ileostomy between 2004 and 2009 was evaluated. GFR was calculated at the time of hospital discharge after constructing the ileostomy and at the time of deciding to close the ileostomy. RESULTS The average GFR at the time of discharge after constructing the ileostomy was a median of 92.50 (60.75-223.88); at the time of deciding to close the ileostomy, it was 75.25 (4-135.13) ml/min/1.73 m(2) (p < 0.001). In 20 patients renal function decreased, with a GFR <60 ml/min/1.73 m(2) during the ileostomy period; in six of these 20 patients, the decrease was severe (GFR <30 ml/min/1.73 m(2)). Underlying diseases, reasons for constructing ileostomies, sex, and time interval to closure did not affect renal function. Patients in whom GFR was decreased at the time of deciding to close the ileostomy presented with significantly more closure-related surgical complications. CONCLUSIONS Renal impairment is a well-known potential complication of loop ileostomy. To avoid this complication, close control and backup support is recommended in these patients.
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Affiliation(s)
- Nicole Beck-Kaltenbach
- Surgical Department, Fürst Stirum Klinik Bruchsal, Gutleutstrasse 1-14, 76646, Bruchsal, Germany
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Balik E, Eren T, Bugra D, Buyukuncu Y, Akyuz A, Yamaner S. Revisiting stapled and handsewn loop ileostomy closures: a large retrospective series. Clinics (Sao Paulo) 2011; 66:1935-41. [PMID: 22086525 PMCID: PMC3203967 DOI: 10.1590/s1807-59322011001100014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 08/02/2011] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To compare the surgical outcomes of stapled and handsewn closures in loop ileostomies. METHODS The data of 225 patients requiring loop ileostomies from 2002 to 2007 were retrospectively evaluated. The patients underwent partial small-bowel resections and either handsewn or stapled anastomoses for the ileostomy closures. They were followed up postoperatively with routine surgical examinations. RESULTS The study group consisted of 124 men and 101 women with a mean age of 49.12 years. The ileostomy closure was performed with handsewn in 129 patients and with stapled in 96 patients. The mean time to the first postoperative flatus was 2.426 days in the handsewn group and 2.052 days in the stapled group (p <0.05). The mean time to the first postoperative defecation was 3.202 days in the handsewn group and 2.667 days in the stapled group (p <0.05). The mean duration of patient hospital stay was 8.581 days for the handsewn group and 6.063 days for the stapled group (p <0.05). CONCLUSIONS Patients who underwent ileostomy closure with stapled recovered faster in the postoperative period and required shorter hospital stays than those whose closures were performed with handsewn. In our opinion, stapled should be considered the gold standard for loop ileostomy closures.
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Affiliation(s)
- Emre Balik
- Department of General Surgery Millet Caddesi, General Surgery, Istanbul Faculty of Medicine, Istanbul University, Sehremini Capa, Turkey.
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Affiliation(s)
- Anna Boyles
- stoma care, King′s College Hospital, Denmark Hill, London SE5 9RS
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Wound Infection Following Stoma Takedown: Primary Skin Closure versus Subcuticular Purse-string Suture. World J Surg 2010; 34:2877-82. [DOI: 10.1007/s00268-010-0753-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Ihedioha U, Muhtaseb S, Kalmar K, Donnelly L, Muir V, Macdonald A. Closure of Loop Ileostomies: Is Early Discharge Safe and Achievable? Scott Med J 2010; 55:27-9. [DOI: 10.1258/rsmsmj.55.1.27] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A prospective audit of the complications associated with reversal of a loop ileostomy was carried out between March 2000 and March 2005. The complication rate, length of inpatient hospitalisation and re-admission rate were assessed in 100 patients, in a single clinical practice. The median (interquartile range) length of time between the primary procedure and closure was 133 days (120 – 270) days. Median length of inpatient stay was two days (one - three) days. The overall complication rate was 18 %. One patient had a post-operative leak leading to local abscess formation. This was drained surgically after initial failure with radiological drainage. A second patient had a late leak, three weeks after closure, leading to fistula formation. This patient required surgical resection of the anastomosis after failure of conservative management. Twelve patients were re-admitted with small bowel obstruction (12%), of whom 11 were managed conservatively, while one underwent further surgery. There was one post- operative death as a result of acute cardiac failure secondary to undiagnosed hypertensive cardiomyopathy. Thus early discharge following closure of a loop ileostomy, can be achieved with an acceptably low serious complication rate.
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Affiliation(s)
- U Ihedioha
- Department of General Surgery, Monklands Hospital, Airdrie, UK
| | - S Muhtaseb
- Audit Department, Monklands Hospital, Airdrie, UK
| | - K Kalmar
- Department of Anaesthetics, Monklands Hospital, Airdrie, UK
| | - L Donnelly
- Audit Department, Monklands Hospital, Airdrie, UK
| | - V Muir
- Department of Anaesthetics, Monklands Hospital, Airdrie, UK
| | - A Macdonald
- Department of General Surgery, Monklands Hospital, Airdrie, UK
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Saha AK, Tapping CR, Foley GT, Baker RP, Sagar PM, Burke DA, Sue-Ling HM, Finan PJ. Morbidity and mortality after closure of loop ileostomy. Colorectal Dis 2009; 11:866-71. [PMID: 19175627 DOI: 10.1111/j.1463-1318.2008.01708.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND A temporary loop ileostomy is commonly used to protect low pelvic anastomoses. Closure is associated with morbidity and mortality. This study investigated patterns of complications after loop ileostomy closure and factors associated with morbidity and mortality. METHOD A review was performed of patients who underwent loop ileostomy closure between 1999 and 2005. RESULTS Three hundred and twenty-five patients underwent closure of loop ileostomy. Reasons for primary surgery were: anterior resection for cancer (n = 160, 49%), ileal pouch-anal anastomosis (n = 114, 35%), diverticular disease (n = 25, 8%), Crohn's colitis (n = 4, 1%) and other conditions (n = 22, 7%). Overall mortality was 2.5% (n = 8) and morbidity was 22.8% (n = 74). Thirty-two patients (10%) developed small bowel obstruction, of whom seven required operative intervention. Overall, the re-operation rate in this series was 28 patients (8.6%). Thirteen (4%) patients had an anastomotic leak of whom 12 patients had re-operation. Preoperative anaemia was significantly associated with leakage (Hb < 11 g/dl; n = 65, P = 0.033). The leakage rate was lower after a stapled anastomosis than a hand-sutured anastomosis (4/203 vs 9/122; P = 0.039). Hypo-albuminaemia (albumin < 34 g/l) was significantly associated with mortality (n = 46, P < 0.001). CONCLUSIONS Loop ileostomy closure is associated with morbidity and mortality. Anaemia and hypo-albuminaemia may be associated with poor outcome.
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Affiliation(s)
- A K Saha
- The John Goligher Colorectal Unit, Research Room D156, D Floor, Clarendon Wing, Leads General Infirmary, Great George Street, Leeds LS1 3EX, UK.
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Giannakopoulos GF, Veenhof AAFA, van der Peet DL, Sietses C, Meijerink WJHJ, Cuesta MA. Morbidity and complications of protective loop ileostomy. Colorectal Dis 2009; 11:609-12. [PMID: 19175642 DOI: 10.1111/j.1463-1318.2008.01690.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The creation of a loop ileostomy is considered suitable to protect a distal anastomosis in colorectal surgery. This technique is, however, associated with failure, complications and even mortality. The aim of this study was to quantify retrospectively the morbidity associated with an ileostomy and its subsequent closure. METHOD One hundred and nineteen patients with a temporary loop ileostomy, created between January 2000 and July 2007 were retrospectively analysed from a review of patient records. RESULTS All ileostomies were closed after a median period of 106 days (interquartile range: 69-174 days). Stoma-related morbidity occurred in 23 (19%) patients. After ileostomy closure, 16 major complications were seen in 14 (12%) patients and 43 minor complications occurred in 25 (21%) patients. Sixty-three patients (53%) had neither stoma-related morbidity or peri- or postoperative complications after stoma closure. CONCLUSION Protective loop ileostomy was found to be associated with a high morbidity. This raises the question of the mode of identifying the specific patients with a low anastomosis who should be provided an ileostomy for protection, set against the potential complications of the formation and closure of the ileostomy.
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The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis 2009; 24:711-23. [PMID: 19221766 DOI: 10.1007/s00384-009-0660-z] [Citation(s) in RCA: 276] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Loop ileostomies are used currently in surgical practice to reduce the consequences of distal anastomotic failure following colorectal resection. It is often assumed that reversal of a loop ileostomy is a simple and safe procedure. However, many studies have demonstrated high morbidity rates following loop ileostomy closure. The aims of this systematic review were to examine all the existing evidence in the literature on morbidity and mortality following closure of loop ileostomy. METHOD A literature search of Ovid, Embase, the Cochrane database, Google Scholar and Medline using Pubmed as the search engine was used to identify studies reporting on the morbidity of loop ileostomy closure (latest at June 15th 2008), was performed. Outcomes of interest included demographics, the details regarding the original indication for operation, operative and hospital-related outcomes, post-operative bowel-related complications, and other surgical and medical complications. RESULTS Forty-eight studies from 18 countries satisfied the inclusion criteria. Outcomes of a total of 6,107 patients were analysed. Overall morbidity following closure of loop ileostomy was found to be 17.3% with a mortality rate of 0.4%. 3.7% of patients required a laparotomy at the time of ileostomy closure. The most common post-operative complications included small bowel obstruction (7.2%) and wound sepsis (5.0%). CONCLUSION The consequences of anastomotic leakage following colorectal resection are severe. However, the consequences of stoma reversal are often underestimated. Surgeons should adopt a selective strategy regarding the use of defunctioning ileostomy, and counsel patients further prior to the original surgery. In this way, patients at low risk may be spared the morbidity of stoma reversal.
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Milanchi S, Nasseri Y, Kidner T, Fleshner P. Wound infection after ileostomy closure can be eliminated by circumferential subcuticular wound approximation. Dis Colon Rectum 2009; 52:469-74. [PMID: 19333048 DOI: 10.1007/dcr.0b013e31819acc90] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Wound infections after ileostomy closure are common with primary closure of the skin. Although this risk can be reduced by secondary closure, cosmetic outcomes are less than desirable. In an effort to balance these issues, we have used circumferential subcuticular wound approximation to decrease wound size. This study compares outcomes of primary closure vs. circumferential subcuticular wound approximation after ileostomy closure. METHODS Forty-nine consecutive patients undergoing ileostomy closure over an 18-month period were reviewed. During the first half of this study, all ileostomy sites underwent primary closure, while during the second half all ileostomy sites underwent circumferential subcuticular wound approximation. Short-term outcomes were tabulated including wound infection. Long-term outcomes were assessed using a novel six-point patient satisfaction scale. RESULTS Primary closure was performed in 25 patients and circumferential subcuticular wound approximation performed in 24 patients. No wound infections occurred in the circumferential subcuticular wound approximation group, compared to 40 percent wound infection rate observed in the primary closure group (P = 0.002). The mean patient satisfaction score was higher in the circumferential subcuticular wound approximation group (18.4) vs. the primary closure group (15.9; P > 0.05). CONCLUSIONS Circumferential subcuticular wound approximation was associated with a significantly lower incidence of wound infection after ileostomy closure compared to primary closure. A trend was present toward better cosmetic results for circumferential subcuticular wound approximation than primary closure.
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Affiliation(s)
- Siamak Milanchi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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27
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Mansfield SD, Jensen C, Phair AS, Kelly OT, Kelly SB. Complications of loop ileostomy closure: a retrospective cohort analysis of 123 patients. World J Surg 2009; 32:2101-6. [PMID: 18563482 DOI: 10.1007/s00268-008-9669-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Loop ileostomies are often formed in order to defunction distal anastomoses. The aim of this study was to review the complications following closure of loop ileostomies. METHODS This is a retrospective case note analysis of all loop ileostomy closures performed in the Northumbria Healthcare NHS Trust (population over 500,000) over a 5-year period between 2001 and 2005. RESULTS A total of 123 case records were reviewed. Complications occurred in 41 patients (33.3%), with 9 patients (7.3%) requiring further intervention. There were 4 (3.3%) postoperative deaths. Complications were more common in patients with increased comorbidity (p = 0.0007) and postoperative death was more frequent among the elderly (p = 0.0006). Postoperative death was more common in those patients who had their stomas created during surgery (elective or emergency) for diverticular disease (3 patients, p = 0.006). Patients with diverticular disease had significantly higher comorbidity and peritoneal contamination at the time of primary surgery. Ileostomy reversal after anterior resection for cancer was associated with a lower complication rate than the rest of the cohort (26%, p = 0.0003) but there was no significant difference in mortality. Neither the grade of the surgeon, the case volume, or the anastomotic technique affected postoperative morbidity. Reoperation was more common in patients whose closure procedure took less time (p = 0.002) and in those who had a shorter wait from creation to reversal of the stoma (p < 0.0001). CONCLUSIONS Reversal of loop ileostomy may be associated with significant morbidity and mortality. Increasing the delay from creation to closure may result in fewer complications.There is an increased risk in older patients with more comorbidity, particularly when the primary procedure is for diverticular disease with significant peritoneal contamination.
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Affiliation(s)
- S D Mansfield
- Department of General Surgery, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK.
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Kim JY, Kim JS, Hur H, Min BS, Kim NK, Sohn SK, Cho CH. Complication and Relevant Factors after an Ileostomy for Fecal Diversion in a Patient with Rectal Cancer. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2009. [DOI: 10.3393/jksc.2009.25.2.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jeong Yeon Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Soo Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Hur
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soh Min
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyu Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Kook Sohn
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Hwan Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Kim DD, Kim EJ, Lee HO, Park IJ, Kim HC, Yu CS, Kim JC. The Complications of Stoma Take-down. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2008. [DOI: 10.3393/jksc.2008.24.2.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Dae Dong Kim
- Colorectal Clinic, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Eun Jung Kim
- Colorectal Clinic, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Hae Ok Lee
- Colorectal Clinic, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - In Ja Park
- Colorectal Clinic, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Hee Cheol Kim
- Colorectal Clinic, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Chang Sik Yu
- Colorectal Clinic, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
| | - Jin Cheon Kim
- Colorectal Clinic, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea
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Kartheuser A, Stangherlin P, Brandt D, Remue C, Sempoux C. Restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis revisited. Fam Cancer 2006; 5:241-60; discussion 261-2. [PMID: 16998670 DOI: 10.1007/s10689-005-5672-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Since restorative proctocolectomy (RPC) with ileal-pouch anal anastomosis (IPAA) removes the entire diseased mucosa, it has become firmly established as the standard operative procedure of choice for familial adenomatous polyposis (FAP). Many technical controversies still persist, such as mesenteric lengthening techniques, close rectal wall proctectomy, endoanal mucosectomy vs. double stapled anastomosis, loop ileostomy omission and a laparoscopic approach. Despite the complexity of the operation, IPAA is safe (mortality: 0.5-1%), it carries an acceptable risk of non-life-threatening complications (10-25%), and it achieves good long-term functional outcome with excellent patient satisfaction (over 95%). In contrast to the high incidence in patients operated for ulcerative colitis (UC) (15-20%), the occurrence of pouchitis after IPAA seems to be rare in FAP patients (0-11%). Even after IPAA, FAP patients are still at risk of developing adenomas (and occasional adenocarcinomas), either in the anal canal (10-31%) or in the ileal pouch itself (8-62%), thus requiring lifelong endoscopic monitoring. IPAA operation does not jeopardise pregnancy and childbirth, but it does impair female fecundity and has a low risk of impairment of erection and ejaculation in young males. The latter can almost completely be avoided by a careful "close rectal wall" proctectomy technique. Some argue that low risk patients (e.g. <5 rectal polyps) can be identified where ileorectal anastomosis (IRA) might be reasonable. We feel that the risk of rectal cancer after IRA means that IPAA should be recommended for the vast majority of FAP patients. We accept that in some very selected cases, based on clinical and genetics data (and perhaps influenced by patient choice regarding female fecundity), a stepwise surgical strategy with a primary IPA followed at a later age by a secondary proctectomy with IPAA could be proposed.
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Affiliation(s)
- Alex Kartheuser
- Colorectal Surgery Unit, St-Luc University Hospital, Université Catholique de Louvain (UCL), 10, Avenue Hippocrate, B-1200, Brussels, Belgium.
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Scarpa M, Sadocchi L, Ruffolo C, Iacobone M, Filosa T, Prando D, Polese L, Frego M, D'Amico DF, Angriman I. Rod in loop ileostomy: just an insignificant detail for ileostomy-related complications? Langenbecks Arch Surg 2006; 392:149-54. [PMID: 17131157 DOI: 10.1007/s00423-006-0105-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Accepted: 08/15/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS The aim of this prospective study was to validate a variant in the loop ileostomy construction to reduce peristomal pressure ulcers and, subsequently, the need of stoma therapist assistance and the frequency of changing the stoma appliance. PATIENTS AND METHODS We have enrolled 33 consecutive patients who underwent two stage restorative proctocolectomies. The first consecutive 13 patients operated on had their ileostomies constructed with a standard rod. In the following 20 patients, we placed a 5.3-mm suction catheter tube closed with a stitch to form a "ring" and without any stitches fixing it to the skin. RESULTS In the "ring" rod group 40% of patients did not report any complication compared to the 8% of patients in the standard rod group (p = 0.046). Pressure ulcers were absent in this group, while it affected 61% of the patients in the standard rod group (p < 0.001). Patients in the "ring" rod group needed significantly less assistance time by the stoma therapist (p < 0.01) and required significantly fewer stoma appliance changes (p < 0.01). In our institution, the overall cost for the complete management of a standard rod ileostomy was 73.16 (29.83-130.49) euro compared to 46.65 (23.15-93.48) euro for a "ring" rod ileostomy (p = 0.002). CONCLUSIONS The adoption of a "ring" rod configuration led to an elimination of pressure ulcers due to the rigid rod, a shorter time requirement for stoma care and a decreased number of appliances required and was subsequently associated with lower costs of assistance. A tighter fitting around the ileostomy that avoided stool infiltration improved the practical management of the stoma with a "ring" rod.
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Affiliation(s)
- Marco Scarpa
- Department of Surgical and Gastroenterological Science, Sezione di Clinica Chirurgica I, University of Padova, Padova, Italy.
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Abstract
OBJECTIVE Defunctioning loop ileostomies are used commonly to protect low colorectal anastomoses and thereby reducing the serious complications of leakage. However, they are associated with specific complications such as retraction. Traditionally, a supporting rod is placed as a bridge to support both limbs of the stoma in the hope of reducing the incidence of stomal retraction. There is little evidence in the published literature to support this practice. The aim of this study was to determine whether using an ileostomy rod would reduce the incidence of stomal retraction. METHOD A prospective, randomised controlled trial was performed in 60 consecutive patients who required a defunctioning loop ileostomy. Patients were allocated to either a 'bridge' or 'bridge-less' protocol. All the patients were assessed by dedicated stoma nurses for at least 3 months and until their stomas were closed. Their postoperative symptoms, including stoma activity and retraction rate, were recorded. RESULTS Between May 2001 and June 2004, 57 patients completed the study (28 bridge; 29 bridge-less). There were no significant differences in the retraction rate between the groups. No clinical anastomotic leakage was recorded and none of the patients required early closure. CONCLUSIONS If a loop ileostomy is constructed properly, stomal retraction is uncommon and routine use of a bridge is unnecessary.
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Affiliation(s)
- M Speirs
- Department of Surgery, Monklands Hospital, Airdrie, UK
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Thalheimer A, Bueter M, Kortuem M, Thiede A, Meyer D. Morbidity of temporary loop ileostomy in patients with colorectal cancer. Dis Colon Rectum 2006; 49:1011-7. [PMID: 16598401 DOI: 10.1007/s10350-006-0541-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE This study was designed to quantify the temporary loop ileostomy-related morbidity in patients with colorectal cancer and contrast the morbidity rates after ileostomy closure before, during, and after the start of adjuvant therapy. METHODS Between 1997 and 2004, 120 patients with colorectal carcinoma underwent colorectal resection and creation of a temporary loop ileostomy to protect the low anastomosis. Stoma-related complications and perioperative morbidity after ileostomy closure were assessed retrospectively by reviewing the medical records. RESULTS Sixteen of the 120 patients (13.3 percent) suffered stoma-related complications, requiring early ileostomy closure in three. After ileostomy closure, anastomotic leakage of the ileoileostomy occurred in 3 of the 120 patients (2.5 percent), 2 of them died postoperatively (1.7 percent). The rate of minor complications (16.7 percent in all patients) was much higher in patients undergoing adjuvant chemotherapy or radiochemotherapy (25.5 percent) than in patients receiving no additional therapy (9.2 percent). In the former patients, there was a trend toward fewer complications when ileostomy closure was performed before (12.5 percent), rather than during (42.9 percent) or after (21.2 percent), the start of adjuvant therapy. CONCLUSIONS The morbidity following closure of a temporary loop ileostomy in colorectal cancer patients is much higher in patients receiving adjuvant chemotherapy or radiochemotherapy. The morbidity, however, might possibly be lowered to the level of patients receiving no additional therapy if ileostomy closure is performed before the start of adjuvant therapy.
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Affiliation(s)
- Andreas Thalheimer
- Department of General Surgery, University of Wurzburg, Oberduerrbacherstrasse 6, 97080 Wurzburg, Germany.
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Kaidar-Person O, Person B, Wexner SD. Complications of Construction and Closure of Temporary Loop Ileostomy. J Am Coll Surg 2005; 201:759-73. [PMID: 16256921 DOI: 10.1016/j.jamcollsurg.2005.06.002] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 06/01/2005] [Indexed: 12/20/2022]
Affiliation(s)
- Orit Kaidar-Person
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston 33331, USA
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Abstract
INTRODUCTION A loop ileostomy is a suitable procedure for faecal diversion. A number of technical improvements and advancement in stoma management have made its creation a suitable alternative to a loop colostomy. We describe an alternative technique for securing a loop ileostomy and perform a retrospective review of this technique. PATIENTS & METHOD 40 patients who had a loop ileostomy performed as part of an abdominal procedure were reviewed. The loop of ileum was secured to the stoma site with a novel 'suture bridge' technique. RESULTS 32 patients had the stoma formed to protect a distal anastomosis, 6 to palliate bowel obstruction, 1 to control faecal incontinence and another for colonic Crohn's disease. There were no incidences of paralytic ileus, mechanical obstruction, prolapse, retraction or bleeding after the loop ileostomies were formed. Thirty patients had their ileostomies closed. In 27 patients this was performed by excising the muco-cutaneous edge and anterior closure. Three patients had their stomas resected and an end-to-end bowel anastomoses. Following closure there were two complications in separate patients--self-limiting paralytic ileus and small bowel obstruction at the site of the stomal closure that required a second operation. There were no incidences of anastomotic leaks or bleeding in patients who had their ileostomy closed. No mortalities were attributed to either stoma formation or closure. CONCLUSION We have described a safe alternative technique for securing a loop ileostomy with negligible complications in construction and closure as demonstrated in our results.
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Affiliation(s)
- J W Nunoo-Mensah
- Department of General Surgery, Furness General Hospital, Barrow-in-Furness, Cumbria, UK.
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Gunnarsson U, Karlbom U, Docker M, Raab Y, Påhlman L. Proctocolectomy and pelvic pouch--is a diverting stoma dangerous for the patient? Colorectal Dis 2004; 6:23-7. [PMID: 14692948 DOI: 10.1111/j.1463-1318.2004.00570.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE A diverting loop ileostomy was previously considered mandatory for minimizing the effects of septic complications in pelvic pouch surgery. During the past decade there has been a trend towards omission of the loop ileostomy without obvious signs of increased numbers of pouch complications or impaired long-term function. The aim of the present study was to evaluate the risk of complications associated with the construction and closure of the loop ileostomy itself. PATIENTS AND METHODS Complications following diverting loop ileostomies in 143 patients subjected to restorative pelvic pouch surgery during the period 1983-97 were studied retrospectively by evaluation of case records. RESULTS In the period between discharge after pelvic pouch surgery and closure of the loop ileostomy, 20 (14%) patients were hospitalized because of excessive stoma flow and 19 (13%) patients were treated for other surgical complications, of whom 10 (7%) required surgical intervention. In the early postoperative period (within 30 days) after closure of the loop ileostomy, 18 (13%) patients suffered complications necessitating surgery. Another 12 (8%) patients were hospitalized because of intestinal obstruction that could be treated conservatively. CONCLUSION The proportion of complications associated with diverting loop ileostomies in pelvic pouch surgery was considerable. A randomised controlled multicentre study is ethically defensible and is recommended.
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Affiliation(s)
- U Gunnarsson
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
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Abstract
OBJECTIVE: To evaluate the complications of the temporary loop ileostomy. METHOD: A retrospective study of 222 consecutive patients with low anterior resection, ileal pouch-anal anastomosis or continent ileostomy and a diverting loop ileostomy routinely fashioned during the primary operation. The loop ileostomy was closed in 213 patients (96%) during the minimum follow-up period of 15 months. RESULTS: Four patients (2%) required preterm closure of the ostomy due to stomal retraction (n = 3) or bowel obstruction (n = 1). Four patients were readmitted due to transient bowel obstruction that resolved without surgery. After closure of the loop ileostomy a total of 27 patients (13%) had complications. In 7 patients emergency re-operation was done due to small bowel obstruction (n = 5) or intra-abdominal abscess (n = 2). Elective re-operation was done in 5 patients for hernia at the site of the previous stoma. Despite the use of a loop ileostomy there was 1 postoperative death after the initial operation in consequence of anastomotic leakage. There was 1 death in consequence of closure of the loop ileostomy after 3 weeks due to intra-abdominal sepsis and heart failure. CONCLUSION: In this series closure of the ostomy wasassociated with one death (0.5%) and overall ostomy-related morbidity included the need to re-operate in 6%.
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Affiliation(s)
- O. Hallböök
- Department of Surgery, University Hospital, Linköping, Sweden Department of Surgery, Medical Center Hospital, Orebro, Sweden
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Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG. Quality of life with a temporary stoma: ileostomy vs. colostomy. Dis Colon Rectum 2000; 43:650-5. [PMID: 10826426 DOI: 10.1007/bf02235581] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The hypothesis is that the impact of a temporary stoma on a patient's daily life is determined by complications and related stoma care problems. METHOD A prospective clinical trial was performed, studying complications and social well-being of 37 patients with loop ileostomy and 39 patients with a loop colostomy (randomly assigned comparison). Patients were categorized according to degree of social restriction. The association between the degree of social restriction and the presence of stoma care problems and complications was assessed. Follow-up was scheduled every three months until the stoma was closed (94 percent). RESULTS There is no relation between stoma type (ileostomy or colostomy) and degree of social restriction (chi-squared test, P = 0.42). The more stoma care problems or complications seen, the higher the degree of social restriction: significantly more stoma care problems were seen in the completely isolated group of patients when compared with the patients who were less socially restricted (Spearman correlation coefficient 1 = 0.35, P = 0.003). Especially stoma leakage, peristomal skin irritation, dietary prescriptions, retraction, and prolapse of the stoma have significant impact on the patient's daily life. CONCLUSION Stoma surgery has a great influence on a patient's daily life. There is a clear relation between the number of stoma care problems and the degree of social restriction. Follow-up of stoma patients under close surveillance of stoma care nurse to minimize stoma care problems and a careful surgical technique are advocated for good stoma care.
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Affiliation(s)
- A W Gooszen
- Department of Surgery, University Hospital Utrecht, The Netherlands
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Abstract
OBJECTIVE A defunctioning loop ileostomy is often fashioned to protect distal colorectal anastomoses, with the aim of limiting the effect of any breakdown that may occur. However, its creation and subsequent closure may be associated with significant morbidity. The aim of this study was to evaluate the alternative use of an unopened loop ileostomy. PATIENTS AND METHODS Patients undergoing colorectal resection and distal anastomosis were given an unopened loop ileostomy instead of a conventional ileostomy. Any complications associated with the stoma and ease of closure were recorded for each patient. RESULTS Complications occurred in seven (58%) of the 12 patients included in the study. Replacement of the ileal loop was difficult in five patients, one patient developed a wound abscess and pseudomembranous colitis, and a further patient had a persistent post-operative pyrexia of unknown cause. CONCLUSION Despite the theoretical advantages of an unopened loop ileostomy, the results of this small study do not support the routine use of such a stoma as an adjunct to high risk colorectal anastomoses.
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Affiliation(s)
- Woodcock
- Department of Surgery, Scarborough Hospital, Scarborough, UK
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Phang PT, Hain JM, Perez-Ramirez JJ, Madoff RD, Gemlo BT. Techniques and complications of ileostomy takedown. Am J Surg 1999; 177:463-6. [PMID: 10414694 DOI: 10.1016/s0002-9610(99)00091-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We use a loop ileostomy for temporary fecal diversion because of ease of technical construction and assumed low complication rate. Here, we review our complications of loop ileostomy and takedown using three techniques of closure. METHODS We reviewed charts of all patients who had temporary ileostomies constructed during 1987 to 1995 (n = 366). Ileostomy takedown was performed in 339 patients using one of three closure techniques: enterotomy suture (65%), resection with handsewn anastomosis (20%), and stapled anastomosis (15%). Complications were recorded for pre-takedown and 30-day post-takedown intervals. RESULTS Overall complication rate was 28%. Pre-takedown complications occurred in 21 patients (5.7%), including small bowel obstruction (2.5%) and dehydration/electrolyte derangement (2.2%). Post-takedown complications occurred in 83 patients (24.5%), including wound infection (14.2%), small bowel obstruction (5%), anastomotic leak (2.9%), and 1 death from a cardiac event. Post-takedown obstruction was higher for closure using resection with sutured anastomosis (12%) compared with enterotomy suture (2.3%), P < or = 0.003. Stapled anastomosis had an intermediate rate of obstruction (7.7%). Anastomotic leak was similar between closure techniques. CONCLUSIONS Loop ileostomy and takedown are associated with low rates of serious complications (5% or less). As such, we continue to advocate use of loop ileostomy as a diversion procedure. Closure by enterotomy suture is preferred over resection. However, if resection is required, closure by stapled anastomosis is preferred over suture anastomosis.
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Affiliation(s)
- P T Phang
- Division of Colon and Rectal Surgery, University of Minnesota, St. Paul, USA
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Patel, Frost, Bearn, Allan. `Canoe closure' of loop ileostomy gives improved cosmesis compared with conventional closure. Colorectal Dis 1999; 1:155-7. [PMID: 23577763 DOI: 10.1046/j.1463-1318.1999.00024.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The cosmetic appearance of the abdominal scar following closure of loop ileostomy can result in puckering and tethering of the skin, together with a shallow depression. A technique to improve the cosmetic result which also facilitates an easier and more secure closure is described. PATIENTS AND METHODS A measured elliptical incision, five times greater in length than the ileostomy diameter, is marked. The skin ellipse, subcutaneous fat and ileo- stomy are mobilized together. The skin is removed and the ileostomy is closed with a stapler. This technique is compared with conventional techniques with regard to operative stay, complications and cosmetic appearance over an 18-month period. RESULTS The median operating time has been 50 min and post-operative stay 5 days. There have been no major complications. CONCLUSION This technique allows better access, improves on cosmesis and has a low complication rate.
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Affiliation(s)
- Patel
- Department of Surgery, The Good Hope Hospital NHS Trust, Sutton Coldfield, UK
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Abstract
PURPOSE This study was undertaken to review and summarize the complications of ileostomy and colostomy creation and subsequent closure. METHODS The English-language medical literature for at least the past 15 years was reviewed comprehensively. RESULTS Complications of surgery for the creation of end, loop, and "end loop" stomas are presented. Technical factors, which might influence complication rates, are discussed. Optimal management of ostomy complications is presented, especially for peristomal hernias. Similarly, techniques and complications for stoma closure are analyzed. CONCLUSIONS Stoma creation is not a trivial undertaking; careful surgical technique minimizes complications (which are relatively frequent), and promotes good ostomy function. Peristomal hernias are difficult to cure permanently. The morbidity of ileostomy and colostomy closure is also appreciable.
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Affiliation(s)
- P C Shellito
- Massachusetts General Hospital, and Department of Surgery, Harvard Medical School, Boston, USA
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Gooszen AW, Geelkerken RH, Hermans J, Lagaay MB, Gooszen HG. Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy. Br J Surg 1998; 85:76-9. [PMID: 9462389 DOI: 10.1046/j.1365-2168.1998.00526.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Loop ileostomy or loop transverse colostomy for temporary decompression of a left colonic anastomosis represents an important issue in abdominal surgery. METHODS A randomized study, comparing loop ileostomy (n = 37; group 1) or loop transverse colostomy (n = 39; group 2), was conducted. Patients were followed from construction to closure of the stoma. RESULTS Age, weight, sex and indication for surgery were similar in both groups. After stoma construction complications were reported in nine of 37 patients in group 1 and in one of 39 in group 2 (P < 0.01), leading to postoperative death in five of 37 in group 1 and one of 39 in group 2. In the period between stoma construction and closure significant differences were observed only in prolapse rate (one of 32 group 1, 16 of 38 group 2; P < 0.01), need for temporary adaptation of clothing (eight of 32 group 1, 22 of 38 group 2; P < 0.01) and dietary guidelines (23 of 32 group 1, four of 38 group 2; P < 0.01). One patient died in group 1 and four in group 2; the deaths were not stoma related. After stoma closure eight of 29 patients in group 1 had complications and there were two deaths compared with three of 32 and no deaths in group 2. CONCLUSION Both types of stoma carry a high complication rate with a considerable associated mortality rate. The interval between stoma construction and closure has substantial impact on social and economic status. Based on all three phases studied, routine use of transverse colostomy is advised if decompression of the left colon is indicated.
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Affiliation(s)
- A W Gooszen
- Department of Surgery, University Hospital of Utrecht, The Netherlands
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