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Ocaña J, García-Pérez JC, Labalde-Martínez M, Rodríguez-Velasco G, Moreno I, Vivas A, Clemente-Esteban I, Ballestero A, Abadía P, Ferrero E, Fernández-Cebrián JM, Die J. Can physiological stimulation prior to ileostomy closure reduce postoperative ileus? A prospective multicenter pilot study. Tech Coloproctol 2022; 26:645-653. [PMID: 35596903 DOI: 10.1007/s10151-022-02620-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/04/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to assess the impact of ileostomy closure following preoperative physiological stimulation (PPS) on postoperative ileus (POI) in patients with loop ileostomy after low anterior resection for rectal cancer. METHODS Patients who underwent ileostomy closure between January 2017 and February 2020 in two tertiary referral centers were prospectively included. PPS stimulation was compared to standard treatment. Stimulation was carried out daily during the 15 days prior to ileostomy closure by the patient's self-instillation of 200 ml of fecal contents from the ileostomy bag via the efferent loop, using a rectal catheter. Standard treatment (ST) consisted of observation. Outcomes measures were POI, morbidity, stimulation feasibility, and predictors to ileus. RESULTS A total of 58 patients were included [42 males and 16 females, median age 67 (43-85) years]. PPS was used in 24 patients, who completed the entire stimulation process, and ST in 34 patients. No differences in preoperative factors were found between the two groups. POI was significantly lower in the PPS group (4.2%) vs the ST group (32.4%); p < 0.01, OR: 0.05 (CI 95% 0.01-0.65). The PPS group had a shorter time to restoration of bowel function (1 day vs 3 days) p = 0.02 and a shorter time to tolerance of liquids (1 day vs 2 days), p = 0.04. Age (p = 0.01), open approach at index surgery, p = 0.03, adjuvant capecitabine (p = 0.01). and previous abdominal surgeries (p = 0.02) were associated with POI in the multivariate analysis. C-reactive-protein values on the 3rd (p = 0.02) and 5th (p < 0.01) postoperative day were also associated with POI. CONCLUSIONS PPS for patients who underwent ileostomy closure after low anterior resection for rectal cancer is feasible and might reduce POI.
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Affiliation(s)
- J Ocaña
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain.
| | - J C García-Pérez
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - M Labalde-Martínez
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - G Rodríguez-Velasco
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - I Moreno
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - A Vivas
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | | | - A Ballestero
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - P Abadía
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - E Ferrero
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - J M Fernández-Cebrián
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - J Die
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
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Zhou T, Zhang X, Yu X, Bai Y, Chen H, Li J, Li H, Yu Y. Modified method for reconstruction of thumb abduction function in children undergoing surgical treatment of thumb duplication. J Child Orthop 2021; 15:97-105. [PMID: 34040655 PMCID: PMC8138790 DOI: 10.1302/1863-2548.15.200197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE This study was performed to evaluate a modified method of reconstructing the thumb abduction function in children undergoing surgical treatment of thumb duplication. METHODS This retrospective study included 33 children (38 thumbs) with Wassel type III to VII thumb duplication who underwent excision of the polydactylism and osteotomy of the preserved thumb. Among them, 16 children (19 thumbs) underwent reconstruction of the attachment of the articular capsule and collateral ligament of the metacarpophalangeal joint, abductor pollicis brevis and flexor pollicis brevis by the anchor technique (Group A), while 17 children (19 thumbs) underwent suturing the attachment of the above-mentioned soft tissues to the periosteum (Group B). All children were followed up for six years after surgery. The appearance, function and joint stability of the preserved thumb were compared between the two groups; the bone alignment and development were observed. RESULTS The deformity rate of preserved thumbs and the positive rate of lateral stress test were significantly lower in Group A than B (p < 0.05). The modified Tada score and the distance of first web were significantly higher in Group A than B (p < 0.05). Flexion, extension, adduction, abduction and palmar movement of the thumbs were good; bone alignment and development were good and no osteophyte or anchor shadow was left in the preserved thumbs in Group A. CONCLUSION Reconstruction of the abduction function using the anchor technique is effective in children undergoing surgical treatment for Wassel type III to VII thumb duplication and it may be superior to the conventional technique. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tong Zhou
- Hebei Medical University, NO.361 East Zhongshan Road, Shijiazhuang 050017, Hebei, People’s Republic of China.,Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China.,Department of Hand Surgery, The Second Hospital of Tangshan, NO.21 North Jianshe Road, Tangshan 063000, Hebei, People’s Republic of China
| | - Xu Zhang
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China
| | - Xiaofei Yu
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China
| | - Yanbin Bai
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China
| | - Huan Chen
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China
| | - Jia Li
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China
| | - Hongjie Li
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China
| | - Yadong Yu
- Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China.,Correspondence should be sent to Yadong Yu, Department of Hand Surgery, The Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China. E-mail:
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The effect of a diverting stoma on morbidity and risk of permanent stoma following anastomotic leakage after low anterior resection for rectal cancer: a nationwide cohort study. Int J Colorectal Dis 2020; 35:1903-1910. [PMID: 32537700 DOI: 10.1007/s00384-020-03625-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diverting stomata (DS) have been shown to mitigate the clinical impact of anastomotic leakage (AL) but not without complications, and their routine use remains a matter of international debate. The objective of this study was to examine the association between stomata and the clinical consequences of AL. METHODS This was a nationwide retrospective cohort study including all patients suffering from AL after low anterior resection from 2001 to 2010. RESULTS Four thousand sixty-three patients were treated in the period of whom 581 (11.9%) developed AL. In case of AL, patients without a diverting stoma had a slightly higher 90-day mortality rate (13.5% versus 8.7%, p = 0.089). Patients suffered more complications due to AL, both surgical (52% versus 28%, p < 0.001) and non-surgical (48% versus 35%, p = 0.004) with a higher Clavien-Dindo score. Twenty percent of patients developed stoma-related complications prior to stoma reversal. Mortality related to stoma reversal was 2.4%. Factors associated with a risk of a permanent stoma were age (HR 1.04, 95% CI 1.01-1.08), blood transfusion during primary surgery (HR 2.35, 95% CI 1.16-4-78), conserved anastomosis after AL (HR 0.019, 95% CI 0.009-0.04), and a diverting stoma fashioned at the index operation (HR 0.50, 95% CI 0.26-0.97). CONCLUSION The use of diverting stomata during low anterior resection mitigates the clinical impact of AL. However, this benefit needs to be balanced against the risk of stoma-related complications, seen in 20%, and mortality with stoma reversal (2.4%). Where practical, the decision to divert should be made pre-operatively in a multidisciplinary setting.
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Garfinkle R, Savage P, Boutros M, Landry T, Reynier P, Morin N, Vasilevsky CA, Filion KB. Incidence and predictors of postoperative ileus after loop ileostomy closure: a systematic review and meta-analysis. Surg Endosc 2019; 33:2430-2443. [PMID: 31020433 DOI: 10.1007/s00464-019-06794-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/09/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Postoperative ileus (POI) is regarded as the most clinically significant morbidity following loop ileostomy closure; however, its incidence remains poorly understood. Our objective was therefore to determine the pooled incidence of POI after loop ileostomy closure and identify risk factors associated with its development. METHODS We systematically searched MEDLINE (via Ovid and PubMed), Embase, the Cochrane Library, Biosis Previews, and Scopus to identify studies reporting the incidence of POI in patients who underwent loop ileostomy closure. Two independent reviewers extracted data and appraised study quality. Cumulative incidence proportions were pooled across studies using a random-effects meta-analytic model. RESULTS Sixty-seven studies, including 9528 patients, met our inclusion criteria. The pooled estimate of POI was 8.0% (95% CI 6.9-9.3%; I2 = 74%). The estimated incidence varied by POI definition: studies with a robust definition of POI (n = 8) demonstrated the highest estimate of POI (12.4%, 95% CI 9.2-16.5%; I2 = 79%) while studies that did not report an explicit POI definition (n = 38) demonstrated the lowest estimate (6.7%, 95% CI 5.3-8.3%; I2 = 61%). Small bowel anastomosis technique (hand-sewn) and interval time from ileostomy creation to closure (longer time) were the factors most commonly associated with POI after loop ileostomy closure. However, most comparative studies were not powered to examine risk factors for POI. CONCLUSIONS POI is an important complication after loop ileostomy closure, and its incidence is dependent on its definition. More research aimed at studying this complication is required to better understand risk factors for POI after loop ileostomy closure.
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Affiliation(s)
- Richard Garfinkle
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Paul Savage
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada.,Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Marylise Boutros
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Tara Landry
- Medical Libraries, McGill University Health Center, Montreal, QC, Canada
| | - Pauline Reynier
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Nancy Morin
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Carol-Ann Vasilevsky
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Kristian B Filion
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. .,Department of Medicine, McGill University, Montreal, QC, Canada.
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Luglio G, Terracciano F, Giglio MC, Sacco M, Peltrini R, Sollazzo V, Spadarella E, Bucci C, De Palma GD, Bucci L. Ileostomy reversal with handsewn techniques. Short-term outcomes in a teaching hospital. Int J Colorectal Dis 2017; 32:113-118. [PMID: 27599702 DOI: 10.1007/s00384-016-2645-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Fecal diversion is considered an effective procedure to protect bowel anastomosis at high risk for leak. Some concerns exist regarding the risk for a significant morbidity associated to ileostomy creation itself and moreover to its closure. Surgical expertise and closure techniques are considered potential factors influencing morbidity. Aim of the study is to present a single-institution experience with ileostomy closures, in a teaching hospital, whereas ileostomy reversal is mainly performed by young residents. METHODS A prospective database was investigated to extract data of patients who underwent loop ileostomy closure between January 2005 and December 2014. Ileostomy reversion was always realized in a handsewn fashion, performing either a direct closure (DC) or a resection plus end-to-end anastomosis (EEA). Postoperative morbidity was graded according to Clavien-Dindo classification. Outcomes after DC and EEA were compared by Fisher's exact test and Wilcoxon rank-sum test. RESULTS Two hundred ninety-eight patients were included. Ileostomy reversal was performed by EEA in 236 patients (79.19 %) and by DC in 62 patients (20.81 %). Surgery was performed with a peristomal access in 296 cases (99.33 %). Incidence of anastomotic leak was 0.67 % (2/298). Overall reoperation rate was 0.34 % (1/298). Short-term overall morbidity rate was 20.47 %; but major complications (≥ grade III) occurred in only one patient (0.34 %). Mortality was nil. No significant differences in postoperative morbidity were found between the DC and EEA group. CONCLUSION Loop ileostomy reversal is a safe procedure, associated to a low major morbidity and excellent results, even if performed with a handsewn technique by supervised trainee surgeons.
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Affiliation(s)
- Gaetano Luglio
- Department of Clinical Medicine and Surgery, University of Naples Federico II-Italy, Via Stellato, 26, 81054, San Prisco, CE, Italy. .,Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Napoli, Italy.
| | - Francesco Terracciano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Napoli, Italy
| | - Mariano Cesare Giglio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Napoli, Italy
| | - Michele Sacco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Napoli, Italy
| | - Roberto Peltrini
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Napoli, Italy
| | - Viviana Sollazzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Napoli, Italy
| | - Emanuela Spadarella
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Napoli, Italy
| | - Cristina Bucci
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Napoli, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Napoli, Italy
| | - Luigi Bucci
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Napoli, Italy
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Low or Ultralow Anterior Resection of Rectal Cancer Without Diverting Stoma: Experience with 28 Patients. Indian J Surg 2016; 77:423-6. [PMID: 26730038 DOI: 10.1007/s12262-013-0863-y] [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: 09/18/2012] [Accepted: 01/17/2013] [Indexed: 10/27/2022] Open
Abstract
A diverting temporary stoma is frequently used to decrease the chance of anastomosis leakage in the middle and lower rectum cancer surgeries, but its role in preventing the leakage is still doubtful. This study has been designed to evaluate any possible anastomosis complications after a rectum resection and a low or ultralow anastomosis when no diverting stoma is applied in patients with rectal cancer. Twenty-eight patients suffering from rectal cancer were treated by a low anterior resection between the years 2005 and 2008 in Imam Reza University Hospital, Mashhad, Iran. Out of the 28 patients, 6 patients had already undergone a course of neoadjuvant radiotherapy. Anastomosis was performed manually in 23 patients, using a stapler in 5 of them. None of the patients had a diverting stoma. Then, the outcome was evaluated. Fecal incontinence occurred in one of the patients (6.7 %) who had already undergone a course of radiotherapy preoperatively and had a stapler used for anastomosis. No leakage was detected in any of them. The very low incidence of complications in this study, such as those not preventable by a diverting stoma, suggest a very low chance of leakage in low or ultralow anastomosis in patients with rectal cancer and in those who were treated with neoadjuvant radiotherapy.
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Abstract
BACKGROUND Postoperative ileus is the most common complication after ileostomy closure with an increase in morbidity, hospital stay, and health care costs. OBJECTIVE The aim of this study is to assess the utility of a new technique for reducing postoperative ileus after protective ileostomy closure. DESIGN This is a prospective randomized study registered at ClinicalTrials.gov (NCT01881594). Patients were randomly assigned to undergo either stimulation through the efferent limb of the ileostomy before surgery or nonstimulation before surgery. SETTING This study was conducted at the Department of Surgery of the Virgen de la Arrixaca Clinical University Hospital (Murcia). PATIENTS Seventy patients underwent surgery for ileostomy closure. In 35 patients, during the 2 weeks before surgery, daily stimulation of the defunctionalized stomal segment was performed by using a thick solution (500 mL of physiological saline associated with 30 g of thickening agent, Nestle Resource, Vevey, Switzerland). In the other 35 patients, stimulation was not performed before surgery. MAIN OUTCOME MEASURES The primary outcome was postoperative ileus. The secondary outcomes included time to tolerating a diet and postoperative stay. RESULTS Both groups of patients were homogenous for demographic data, characteristics of the first rectal cancer operation, and intersurgery periods. After ileostomy closure, the stimulated group of patients had an earlier return to oral tolerance (1.06 vs 2.57 days; p = 0.007) and passage of flatus or stool (1.14 vs 2.85 days; p <0.001) than the nonstimulated group of patients. The incidence of postoperative ileus (2.85% vs 20%; p = 0.024) and hospital stay (2.49 vs 4.61 days; p = 0.002) was also lower in the stimulated patients. LIMITATIONS Small numbers of patients means that no definitive statements can be made regarding the effectiveness of this technique. CONCLUSIONS Stimulation of the efferent limb of the ileostomy before closure is a safe technique that reduces postoperative ileus and fosters early intestinal transit and oral tolerance with a shorter postoperative hospital stay.
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Comparing methods of ileostomy closure constructed in colorectal surgery in Turkey. GASTROENTEROLOGY REVIEW 2014; 9:291-6. [PMID: 25396004 PMCID: PMC4223118 DOI: 10.5114/pg.2014.46165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 12/28/2013] [Accepted: 01/02/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Stoma construction is a life saver method for emergent and elective operations in colorectal surgery. However, they are associated with high rates of morbidity and mortality. AIM To compare the operative findings, early postoperative complications, and costs of stapled and hand-sewn closures in loop ileostomies that are constructed in emergent and elective colorectal surgery. MATERIAL AND METHODS The data of 68 patients requiring loop ileostomies during colorectal surgery were retrospectively evaluated. SPSS (version 20) was used for data analysis. RESULTS The study group consisted of 44 men and 24 women with a mean age of 55.5 years. The ileostomy closures were performed with hand-sewn method in 36 patients (group 1) and stapled method in 32 patients (group 2). The mean operation time was 75.4 min in group 1 and 46.7 min in group 2 (p < 0.001). Early postoperative complications were wound infection (8.8%), small bowel obstruction (6.06%), and anastomotic leakage (2.9%). Total costs, flatulence and faeces outlet time, oral feeding starting time, time of hospital stay, and early postoperative complications were lower in the stapled group. CONCLUSIONS Morbidity and mortality rates of stoma construction and its closure are still considerable. Lower anastomotic leakage rate, complication rate, and costs and shorter operative times in the stapled group make this method preferable.
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Pérez Domínguez L, García Martínez MT, Cáceres Alvarado N, Toscano Novella A, Higuero Grosso AP, Casal Núñez JE. Morbidity and mortality of temporary diverting ileostomies in rectal cancer surgery. Cir Esp 2014; 92:604-8. [PMID: 24969349 DOI: 10.1016/j.ciresp.2013.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 12/04/2013] [Accepted: 12/08/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A temporary diverting ileostomy is frequently used to reduce the consequences of a distal anastomotic leakage after total mesorectal excision in rectal cancer surgery. This surgical technique is associated with high morbidity and a not negligible mortality. The aim of this study is to evaluate the morbidity and mortality rate associated with an ileostomy and its posterior closure. MATERIAL AND METHODS Between 2001 and 2012, 96 patients with temporary diverting ileostomy were retrospectively analyzed. Morbidity and mortality were analyzed before and after the stoma closure. The studied variables included age, sex, comorbidities, time to bowel continuity restoration and adjuvant chemotherapy. RESULTS In 5 patients the stoma was permanent and another 5 died. The morbidity and mortality rates associated with the stoma while it was present were 21 and 1% respectively. We performed a stoma closure in 86 patients, 57% of whom had previously received adjuvant therapy. There was no postoperative mortality after closure and the morbidity rate was 24%. The average time between initial surgery and restoration of intestinal continuity was 152.2 days. This interval was significantly higher in patients who had received adjuvant therapy. No statistically significant difference was found between the variables analyzed and complications. CONCLUSIONS Diverting ileostomy is associated with low mortality and high morbidity rates before and after closure. Adjuvant chemotherapy significantly delays bowel continuity restoration, although in this study did not influence in the rate of complications.
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Affiliation(s)
- Lucinda Pérez Domínguez
- Servicio de Cirugía General y Aparato Digestivo, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España.
| | - María Teresa García Martínez
- Servicio de Cirugía General y Aparato Digestivo, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
| | - Nieves Cáceres Alvarado
- Servicio de Cirugía General y Aparato Digestivo, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
| | - Angeles Toscano Novella
- Servicio de Cirugía General y Aparato Digestivo, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
| | - Antonio Pedro Higuero Grosso
- Servicio de Cirugía General y Aparato Digestivo, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
| | - José Enrique Casal Núñez
- Servicio de Cirugía General y Aparato Digestivo, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
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Vallribera Valls F, Villanueva Figueredo B, Jiménez Gómez LM, Espín Bassany E, Sánchez Martinez JL, Martí Gallostra M, Armengol Carrasco M. [Ileostomy closure in a colorectal surgery unit. Comparative analysis of different techniques]. Cir Esp 2014; 92:182-7. [PMID: 24412284 DOI: 10.1016/j.ciresp.2013.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/25/2013] [Accepted: 04/28/2013] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The objective of this study is to assess whether the results of loop ileostomy closure in terms of morbidity and hospital stay are influenced by the type of anastomosis and suture used. METHOD All patients who underwent loop ileostomy closure were reviewed. A retrospective cohort study comparing morbidity and hospital stay according to the type of anastomosis (TT/LL) and the type of suture (hand sewn/mechanical) was performed. RESULTS From January 2003 to November 2011 a total of 167 loop ileostomy closures were analized. The groups were: type of anastomosis (TT 95/LL 72) and type of suture (manual 105/stapled 62). In 76% of the observed population the underlying disease was cancer. Mortality occurred in one case. The stratified morbidity analysis by type of complications showed no significant differences between the groups in terms of local (7.4% TT, LL 8.3%, 6.7% hand sewn, stapled 9.7%), general (TT 9.5%, 16.7% LL, hand sewn 6.7%, 6.5% stapled) and surgical (TT 15.8%, 19.4% LL, hand sewn 17.1%, 17.7% stapled) complications, nor in the rate of reoperations (TT 6.3%, 6.9% LL, hand sewn 6.7%, 6.5% stapled) and hospital stay in days (TT 7.8, 8 LL, hand sewn 8.6, stapled 6.7) CONCLUSIONS: Closure of loop ileostomy can be performed regardless of the type of suture or anastomosis used, with the same rate of morbidity and hospital stay.
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Affiliation(s)
- Francesc Vallribera Valls
- Servicio de Coloproctología, Unidad de Cirugía General y del Aparato Digestivo, Hospital Vall d'Hebrón, Barcelona, España
| | - Borja Villanueva Figueredo
- Servicio de Coloproctología, Unidad de Cirugía General y del Aparato Digestivo, Hospital Vall d'Hebrón, Barcelona, España.
| | - Luis Miguel Jiménez Gómez
- Servicio de Coloproctología, Unidad de Cirugía General y del Aparato Digestivo, Hospital Vall d'Hebrón, Barcelona, España
| | - Eloi Espín Bassany
- Servicio de Coloproctología, Unidad de Cirugía General y del Aparato Digestivo, Hospital Vall d'Hebrón, Barcelona, España
| | - José Luis Sánchez Martinez
- Servicio de Coloproctología, Unidad de Cirugía General y del Aparato Digestivo, Hospital Vall d'Hebrón, Barcelona, España
| | - Marc Martí Gallostra
- Servicio de Coloproctología, Unidad de Cirugía General y del Aparato Digestivo, Hospital Vall d'Hebrón, Barcelona, España
| | - Manuel Armengol Carrasco
- Servicio de Coloproctología, Unidad de Cirugía General y del Aparato Digestivo, Hospital Vall d'Hebrón, Barcelona, España
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Estimulación del asa eferente previa al cierre de ileostomía. Cir Esp 2013; 91:50-2. [DOI: 10.1016/j.ciresp.2012.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 08/31/2012] [Accepted: 09/15/2012] [Indexed: 11/22/2022]
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D’Haeninck A, Wolthuis A, Penninckx F, D’Hondt M, D’Hoore A. Morbidity after closure of a defunctioning loop ileostomy. Acta Chir Belg 2011; 111:136-41. [PMID: 21780519 DOI: 10.1080/00015458.2011.11680724] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE A low pelvic anastomosis is associated with a substantial risk of leakage. A defunctioning stoma (DS) reduces the clinical anastomotic leak rate and the need for re-operation, but stoma closure has its own risk of morbidity and mortality. This study aims to audit morbidity and mortality after loop ileostomy (LI) closure. PATIENTS AND METHODS The medical records of 197 consecutive patients who underwent closure of a defunctioning LI between August 2003 and July 2008 were reviewed. Postoperative morbidity and mortality were recorded. RESULTS Transverse closure of the enterotomy was performed in 149 patients (75.6%), segmental enterectomy with hand-sewn end-to-end anastomosis in 26 (13.2%) and stapled side-to-side anastomosis in 22 (11.2%). Overall postoperative morbidity and mortality were 32.0% and 0.5%, respectively. The surgical complication rate was 30.5%, including prolonged ileus (11.2%), small bowel obstruction (4.1%), anastomotic leak (3.0%) and wound infection (4.6%). Surgical complications were more frequent in male patients (p = 0.005). Prolonged ileus was more frequent when the interval to stoma reversal exceeded 12 weeks (14.3% versus 3.5% ; p = 0.02). The incidence of complications was not influenced by the closure technique. Nineteen patients (9.6%) required re-operation for anastomotic leak (n = 8), wound infection (n = 1), small bowel obstruction (n = 3) and incisional herniation (n = 7). CONCLUSION LI closure is associated with clinically relevant morbidity and mortality. This association should be taken into account in the context of a routine DS policy and should be part of the patient's information.
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Affiliation(s)
- A. D’Haeninck
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - A.M. Wolthuis
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - F. Penninckx
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - M. D’Hondt
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
| | - A. D’Hoore
- Department of Abdominal Surgery, University Hospital Gasthuisberg, Leuven, Belgium
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Courtier R, Parés D, Silva CA, Gil MJ, Pascual M, Alonso S, Pera M, Grande L. [Clinical results of loop ileostomy closures in rectal cancer surgical patients. Effect of chemotherapy in the waiting period]. Cir Esp 2011; 88:308-13. [PMID: 20889147 DOI: 10.1016/j.ciresp.2010.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 07/23/2010] [Accepted: 08/20/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The introduction of sphincter preservation surgery in rectal cancer has led to an increase in the number of low resections protected with a loop ileostomy. This requires subsequent closure of the stoma, a surgical procedure which is not devoid of morbidity or mortality. The aims of the study were to analyse the clinical results of the passage reconstruction surgery and to find out the interval between both surgeries, as well as the role chemotherapy plays in this. PATIENTS AND METHOD The prospective data of patients previously operated on for rectal cancer were used retrospectively with those whose ileostomy was closed between May 2004 and September 2008. Data associated to chemotherapy indication, interval between surgeries and complications were collected and analysed. RESULTS A total of 54 consecutive patients with a mean age of 66 years were analysed. The mean interval between surgeries was 178 days, being significantly less in the patient group that did not receive chemotherapy (p=0.008). The post-operative stay was 6.3 days (SD=4.1). Mortality due to respiratory failure was 1.8% and the morbidity was 22.2%, with 7.4% requiring further surgery. CONCLUSIONS The mortality and morbidity of ileostomy closures are not inconsiderable, although its advantages in the protection of the stoma justify its use. The ileostomy construction interval appears to be significantly affected by post-operative chemotherapy.
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Affiliation(s)
- Ricardo Courtier
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
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