Virtual ileostomy in elective colorectal surgery: a systematic review of the literature

BACKGROUND

Anastomotic leak (AL) following colorectal surgery can be a life-threatening complication. The use of a diverting stoma has been proposed, to prevent or reduce morbidity and mortality associated with AL. Stomas, however, have their own distinct complications. Thus, virtual ileostomy (VI) has been proposed as an alternative to diverting stoma. The aim of the present study was to further evaluate the role of VI through systematic review of existing literature.

METHODS

A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Cochrane handbook for systematic reviews of interventions. The primary endpoint of our study was the estimation of the overall VI complication rate. Secondary endpoints included the identification of the VI-specific adverse outcomes, perioperative endpoints such as the length of hospital stay, transfusion and postoperative leak rates, description of the operative variations of VI reported VI operative variations and details regarding the primary operation and previous neoadjuvant therapy.

RESULTS

In total, 11 studies and 554 patients were included in this systematic review. Overall, 158 laparoscopic and 191 open procedures were performed. The AL and VI conversion rates were 11.9% and 10.46%, respectively. The total complication rate was estimated to be 13.9%, while VI-specific adverse events were recorded in 2.1% of all cases.

CONCLUSIONS

VI could be a safe and effective alternative to a diverting stoma. Although currently, VI is not widely used, it could have a widespread application in laparoscopic surgery. However, definitive trials are needed before firm recommendations on the use of VI can be made.

[Reinforcement of staple line of colorectal anastomosis for leakage prevention: a systematic review and metaanalysis]

OBJECTIVE

To evaluate the influence of reinforcement of staple line of colorectal anastomosis on the incidence of leakage.

MATERIAL AND METHODS

A systematic review was performed in accordance with the PRISMA recommendations. Statistical analysis was carried out in the Review Manager 5.3 software.

RESULTS

This trial included four original articles published in 2011-2018. There were 493 patients. Reinforcement of anastomosis was made in 232 (47%) cases, colorectal anastomosis was not reinforced in 261 (53%) patients. Anastomotic leakage rate was 5.6 and 11.1% in both groups, respectively (OR 0.55, CI 0.13-2.33; p=0.42). Transabdominal reinforcement reduced leakage rate by 10.2% (OR 0.18, CI 0.06-0.55; p=0.002) while transanal reinforcement was ineffective (OR 1.66, CI 0.38-7.19; p=0,5). Incidence of preventive stoma was similar (OR 0.3, CI 0.07-1.22; p=0.09), but it was possible to abandon preventive stoma in 18% of cases after anastomotic reinforcement.

CONCLUSION

A small number of studies dedicated to anastomosis reinforcement resulted controversial data.

Stoma prolapse handmade repair under local anesthesia with variation of Altemeier method in severe patients: a case report and review of the literature

Stoma prolapse represents one of the most common late complications, occurring in 1–16%. Final rate depends on systematic follow up of the patient and the primary technique. A 49-year-old male patient presented in the Emergency Department, complaining about stoma prolapse, pain and stoma care difficulties. On admission, his colostomy protruded ~20 cm from the skin. The symptoms were local pain and psychological stress. The prolapse was repaired successfully with a simple revision procedure under local anesthesia, by resecting the prolapsed part of the bowel and reconstruction of stoma. Prolapsed part of the colon is removed and the remaining end of the colon is fixated to the abdominal wall. Colorectal surgeons must familiarize with management of stoma complications. Stoma revision under local anesthesia is an alternative and safe method.