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Matsumoto Y, Aisu N, Kajitani R, Nagano H, Yoshimatsu G, Hasegawa S. Complications associated with loop ileostomy: analysis of risk factors. Tech Coloproctol 2024; 28:60. [PMID: 38801595 DOI: 10.1007/s10151-024-02926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/03/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Loop ileostomy is a common surgical procedure but is associated with complications such as outlet obstruction (OO), parastomal hernia (PH), and high-output stoma (HOS). This study aimed to identify risk factors for these complications, as well as their causal relationships. METHODS The study included 188 consecutive patients who underwent loop ileostomy between April 2016 and September 2021. Clinical factors and postoperative stoma-related complications (OO, HOS, and PH) were analyzed retrospectively. Stoma-related factors were evaluated using specific measurements from computed tomography (CT) scans. The incidence, clinical course, and risk factors for the stoma-related complications were investigated. RESULTS OO was diagnosed in 28 cases (15.7%), PH in 60 (32%), and HOS in 57 (31.8%). A small longitudinal stoma diameter at the rectus abdominis level on CT and a right-sided stoma were significantly associated with OO. Creation of an ileostomy for anastomotic leakage was independently associated with HOS. Higher body weight and a large longitudinal stoma diameter at the rectus abdominis level on CT were significantly associated with PH. There was a significant relationship between the occurrence of OO and HOS. However, the association between OO and PH was marginal. CONCLUSION This study identified key risk factors for OO, HOS, and PH as complications of loop ileostomy and their causal relationships. Our findings provide insights that may guide the prevention and management of complications related to loop ileostomy.
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Affiliation(s)
- Yoshiko Matsumoto
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Ryuji Kajitani
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hideki Nagano
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Gumpei Yoshimatsu
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan.
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Wilson HH, Augenstein VA, Colavita PD, Davis BR, Heniford BT, Kercher KW, Kasten KR. Disparate potential for readmission prevention exists among inpatient and outpatient procedures in a minimally invasive surgery practice. Surgery 2024; 175:847-855. [PMID: 37770342 DOI: 10.1016/j.surg.2023.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Administrators have focused on decreasing postoperative readmissions for cost reduction without fully understanding their preventability. This study describes the development and implementation of a surgeon-led readmission review process that assessed preventability. METHODS A gastrointestinal surgical group at a tertiary referral hospital developed and implemented a template to analyze inpatient and outpatient readmissions. Monthly stakeholder assessments reviewed and categorized readmissions as potentially preventable or not preventable. Continuous variables were examined by the Student's t test and reported as means and standard deviations. Categorical variables were examined by the Pearson χ2 statistic and Fisher's exact test. RESULTS There were 61 readmission events after 849 inpatient operations (7.2%) and 16 after 856 outpatient operations (1.9%), the latter of which were all classified as potentially preventable. Colorectal procedures represented 65.6% of readmissions despite being only 37.2% of all cases. The majority (67.2%) of readmission events were not preventable. Compared to the not-preventable group, the potentially preventable group experienced more dehydration (30.0% vs 9.8%, P = .045) and ileostomy creation (78.6% vs 33.3%, P = .017). The potential for outpatient management to prevent readmission was significantly higher in the potentially preventable group (40.0% vs 0.0%, P < .001), as was premature discharge prevention (35.0% vs 0.0%, P < .001). CONCLUSION The use of the standardized template developed for analyzing readmission events after inpatient and outpatient procedures identified a disparate potential for readmission prevention. This finding suggests that a singular focus on readmission reduction is misguided, with further work needed to evaluate and implement appropriate quality-based strategies.
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Imaizumi Y, Takano Y, Okamoto A, Nakano T, Takada N, Sugano H, Takeda Y, Ohkuma M, Kosuge M, Eto K. High-output stoma is a risk factor for stoma outlet obstruction in defunctioning loop ileostomies after rectal cancer surgery. Surg Today 2024; 54:106-112. [PMID: 37222815 DOI: 10.1007/s00595-023-02704-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/01/2023] [Indexed: 05/25/2023]
Abstract
PURPOSE Defunctioning loop ileostomy has been reported to reduce symptomatic anastomotic leakage after rectal cancer surgery; however, stoma outlet obstruction (SOO) is a serious postileostomy complication. We, therefore, explored novel risk factors for SOO in defunctioning loop ileostomy after rectal cancer surgery. METHODS This is a retrospective study that included 92 patients who underwent defunctioning loop ileostomy with rectal cancer surgery at our institution. Among them, 77 and 15 ileostomies were created at the right lower abdominal and umbilical sites, respectively. We defined the output volumeMAX as the maximum output volume the day before the onset of SOO or-for those without SOO-that was observed during hospitalization. Univariate and multivariate analyses were performed to evaluate risk factors for SOO. RESULTS SOO was observed in 24 cases, and the median onset was 6 days postoperatively. The stoma output volume in the SOO group was consistently higher than that in the non-SOO group. In the multivariate analysis, the rectus abdominis thickness (p < 0.01) and output volumeMAX (p < 0.01) were independent risk factors for SOO. CONCLUSION A high-output stoma may predict SOO in patients with defunctioning loop ileostomy for rectal cancer. Considering that SOO occurs even at umbilical sites with no rectus abdominis, a high-output stoma may trigger SOO primarily.
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Affiliation(s)
- Yuta Imaizumi
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Yasuhiro Takano
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Atsuko Okamoto
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takafumi Nakano
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Naoki Takada
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroshi Sugano
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yasuhiro Takeda
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masahisa Ohkuma
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Makoto Kosuge
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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Ihara K, Nakamura T, Takayanagi M, Fujita J, Maeda Y, Nishi Y, Shibuya N, Hachiya H, Ishizuka M, Tominaga K, Kojima K, Irisawa A. Risk Factors for Stoma Outlet Obstruction after Proctocolectomy for Ulcerative Colitis. J Anus Rectum Colon 2024; 8:18-23. [PMID: 38313747 PMCID: PMC10831979 DOI: 10.23922/jarc.2023-018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/19/2023] [Indexed: 02/06/2024] Open
Abstract
Objectives Stoma outlet obstruction (SOO) occurs with an incidence of approximately 40% after proctocolectomy for Ulcerative colitis (UC) with diverting ileostomy. This study aimed to identify the risk factors for SOO after proctocolectomy with diverting ileostomy for patients with UC. Methods We reviewed the data of 68 patients with UC who underwent proctocolectomy and diverting ileostomy between April 2006 and September 2021. These cases were analyzed on the basis of clinicopathological and anatomical factors. SOO was defined as small bowel obstruction displaying symptoms of intestinal obstruction, such as abdominal distention, abdominal pain, insertion of a tube through the stoma. Results The study included 38 (56%) men and 30 (44%) women with a median age of 42 years (range, 21-80). SOO categorized as at least Clavien-Dindo grade II occurred in 11 (16%) patients. Six patients required earlier stoma closure than scheduled. Compared with patients without SOO, patients with SOO had a significantly higher total steroid dose from the onset of UC to surgery (p = 0.02), a small amount of intraabdominal fat (p = 0.04), and a higher rate of laparoscopic surgery (p < 0.01). Conclusions A high preoperative steroid dose, a small amount of intraabdominal fat and laparoscopic surgery were identified as risk factors for SOO. Early detection and treatment for SOO are important for patients at risk.
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Affiliation(s)
- Keisuke Ihara
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
- Department of Surgical Oncology, Dokkyo Medical University, Shimotsuga, Japan
| | - Takatoshi Nakamura
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
- Department of Surgical Oncology, Dokkyo Medical University, Shimotsuga, Japan
| | - Masashi Takayanagi
- Department of Surgical Oncology, Dokkyo Medical University, Shimotsuga, Japan
| | - Junki Fujita
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
- Department of Surgical Oncology, Dokkyo Medical University, Shimotsuga, Japan
| | - Yasunori Maeda
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
- Department of Surgical Oncology, Dokkyo Medical University, Shimotsuga, Japan
| | - Yusuke Nishi
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
| | - Norisuke Shibuya
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
| | - Hiroyuki Hachiya
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
| | - Mitsuru Ishizuka
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Shimotsuga, Japan
| | - Kazuyuki Kojima
- Department of Surgical Oncology, Dokkyo Medical University, Shimotsuga, Japan
| | - Atsushi Irisawa
- Center for Colorectal Surgery, Dokkyo Medical University Hospital, Shimotsuga, Japan
- Department of Gastroenterology, Dokkyo Medical University, Shimotsuga, Japan
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Albulescu EL, Bratiloveanu T, Sandulescu S, Ramboiu S, Nemes R, Surlin V, Chiutu L. Role of a Stoma Nurse in the Management of the Specific Stoma-Related Complications. CURRENT HEALTH SCIENCES JOURNAL 2024; 50:5-11. [PMID: 38846478 PMCID: PMC11151942 DOI: 10.12865/chsj.50.01.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/12/2024] [Indexed: 06/09/2024]
Abstract
Nursing care for patients with intestinal stomas is essential for ensuring their comfort, to prevent complications and promote their overall well-being. The quality of life of the patients with stomas can vary widely depending on their ability to adapt to the new physical and emotional state, but also to social changes that came with it. Health care professionals specializing in ostomy care can provide valuable guidance and support throughout the process. This study aims to identify and to summarize methods of nursing care for patients with an intestinal stoma and how these impact the perceived quality of life for those patients. Preoperative evaluation by an entero-stomal therapist and stoma site marking has been proved to reduce postoperative complications. Many of the peristomal skin complications can be prevented entirely by meticulous skin care. Follow-up is essential for the patient with a newly acquired intestinal ostomy to detect and provide treatment for ostomy-related complications that may occur. Regular monitoring and early intervention can help manage parastomal hernias effectively and improve the patient's quality of life.
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Affiliation(s)
- Elena Luminita Albulescu
- University of Medicine and Pharmacy of Craiova, 2-4 Petru Rares Street, 200392, Craiova, Dolj, Romania
| | - Tudor Bratiloveanu
- University of Medicine and Pharmacy of Craiova, 2-4 Petru Rares Street, 200392, Craiova, Dolj, Romania
| | - Sarmis Sandulescu
- University of Medicine and Pharmacy of Craiova, 2-4 Petru Rares Street, 200392, Craiova, Dolj, Romania
| | - Sandu Ramboiu
- University of Medicine and Pharmacy of Craiova, 2-4 Petru Rares Street, 200392, Craiova, Dolj, Romania
| | - Raducu Nemes
- University of Medicine and Pharmacy of Craiova, 2-4 Petru Rares Street, 200392, Craiova, Dolj, Romania
| | - Valeriu Surlin
- University of Medicine and Pharmacy of Craiova, 2-4 Petru Rares Street, 200392, Craiova, Dolj, Romania
| | - Luminita Chiutu
- University of Medicine and Pharmacy of Craiova, 2-4 Petru Rares Street, 200392, Craiova, Dolj, Romania
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Wang X, Wang Y, Lin B, Liu Y, Gu J, Ling L, Xu D, Ding K. Transatmospheric ileal stoma manometry can be applied for the early detection of stoma outlet obstruction. Front Oncol 2023; 13:1187858. [PMID: 37588096 PMCID: PMC10426377 DOI: 10.3389/fonc.2023.1187858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/06/2023] [Indexed: 08/18/2023] Open
Abstract
Background Stoma outlet obstruction (SOO) is a common complication of diverting ileostomy and usually detected at the advanced stage when the intestine is obviously obstructed. The objective of this study is to explore the efficacy of transatmospheric ileal stoma manometry (TISM) in early detection of SOO before the manifestation of intestinal obstruction. Methods A single-center prospective study was performed in patients scheduled to undergo reversal ileostomy and laparoscopic anterior rectal resection and diverting ileostomy in Second Affiliated Hospital of Zhejiang University School of Medicine from 1st July 2022 to 31st December 2022. The stoma pressure was measured by TISM at different time points. Results The mean stoma pressure of the 30 patients before reversal ileostomy was 5.21 cmH2O which was considered as normal standard of stoma pressure, and ranged from 1.2 to 8.56 cmH2O. After excluding two patients with anastomotic leakage, a total of 38 patients who were subjected to laparoscopic anterior rectal resection and diverting ileostomy were further included in this study. The incidence of anastomotic leakage was 5% and that of SOO was 12.5%. The mean postoperative obstruction time was 5.2 (3-7) days and the mean time from elevated stoma pressure to diagnosed as SOO was 2.8 (2-4) days in the five patients who developed SOO. The pressure measured at the third stoma manometry time point (second day after return of gut function) (10.23 vs. 6.04 cmH2O, p<0.001) and the postoperative hospital stay (10 vs. 8.49 days, p=0.028) showed significantly difference between the SOO and non-SOO groups. The pressures measured at the first time point (before return of gut function) (4 vs. 4.49 cmH2O, p=0.585), the second time point (the day of return of gut function) (6.8 vs. 5.62 cmH2O, p=0.123), and the fourth time point (discharge day) (5.88 vs. 5.9 cmH2O, p=0.933) showed no significant difference in both groups. Conclusion TISM can be utilized for early detection of SOO and can be incorporated as a novel diagnostic method together with abdominal CT scan to realize the goal of ERAS.
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Affiliation(s)
- Xiaowei Wang
- Department of Anorectal Surgery, The First People’s Hospital of Wenling, Wenling, Zhejiang, China
| | - Yizhi Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Beibei Lin
- Department of Colorectal Surgery and Oncology Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yue Liu
- Department of Colorectal Surgery and Oncology Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jin Gu
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Limian Ling
- Department of Colorectal Surgery and Oncology Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Dong Xu
- Department of Colorectal Surgery and Oncology Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Kefeng Ding
- Department of Colorectal Surgery and Oncology Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Kumano K, Kitaguchi D, Owada Y, Kinoshita E, Moue S, Furuya K, Ohara Y, Enomoto T, Oda T. A comparative study of stoma-related complications from diverting loop ileostomy or colostomy after colorectal surgery. Langenbecks Arch Surg 2023; 408:139. [PMID: 37016188 DOI: 10.1007/s00423-023-02877-6] [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: 07/10/2022] [Accepted: 03/31/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE Even though minor, stoma-related complications significantly impact quality of life, they are often excluded from clinical analyses that compare short-term postoperative outcomes of loop ileostomy and loop colostomy. This study compares stoma-related complications between loop ileostomy and loop colostomy after rectal resection, including minor complications, and discusses the characteristics of diverting stoma types. METHODS A retrospective review was conducted in patients who underwent diverting stoma construction after rectal resection. Data on patient background and postoperative short-term outcomes, including stoma-related complications and morbidity after stoma closure, were collected and compared between loop ileostomy and loop colostomy groups. Morbidities of all severity grades were targeted for analysis. RESULTS A total of 47 patients (27 loop ileostomy, 20 loop colostomy) underwent diverting stoma construction following rectal resection. Overall stoma-related complications, incidence of skin irritation, high-output stoma, and outlet obstruction were significantly higher in the loop ileostomy group but high-output stoma and outlet obstruction were absent in the loop colostomy group. Regarding morbidity after stoma closure, operation times and surgical site infections were significantly higher in the loop colostomy group while anastomotic leakage after diverting stoma closure occurred (2 cases; 15%) in the loop colostomy group but not the loop ileostomy group. CONCLUSION Because stoma-related complications were significantly higher in the loop ileostomy group, and even these minor complications may impair QOL, early loop ileostomy closure is recommended. For loop colostomy, stoma-related morbidities are lower but post-closure leakage is a calculated risk.
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Affiliation(s)
- Koichiro Kumano
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Daichi Kitaguchi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Yohei Owada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Eiki Kinoshita
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shoko Moue
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kinji Furuya
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yusuke Ohara
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tsuyoshi Enomoto
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tatsuya Oda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, Japan
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Babakhanlou R, Larkin K, Hita AG, Stroh J, Yeung SC. Stoma-related complications and emergencies. Int J Emerg Med 2022; 15:17. [PMID: 35534817 PMCID: PMC9082897 DOI: 10.1186/s12245-022-00421-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractStoma creations are common procedures in surgical specialties. They can be created either as a temporary or a permanent measure. Despite advancements in surgical technique and stoma care, complications are common. Patients experiencing stoma-related complications often present to the emergency department. Emergency physicians are not expected to be stoma experts, yet they are often the first point of contact for patients experiencing stoma-related complications. Accordingly, emergency physicians should be familiar with the types of stomas and complications and emergencies associated with them so that they can appropriately address the problems related to stomas. This article will provide a review of emergencies and complications associated with ileostomies, colostomies, and urostomies.
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Kuwahara K, Mokuno Y, Matsubara H, Uji M, Kobayashi I, Iyomasa S. Risk Factors for Stoma Outlet Obstruction: Preventing This Complication after Construction of Diverting Ileostomy during Laparoscopic Colorectal Surgery. JMA J 2022; 5:207-215. [PMID: 35611234 PMCID: PMC9090553 DOI: 10.31662/jmaj.2021-0187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/03/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction Bowel obstruction at the outlet of the stoma, also referred to as "stoma outlet obstruction" (SOO), has been noted to be more common after laparoscopic colorectal surgery with diverting ileostomy than after laparotomy. Thus, the aim of this study is to identify the risk factors for SOO and to evaluate the effectiveness of a modified ileostomy procedure for reducing its incidence. Methods The medical records of 63 patients who underwent laparoscopic colorectal surgery with diverting ileostomy between January 2014 and July 2021 were retrospectively reviewed. We analyzed the risk factors for SOO using computed tomography findings. Results In total, 34 patients underwent surgery before modification of the ileostomy procedure (LSa group), and 29 patients underwent surgery after modification (LSb group). In the LSa group, 6 patients have reportedly developed SOO (SOO group), whereas 28 patients did not (non-SOO group). No patients in the LSb group developed SOO. The thickness of the abdominal rectus muscle (ThM) in the SOO group and the non-SOO group was 13.4 mm and 9.6 mm, respectively (p = 0.005). The angle between the ileostomy and the abdominal wall (AIW) was 95.8° in the non-SOO group and 82.2° in the SOO group (p = 0.033). The AIW was 93.4° in the LSa group and 99.7° in the LSb group (p = 0.043). Conclusions As per our findings, a thick abdominal rectus muscle is predictive of SOO. Correction of the AIW (eliminating medial inclination) by modifying the operative technique has eliminated the occurrence of SOO in our patient population.
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Affiliation(s)
| | - Yasuji Mokuno
- Department of Surgery, Yachiyo Hospital, Anjo, Japan
| | | | - Masahito Uji
- Department of Surgery, Yachiyo Hospital, Anjo, Japan
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Takehara Y, Nakagawa M, Kobayashi H, Kakisako K, Takano Y, Seki J, Shimada S, Nakahara K, Mukai S, Enami Y, Sawada N, Ishida F, Kudo SE. A technique for constructing diverting loop ileostomy to prevent outlet obstruction after rectal resection and total colectomy: a retrospective single-center study. Surg Today 2022; 52:587-594. [PMID: 34689284 PMCID: PMC8948144 DOI: 10.1007/s00595-021-02381-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/08/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE Preventing outlet obstruction associated with a diverting stoma is important. Previously, we constructed a diverting loop ileostomy with the proximal limb of the small intestine on the caudal side, namely the oral inferior (OI) method. However, to address the issue of twisting and stenosis of the small intestine, we recently constructed a diverting loop ileostomy with the proximal limb on the cranial side, namely the oral superior (OS) method. We compared the incidence of outlet obstruction between the two methods. METHODS The subjects of this retrospective study were 133 patients who underwent colorectal resection or total colectomy, with D2 or more lymph node dissection and diverting loop ileostomy construction, between April, 2001 and December, 2018, at our hospital. The OI method was performed in 54 patients and the OS method was performed in 79 patients. RESULTS In the OS group, a history of laparotomy, neoadjuvant therapy, clinical stage III, and the use of anti-adhesion materials were more common, whereas blood loss and the incidence of outlet obstruction were significantly lower. Multivariate analysis identified only OS placement as a significant factor for reducing the incidence of outlet obstruction. CONCLUSION When constructing a diverting loop ileostomy, placing the proximal limb on the cranial side is important.
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Affiliation(s)
- Yusuke Takehara
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, Kanagawa Prefecture, 224-8503, Japan.
| | - Mihoko Nakagawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, Kanagawa Prefecture, 224-8503, Japan
| | - Hiroaki Kobayashi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, Kanagawa Prefecture, 224-8503, Japan
| | - Kensuke Kakisako
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, Kanagawa Prefecture, 224-8503, Japan
| | - Yojiro Takano
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, Kanagawa Prefecture, 224-8503, Japan
| | - Junichi Seki
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, Kanagawa Prefecture, 224-8503, Japan
| | - Shoji Shimada
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, Kanagawa Prefecture, 224-8503, Japan
| | - Kenta Nakahara
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, Kanagawa Prefecture, 224-8503, Japan
| | - Shumpei Mukai
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, Kanagawa Prefecture, 224-8503, Japan
| | - Yuta Enami
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, Kanagawa Prefecture, 224-8503, Japan
| | - Naruhiko Sawada
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, Kanagawa Prefecture, 224-8503, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, Kanagawa Prefecture, 224-8503, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki-ku, Yokohama, Kanagawa Prefecture, 224-8503, Japan
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11
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Nozawa H, Hata K, Sasaki K, Murono K, Kawai K, Emoto S, Ishihara S. Laparoscopic vs open restorative proctectomy after total abdominal colectomy for ulcerative colitis or familial adenomatous polyposis. Langenbecks Arch Surg 2022; 407:1605-1612. [PMID: 35294600 DOI: 10.1007/s00423-022-02492-x] [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: 09/03/2021] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Randomized controlled trials (RCTs) demonstrated that a laparoscopic approach provides short-term benefits, such as reduced blood loss and a shorter hospital stay, in patients who undergo rectal surgery. On the other hand, a few RCTs investigating proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) or familial adenomatous polyposis (FAP) suggested limited advantages of laparoscopic surgery over open surgery. A substantial proportion of patients with UC or FAP may undergo staged operations with IPAA, but no study has compared the two approaches for proctectomy with IPAA after total abdominal colectomy. METHODS We examined 61 consecutive patients with UC or FAP who underwent proctectomy with IPAA after colectomy in our hospital. Patients were divided into the Lap group (n = 37) or the Op group (n = 24) according to surgical approach. Patient background and outcomes, such as operative time, blood loss, first bowel movement, postoperative complications, and pouchitis, were compared between these groups. RESULTS One patient required conversion to open surgery in the Lap group. The median volume of blood loss was 90 mL in the Lap group and 580 mL in the Op group (p < 0.0001). The Lap group showed a shorter time to first bowel movement than the Op group (median: 1 vs 2 days, p = 0.0003). The operative time, frequencies of postoperative complications, and accumulation rate of pouchitis were similar between the two groups. CONCLUSIONS Laparoscopic surgery was beneficial for patients undergoing restorative proctectomy in terms of blood loss and bowel recovery without increasing the operative time or rate of complications.
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Affiliation(s)
- Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Keisuke Hata
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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12
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Khubezov DA, Sazhin VP, Ignatov IS, Ogoreltsev AY, Li YB, Vedishchev VV, Puchkov DK, Kochetkov FD. [Loop colostomy as a risk factor of postoperative ileus in elective colorectal cancer surgery]. Khirurgiia (Mosk) 2021:56-62. [PMID: 34941210 DOI: 10.17116/hirurgia202112156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify risk factors of postoperative ileus (POI) in elective colorectal cancer (CRC) surgery. MATERIAL AND METHODS A non-randomized retrospective study included 220 patients who underwent elective surgery for colorectal tumors. The indication for surgery was CRC stage 0-IV in 213 (96.8%) cases, villous adenoma in 7 cases (3.2%). Risk factors of POI defined in univariate analysis were included into multivariate analysis. Logistic regression was used in this case. RESULTS Risk factors of POI were male sex (p=0.04), multifocal CRC (p=0.03), intraoperative transfusion (p=0.005), postoperative transfusion (p=0.035), left-sided hemicolectomy (p=0.01), colostomy (p=0.02), loop transversostomy (p=0.003), loop colostomy (p=0.02). According to logistic regression, independent risk factors of POI were male sex (p=0.015), left-sided hemicolectomy (p=0.004), intraoperative transfusion p=0.002), loop transversostomy (p=0.019). CONCLUSION Independent risk factors of POI in elective colorectal cancer surgery were male sex, left-sided hemicolectomy, intraoperative transfusion and loop transversostomy.
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Affiliation(s)
| | - V P Sazhin
- Ryazan State Medical University, Ryazan, Russia
| | - I S Ignatov
- Ryazan State Clinical Hospital, Ryazan, Russia
| | - A Yu Ogoreltsev
- Ryazan State Medical University, Ryazan, Russia.,Ryazan State Clinical Hospital, Ryazan, Russia
| | - Yu B Li
- Ryazan State Clinical Hospital, Ryazan, Russia
| | | | - D K Puchkov
- Ryazan State Medical University, Ryazan, Russia
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13
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Enomoto H, Suwa K, Takeuchi N, Hannya Y, Tsukazaki Y, Ushigome T, Okamoto T, Eto K. Risk of Outlet Obstruction Associated With Defunctioning Loop Ileostomy in Rectal Cancer Surgery. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:465-470. [PMID: 35403166 PMCID: PMC8962870 DOI: 10.21873/cdp.10062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/01/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND The outlet obstruction (OO) rate is 5.4-18.4% after defunctioning ileostomy (DI) following rectal cancer resection to reduce the incidence and severity of anastomotic leakage; OO affects a patient's quality of life and prolongs hospitalization. PATIENTS AND METHODS A retrospective analysis was performed of patients who underwent anterior rectal resection and DI for rectal cancer. RESULTS Among 100 patients undergoing anterior rectal resection with DI for rectal cancer, 28 (28%) developed OO. Anastomotic leakage and a rectus abdominis muscle thickness ≥10 mm on preoperative computed tomography were significantly associated with the risk of OO in univariate analysis. Multivariate analysis also demonstrated that anastomotic leakage (odds ratio=4.320, 95% confidence interval=1.280-14.60, p=0.019) and rectus abdominis muscle thickness ≥10 mm (odds ratio=3.710, 95% confidence intervaI=1.280-10.70, p=0.016) were significantly risk factors for OO. CONCLUSION When OO is observed, an anastomotic leakage should be suspected, especially if there is a high rectus abdominis muscle thickness.
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Affiliation(s)
- Hiroya Enomoto
- Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan
| | - Katsuhito Suwa
- Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan
| | - Nana Takeuchi
- Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan
| | - Yoshito Hannya
- Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan
| | - Yuhei Tsukazaki
- Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan
| | - Takuro Ushigome
- Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan
| | - Tomoyoshi Okamoto
- Department of Surgery, The Jikei University Daisan Hospital, Komae, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University Hospital, Tokyo, Japan
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14
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Mori R, Ogino T, Sekido Y, Hata T, Takahashi H, Miyoshi N, Uemura M, Doki Y, Eguchi H, Mizushima T. Long Distance Between the Superior Mesenteric Artery Root and Bottom of the External Anal Sphincter Is a Risk Factor for Stoma Outlet Obstruction After Total Proctocolectomy and Ileal‐Pouch Anal Anastomosis for Ulcerative Colitis. Ann Gastroenterol Surg 2021; 6:249-255. [PMID: 35261950 PMCID: PMC8889852 DOI: 10.1002/ags3.12512] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/10/2021] [Accepted: 09/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background Stoma outlet obstruction (SOO) is much more common after total proctocolectomy (TPC) and ileal‐pouch anal anastomosis (IPAA) for ulcerative colitis (UC) compared to after rectal surgery for cancer. Few prior reports have evaluated anatomical risk factors for SOO. In this study we aimed to clarify the risk factors for SOO after IPAA, focusing on the anatomical perspective. Methods This study included 68 UC patients who underwent IPAA with diverting ileostomy. These cases were analyzed based on clinicopathological factors and computed tomography (CT)‐based anatomical factors. Results SOO was identified in 18 patients (26.5%). We compared this SOO group with the non‐SOO group. The two groups significantly differed in sex distribution, and patients in the SOO group tended to have a longer postoperative hospital stay. Regarding surgery‐related factors, patients who underwent two‐stage surgery and experienced high‐output syndrome tended to develop SOO. Analysis of anatomical risk factors revealed that SOO was more common in patients with a longer distance between the root of their superior mesenteric artery and the bottom of the external anal sphincter (rSMA‐bEAS). This tendency remained significant even with adjustment for patient height. In multivariate analyses, adjusted rSMA‐bEAS (>191.0 mm/m) and male sex were independent risk factors associated with SOO. Conclusion A long rSMA‐bEAS distance suggests that the mesentery is likely to be under tension. In such cases, surgeons should endeavor to avoid tension in the mesentery as much as possible.
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Affiliation(s)
- Ryota Mori
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Takayuki Ogino
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
- Department of Therapeutics for Inflammatory Bowel Diseases Graduate School of Medicine Osaka University Osaka Japan
| | - Yuki Sekido
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Tsuyoshi Hata
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Hidekazu Takahashi
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Norikatsu Miyoshi
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Mamoru Uemura
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery Graduate School of Medicine Osaka University Osaka Japan
- Department of Therapeutics for Inflammatory Bowel Diseases Graduate School of Medicine Osaka University Osaka Japan
- Department of Surgery Osaka Police Hospital Osaka Japan
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15
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Abe T, Nishimura J, Yasui M, Matsuda C, Haraguchi N, Nakai N, Wada H, Takahashi H, Omori T, Miyata H, Ohue M. Risk Factors for Outlet Obstruction in Patients with Diverting Ileostomy Following Rectal Surgery. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:254-260. [PMID: 34395937 PMCID: PMC8321594 DOI: 10.23922/jarc.2021-007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/14/2021] [Indexed: 01/15/2023]
Abstract
Objectives: Anastomotic leakage is one of the most severe complications of rectal cancer surgery. A diverting ileostomy was constructed for the purpose of reducing anastomotic failure risk. Outlet obstruction (OO) is one of the complications of diverting stoma that results in a lack of fecal discharge from the stoma. Detailed etiologies and preventive measures for outlet obstruction have not yet been identified. Methods: We studied 125 patients who underwent rectal resection, anastomosis, and elective ileostomy. We evaluated the incidence of outlet obstruction and looked for any relationship between perioperative factors and outlet obstruction. Results: Outlet obstruction was detected in 20 cases (16.0%). Outlet obstruction occurred 9 days after surgery in most cases. Inserting a decompressing tube improved obstructive symptoms in 4 days. Patients were divided into two cohorts according to the occurrence of outlet obstruction. Postoperative hospital stay was longer in the outlet obstruction group (19 vs. 15 days; p = 0.0003). A multivariate analysis identified that younger patients, a postoperative thicker rectus abdominis muscle at the stoma passage and high output syndrome were independent risk factors for outlet obstruction. Conclusions: Younger patients, a postoperative thicker rectus abdominis muscle at stoma passage and high output syndrome were independent risk factors for outlet obstruction.
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Affiliation(s)
- Tomoki Abe
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Junichi Nishimura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masayoshi Yasui
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Chu Matsuda
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Naotsugu Haraguchi
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Nozomu Nakai
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hidenori Takahashi
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Takeshi Omori
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Miyata
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
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16
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Risk factors for outlet obstruction after laparoscopic surgery and diverting ileostomy for rectal cancer. Surg Today 2020; 51:366-373. [PMID: 32754842 DOI: 10.1007/s00595-020-02096-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 07/20/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Outlet obstruction is defined as bowel obstruction at the stoma opening. The aim of this study was to evaluate the risk factors for outlet obstruction in patients with rectal cancer who underwent laparoscopic surgery and diverting ileostomy. METHODS Among consecutive patients who underwent laparoscopic curative resection for primary rectal cancer between 2013 and 2015, 261 patients with diverting ileostomy were included in the analysis. The thickness of the abdominal wall, including the thickness of the rectus abdominis muscle, was measured using preoperative computed tomography. The clinicopathological factors were compared between the patients with and without outlet obstruction. RESULTS Fourteen (5.4%) patients were diagnosed with outlet obstruction, but reoperation was not required. The rectus abdominis muscle was significantly thicker in male patients with outlet obstruction compared to those without outlet obstruction, but not in females. In a multivariate analysis, a rectus abdominis muscle thickness of 10 mm or more was determined to be an independent risk factor for outlet obstruction (odds ratio, 7.0482; p = 0.0061). CONCLUSIONS The thickness of the rectus abdominis muscle may be used to predict the occurrence of outlet obstruction in male patients with rectal cancer who undergo laparoscopic surgery and diverting ileostomy.
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