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Ameer A, Mirza MB, Talat N. The Outcome of Purse-string Versus Conventional Wound Closure Techniques in Patients Undergoing Stoma Reversal: A Randomized Controlled Trial. J Pediatr Surg 2024; 59:1186-1189. [PMID: 37978002 DOI: 10.1016/j.jpedsurg.2023.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/14/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Patients undergoing stoma reversal may experience surgical site infections and poor scarring. A purse-string closure approach may lower the incidence of surgical site infections due to its inherent ability to drain wound exudates. This study compared the frequency of surgical site infections and the cosmetic outlook of the scar among patients undergoing stoma reversal with linear and purse-string skin closure techniques. SETTING AND DURATION Department of Pediatric Surgery, University of Child Health Sciences Lahore with a duration of one year (June 2021 to June 2022). METHODS This randomized controlled trial (TCTR20210417001) was conducted with IRB approval. A total of 124 patients undergoing stoma reversal were randomly assigned to two groups (62 in each): Group A received conventional linear skin closure, while Group B received purse-string wound closure. The study evaluated surgical site infection, cosmetic outcome, and length of stay. RESULTS Both groups had similar age, gender ratio, indication for surgery, and length of stay. The purse-string group had a significantly lower incidence of SSI (38.7 % vs. 14.5 %; p = 0.002) and better scar quality (Manchester scar scale showed 'good' scar quality in 63 % of patients vs. 22.6 % in the linear closure group, p-value <0.0001). CONCLUSION The purse-string technique for skin closure resulted in fewer surgical site infections and improved scar appearance.
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Affiliation(s)
- Assad Ameer
- Department of Pediatric Surgery, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Muhammad Bilal Mirza
- Department of Pediatric Surgery, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan.
| | - Nabila Talat
- Department of Pediatric Surgery, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
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Ramírez-Giraldo C, Van-Londoño I, Monroy DC, Navarro-Alean J, Hernández-Ferreira J, Hernández-Álvarez D, Rojas-López S, Avendaño-Morales V. Risk factors associated to incisional hernia in stoma site after stoma closure: A systematic review and meta-analysis. Int J Colorectal Dis 2023; 38:267. [PMID: 37975888 DOI: 10.1007/s00384-023-04560-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND This study aims to identify which risk factors are associated with the appearance of an incisional hernia in a stoma site after its closure. This in the sake of identifying which patients would benefit from a preventative intervention and thus start implementing a cost-effective protocol for prophylactic mesh placement in high-risk patients. METHODS A systematic review of PubMed, Cochrane library, and ScienceDirect was performed according to PRISMA guidelines. Studies reporting incidence, risk factors, and follow-up time for appearance of incisional hernia after stoma site closure were included. A fixed-effects and random effects models were used to calculate odds ratios' estimates and standardized mean values with their respective grouped 95% confidence interval. This to evaluate the association between possible risk factors and the appearance of incisional hernia after stoma site closure. RESULTS Seventeen studies totaling 2899 patients were included. Incidence proportion between included studies was of 16.76% (CI95% 12.82; 21.62). Out of the evaluated factors higher BMI (p = 0.0001), presence of parastomal hernia (p = 0.0023), colostomy (p = 0,001), and end stoma (p = 0.0405) were associated with the appearance of incisional hernia in stoma site after stoma closure, while malignant disease (p = 0.0084) and rectum anterior resection (p = 0.0011) were found to be protective factors. CONCLUSIONS Prophylactic mesh placement should be considered as an effective preventative intervention in high-risk patients (obese patients, patients with parastomal hernia, colostomy, and end stoma patients) with the goal of reducing incisional hernia rates in stoma site after closure while remaining cost-effective.
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Affiliation(s)
- Camilo Ramírez-Giraldo
- Hospital Universitario Mayor-Méderi, Bogotá, Colombia.
- Universidad del Rosario, Bogotá, Colombia.
| | | | - Danny Conde Monroy
- Hospital Universitario Mayor-Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | - Jorge Navarro-Alean
- Hospital Universitario Mayor-Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
| | | | | | - Susana Rojas-López
- Hospital Universitario Mayor-Méderi, Bogotá, Colombia
- Universidad del Rosario, Bogotá, Colombia
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Schreiber ME, Schneider MA, Murray FR, Turina M, Gubler C. Routine Endoscopy Prior to Surgical Ostomy Closure: An Obsolete Concept. Dig Dis Sci 2023; 68:4130-4139. [PMID: 37707748 PMCID: PMC10570172 DOI: 10.1007/s10620-023-08088-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Closure of temporary diverting ostomies is commonly preceded by an endoscopic study of the colonic mucosa and anastomosis, despite lacking evidence of its relevance and impact on subsequent operative management. AIM We sought to determine the incidence of pathological findings and therefore evaluate the clinical benefit of routine pre-operative endoscopy in asymptomatic patients, hypothesizing sole evaluation of the anastomotic integrity to be sufficient in these cases. METHODS We retrospectively identified all adult patients with ostomy installations who were followed up for potential reversal surgery between 2002 and 2020 at the University Hospital of Zurich, Switzerland. Main outcome measures were the incidence of endoscopically identified pathological findings in the asymptomatic case cohort and their impact on the subsequent course of treatment. RESULTS Pre-procedural endoscopic data of 187 cases evaluated for ostomy closure were evaluated. Relevant mucosal findings in the asymptomatic cohort were documented in 26.3% and findings at the anastomotic site detected in 8.7%. A change in subsequent surgical management was noted in 10 patients of the entire cohort (5.3%) and in 9 (5.1%) of all asymptomatic cases. Upon multivariate analyses, the age range of 51 to 60 years old was found to be significantly linked to the presence of endoscopic findings entailing a change in patient management. CONCLUSION Our findings strongly suggest ostomy closure surgery without previous assessment of the bowel mucosa by means of endoscopy to be acceptable in asymptomatic patients. However, we found it to be indicated in all patients meeting the screening criteria for colorectal carcinoma.
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Affiliation(s)
- Maxine E. Schreiber
- Department of Gastroenterology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Marcel A. Schneider
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Fritz R. Murray
- Department of Gastroenterology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Department of Gastroenterology, Stadtspital Zurich, Birmensdorferstrasse 497, 8063 Zurich, Switzerland
| | - Matthias Turina
- Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Christoph Gubler
- Department of Gastroenterology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Department of Gastroenterology, Stadtspital Zurich, Birmensdorferstrasse 497, 8063 Zurich, Switzerland
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Tirelli F, Lorenzon L, Biondi A, Langellotti L, Santoro G, Agnes A, Pezzuto R, Persiani R, D'Ugo D. Predictors of Clostridium difficile infection after stoma reversal following TaTME surgery. Updates Surg 2023; 75:1589-1596. [PMID: 37540407 PMCID: PMC10435656 DOI: 10.1007/s13304-023-01614-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The aim of this study was to determine the incidence of Clostridium Difficile infection (CDI) after stoma reversal in patients who underwent transanal Total Mesorectal Excision (TaTME) and to evaluate variables correlated with this post-operative infection. METHODS Patients who underwent stoma reversal surgery following TaTME for rectal cancer between 2015 and 2023 at a high-volume Institution, were retrospectively reviewed for the post-operative occurrence of diarrhea and in-hospital CDI (positive toxin in the stools). Patients were divided into the following subgroups according to the post-operative course: Group A-no clinical symptoms; Group B-mild diarrhea (< 10 evacuations/day); Group C-severe watery diarrhea (> 10 evacuations/day) with CDI negative; and Group D-severe watery diarrhea (> 10 evacuations/day) CDI positive. Clinical and laboratory data were analyzed for their correlation with CDI. A machine learning approach was used to determine predictors of diarrhea following stoma reversal. RESULTS A total of 126 patients were selected, of whom 79 were assessed as Group A, 16 Group B, 25 Group C and 6 (4.8%) Group D. Univariable analysis documented that delayed stoma reversal correlated with CDI (Group A mean interval 44.6 weeks vs. Group D 68.4 weeks, p 0.01). The machine learning analysis confirmed the delay in stoma closure as a probability factor of presenting diarrhea; also, diarrhea probability was 80.5% in males, 77.8% in patients who underwent neoadjuvant therapy, and 63.9% in patients who underwent adjuvant therapy. CONCLUSIONS Stoma reversal surgery can result in moderate rate of in-hospital CDI. Time-to stoma reversal is a crucial variable significantly related with this adverse outcome.
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Affiliation(s)
- Flavio Tirelli
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Laura Lorenzon
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Alberto Biondi
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Lodovica Langellotti
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Gloria Santoro
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Annamaria Agnes
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Roberto Pezzuto
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Roberto Persiani
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Domenico D'Ugo
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168, Rome, Italy
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Patel C, Elmasry A, Giridharan S. Concurrent Chemo-radiotherapy in Anal Squamous Cell Carcinoma: A Retrospective Review of a Tertiary Centre Experience. J Gastrointest Cancer 2023; 54:867-872. [PMID: 36269537 DOI: 10.1007/s12029-022-00866-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 10/24/2022]
Abstract
PURPOSE Anal cancer is a rare form of gastrointestinal malignancy, and treatment is often confined to specialist centres. It has a high cure rate with non-surgical approach resulting in organ preservation. The current accepted schedule is chemo-radiotherapy (CRT) with 5-fluorouracil and mitomycin with radiotherapy doses between 50.4 and 53.2 Gray in 28 fractions. METHODS This study included patients who had histological confirmation of squamous cell carcinoma and had completed the full CRT course for anal cancer between 2008 and 2018 in our centre. Data was collected retrospectively assessing demographics, staging, surgery, relapse, latest follow-up, date of death, CRT regimen and TNM stage. Outcome data and stoma reversal rate were analysed. RESULTS Overall, 87 patients were included in the study. At diagnosis 94.3% of patients had T2-T4 disease, and 44.8% had involvement of positive loco-regional lymph nodes. Overall survival (OS) probability at 1, 3 and 5 years were 98.8%, 87.4% and 83.7%, respectively. Results also revealed a statistically significant effect of time from diagnosis to the start of radiotherapy on OS (p = 0.039). Sixty-nine (79.3%) patients achieved complete remission at last follow-up. Twenty-one patients (24%) underwent surgery for a de-functioning stoma, and only five of these patients subsequently received stoma reversal surgery. CONCLUSIONS Our data reflects the efficacy of CRT as the primary modality of treatment in the management of anal squamous cell carcinoma with effective organ preservation and disease control. Early stoma reversal may also enhance quality of life.
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Affiliation(s)
- Chantal Patel
- Oncology Department, University Hospitals of North Midlands, Newcastle Rd, Stoke-on-Trent, ST4 6QG, UK.
- Cambridge University Hospitals, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Abdelfattah Elmasry
- Oncology Department, University Hospitals of North Midlands, Newcastle Rd, Stoke-on-Trent, ST4 6QG, UK
- University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, UK
| | - Selvaraj Giridharan
- Oncology Department, University Hospitals of North Midlands, Newcastle Rd, Stoke-on-Trent, ST4 6QG, UK
- Keele University, Keele, Newcastle, ST5 5BG, UK
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Kofoed NG, Falconer H, Vanky H, Johansson H, Abraham-Nordling M, Salehi S. Survival and chance of reversal after intestinal stoma formation during cytoreductive surgery for advanced ovarian cancer; a population-based cohort study. Gynecol Oncol 2023; 170:259-265. [PMID: 36738484 DOI: 10.1016/j.ygyno.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Our objective was to examine oncologic outcome in women with advanced epithelial ovarian cancer (aEOC) receiving an intestinal stoma (IS) at the time of cytoreductive surgery (CRS), probability of stoma reversal (SR) and variables affecting odds of SR. METHODS This population-based cohort study included all women diagnosed with aEOC between 2009 and 2018 in the Stockholm/Gotland Region of Sweden. The association between IS formation at CRS and survival was analyzed with proportional hazards regression yielding hazard ratios (HR) with 95% confidence intervals (CI), adjusted for predefined confounders. Cumulative incidence functions, with death or recurrence as competing risk, were used to estimate chance of SR. The association between clinical factors and SR was analyzed with logistic regression yielding odds ratios (OR) with 95% CI. RESULTS The final analysis included 888 women undergoing CRS for aEOC. Of these, 129 (14,5%) received an IS of which 74% (n = 95) were defunctioning and 26% (n = 34) permanent. IS was associated with an increased hazard of death (HR 1.30, CI 95%, 1.05-1.61; p = 0.02) in the univariate analysis, however not in the adjusted analysis. The probability of SR of defunctioning IS within 2 years was 48% (95% CI, 38-58). Median time to SR was 10 months. High surgical complexity score (SCS) was associated with increased odds of reversal (OR 3.43, 95% CI, 1.06-11.05; p = 0.04). CONCLUSIONS IS formation does not seem to affect prognosis in women with aEOC. We could not identify any factor, known at time of CRS, that may predict the odds of SR except a high SCS.
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Affiliation(s)
- Nina Groes Kofoed
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
| | - Henrik Falconer
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Vanky
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Mirna Abraham-Nordling
- Department of Molecular medicine and Surgery Karolinska Institutet and Department of Pelvic Cancer, Theme Cancer Karolinska University Hospital, Stockholm, Sweden
| | - Sahar Salehi
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden; Department of Microbiology Tumor and Cell Biology, Karolinska Institutet, Sweden
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Stabilini C, Garcia-Urena MA, Berrevoet F, Cuccurullo D, Capoccia Giovannini S, Dajko M, Rossi L, Decaestecker K, López Cano M. An evidence map and synthesis review with meta-analysis on the risk of incisional hernia in colorectal surgery with standard closure. Hernia 2022; 26:411-436. [PMID: 35018560 DOI: 10.1007/s10029-021-02555-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/27/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To assess the incidence of incisional hernia (IH) across various type of incisions in colorectal surgery (CS) creating a map of evidence to define research trends, gaps and areas of future interest. METHODS Systematic review of PubMed and Scopus from 2010 onwards. Studies included both open (OS) and laparoscopic (LS). The primary outcome was incidence of IH 12 months after index procedure, secondary outcomes were the study features and their influence on reported proportion of IH. Random effects models were used to calculate pooled proportions. Meta-regression models were performed to explore heterogeneity. RESULTS Ninetyone studies were included reporting 6473 IH. The pooled proportions of IH for OS were 0.35 (95% CI 0.27-0.44) I2 0% in midline laparotomies and 0.02 (95% CI 0.00-0.07), I2 52% for off-midline. In case of LS the pooled proportion of IH for midline extraction sites were 0.10 (95% CI 0.07-0.16), I2 58% and 0.04 (95% CI 0.03-0.06), I2 86% in case of off-midline. In Port-site IH was 0.02 (95% CI 0.01-0.04), I2 82%, and for single incision surgery (SILS) of 0.06-95% CI 0.02-0.15, I2 81%. In case of stoma reversal sites was 0.20 (95% CI 0.16-0.24). CONCLUSION Midline laparotomies and stoma reversal sites are at high risk for IH and should be considered in research of preventive strategies of closure. After laparoscopic approach IH happens mainly by extraction sites incisions specially midline and also represent an important area of analysis.
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Affiliation(s)
- C Stabilini
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - M A Garcia-Urena
- Faculty of Health Sciences, Francisco de Vitoria University, Henares University Hospital, Carretera Pozuelo-Majadahonda km 1,8, 28223, Pozuelo de Alarcón, Madrid, Spain.
| | - F Berrevoet
- Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - D Cuccurullo
- Department of Surgery, Ospedale Monaldi-Azienda Ospedaliera dei Colli, Naples, Italy
| | - S Capoccia Giovannini
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - M Dajko
- Gastroenterology and Clinical Oncology Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Rossi
- Department of Surgery (DiSC), University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
| | - K Decaestecker
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - M López Cano
- Abdominal Wall Surgery Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.,Vall d'Hebron Research Institute General and Gastrointestinal Surgery Research Group, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Simmonds I, Towle-Miller LM, Myneni AA, Gray J, Jordan JM, Schwaitzberg SD, Hoffman AB, Noyes K. Is New York State good at managing hollow viscus injury? Surg Endosc 2022; 36:6789-6800. [PMID: 34997346 DOI: 10.1007/s00464-021-08964-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/12/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND There are an estimated 100,000 cases of abdominal injury (ABI) in the USA, annually resulting in over $12 billion in direct medical cost and $18 billion in lost productivity. This study assesses the timeliness, safety, and efficacy of the surgical management of abdominal injuries (ABIs), hollow viscus injuries (HVIs), and colonic injuries (CIs) for patients residing in New York State (NYS). METHODS Using data from NYS's Statewide Planning and Research Cooperative System (SPARCS), we identified all trauma patients with ABI admitted between 2006 and 2015. We subdivided ABI into HVI and CI using diagnosis and procedure codes and examined processes of care and outcomes adjusting for patient characteristics, injury severity score, structural, and process indicators. RESULTS We identified 31,043 hospitalized patients with ABI, 71% were incurred from blunt forces. Most patients with ABI (72%) were treated at a Level I/II trauma center (TC) and 7% patients were transferred to Level I/II TC. Failure to be treated at Level I/II TC was associated with 16% increased hazard of death. HVI was diagnosed in 23% of ABI patients (n = 7294); 18% experienced delayed hollow viscus repair (dHVR); dHVR was associated with a 76% increased hazard of death. CI was diagnosed in 9% of ABI patients (n = 2921) and 18% experienced dHVR. Seventy-five percent of CI were repaired primarily (n = 1354). Less than 37% of stomas were reversed by 4 years of index trauma. CONCLUSION Most abdominal trauma in NYS was caused by motor vehicle accidents, falls, and assault. dHVR and not being treated at Level I/II TC were associated with worse outcomes. More research is needed to reduce under-triage and delays in the operative treatment of blunt abdominal trauma.
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Affiliation(s)
- Iman Simmonds
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Lorin M Towle-Miller
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Ajay A Myneni
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Justin Gray
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Jeffrey M Jordan
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Steven D Schwaitzberg
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Aaron B Hoffman
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Katia Noyes
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA. .,Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
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Han LE, Bean A, Emmett C, Plusa SM. Stoma reversal in functional bowel disease: managing patient choice. Ann R Coll Surg Engl 2021; 103:745-751. [PMID: 34414788 PMCID: PMC9773920 DOI: 10.1308/rcsann.2021.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study aims to assess the rate of stoma reversal in patients who have undergone stoma formation with permanent intent for functional bowel disorder. We also assessed the incidence of malignancy in defunctioned bowel. METHODS This is a retrospective study of the outcomes of patients undergoing planned permanent stoma formation for functional bowel disorder over a 10-year period at a single tertiary centre. RESULTS Of 92 patients included in the study, 11 (12%) requested and underwent stoma reversal following stoma formation for functional bowel disorder. Of 84 patients with defunctioned bowel left in situ, two (2%) developed bowel malignancy during our study period. CONCLUSIONS Stoma formation may be necessary for patients with incontinence and constipation when conservative treatments fail. Some patients have very firm views about the need for a stoma, but a significant proportion of patients do not cope with a stoma and request reversal, therefore patient selection and pre-procedure counselling are important. The risk of developing malignant disease in the defunctioned colon is potentially significant, and consideration should be given to appropriate surveillance in this group of patients. Evidence for stoma formation in functional gastrointestinal disorders is lacking; this study reports outcomes in a large cohort of patients over a long period, and highlights areas where further research and practice guidelines are needed. If large numbers of patients are undergoing stoma reversal posing significant mortality and morbidity risks, this suggests that patient selection and preoperative counselling need refinement.
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Affiliation(s)
- LE Han
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - A Bean
- Northumbria Healthcare NHS Foundation Trust, UK
| | - C Emmett
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - SM Plusa
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
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10
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Pape E, Vlerick I, Van Nieuwenhove Y, Pattyn P, Van de Putte D, van Ramshorst GH, Geboes K, Van Hecke A. Experiences and needs of patients with rectal cancer confronted with bowel problems after stoma reversal: A systematic review and thematic-synthesis. Eur J Oncol Nurs 2021; 54:102018. [PMID: 34543812 DOI: 10.1016/j.ejon.2021.102018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/09/2021] [Accepted: 08/17/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE After the reversal of the temporary stoma, rectal cancer survivors are often confronted with bowel complaints largely impacting on their quality of life. This systematic review aims to identify and synthesise the experiences and needs of patients with rectal cancer confronted with bowel problems after stoma reversal. METHODS A systematic search was performed through Pubmed, CINAHL and Web of Science. Only studies with a qualitative design were included in this review. Quality assessment was done by the critical appraisal skill programme (CASP) Qualitative Studies Checklist. A thematic-synthesis was performed. RESULTS Of 2713 identified papers, 10 were included in this systematic review. Two general themes were identified: 'experiences and needs about bowel function before surgery' and 'experiences and needs afterwards'. Before restoration of continuity patients had to cope with the temporary stoma, and they felt uncertain about what to expect. Patients indicated that the timing of providing information was crucial but varied. Bowel problems after surgery had a physical and emotional impact on patients' family life. They were also confronted with shame and stigma. Patients were happy to be alive and cancer free but were hopeful that the bowel problems would resolve. They used several strategies to manage and cope with these symptoms. Peers and healthcare professionals proved valuable resources of support. CONCLUSION Rectal cancer survivors experience ongoing bowel problems after treatment. Patients describe experiences and needs before rectal cancer surgery and afterwards when confronting with bowel problems. Follow-up care should be organised proactively and focus on management strategies and emotional support.
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Affiliation(s)
- E Pape
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium.
| | - I Vlerick
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Y Van Nieuwenhove
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - P Pattyn
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - D Van de Putte
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - G H van Ramshorst
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - K Geboes
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - A Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium; Staff Member Nursing Department, Ghent University Hospital, Ghent, Belgium
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11
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van Loon YT, Clermonts SHEM, Belgers EHJ, Kurihara H, Spinelli A, Joshi HM, Gorissen KJ, Zimmerman DDE. Reversal of left-sided colostomy utilizing single-port laparoscopy a multicenter European audit and overview of the literature. Surg Endosc 2021; 36:3389-3397. [PMID: 34312728 PMCID: PMC9001236 DOI: 10.1007/s00464-021-08657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
Background Stoma reversal surgery can result in considerable morbidity and even mortality. Feasibility of utilizing single-port laparoscopy through the stoma fenestration have been shown before. Aim of the present observational study is to evaluate multicenter experiences of single-port reversal of left-sided colostomy (SPRLC) throughout Europe and to provide an overview of available literature on this topic. Methods All patients undergoing SPRLC in four different teaching hospitals throughout Europe are included. Primary outcome was 30-day postoperative complication rate. Secondary outcomes were postoperative length of stay (LOS), single-port success rate and conversion rates. Appraisal of the available literature in PubMed was performed. Results Of 156 SPRLC procedures, 98.7% of them were technically successful and 71.8% were without postoperative complications. No postoperative mortality was encountered. Superficial site infection occurred in 14.7%, anastomotic leakage in 3.9% and major complications in 8.3%. Median LOS was 4.0 days (1–69), single-port success rate was 64.7%, 12.8% and 21.2% (33/154) were converted to an open and multiport laparoscopic procedure, respectively. Literature shows equally favorable results in 131 patients divided over 5 cohorts with morbidity ranging from 0 to 30.4% and mortality from 0 to 2.2% and median LOS of 4–8 days. Conclusion This study confirms the safety, feasibility and favorable results of the use of single-port approach in the reversal of left-sided colostomy in different centers in Europe with laparoscopic experienced colorectal surgeons. The available literature on this topic support and show equally favorable results using single-port laparoscopy for left-sided colostomy reversal surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08657-x.
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Affiliation(s)
- Y T van Loon
- Department of Surgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022GC, Tilburg, The Netherlands.
| | - S H E M Clermonts
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Surgery, Zuyderland Hospital, Heerlen and Sittard, The Netherlands
| | - E H J Belgers
- Department of Colorectal Surgery, Humanitas University, Milan, Italy
| | - H Kurihara
- Department of Emergency Surgery and Trauma Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - A Spinelli
- Department of Colon and Rectal Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, Milan, Italy
| | - H M Joshi
- Department of Colorectal Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K J Gorissen
- Department of Emergency and Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D D E Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022GC, Tilburg, The Netherlands
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12
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Kamada T, Ito E, Ohdaira H, Takahashi J, Takeuchi H, Kitagawa K, Akiba T, Suzuki Y. New Scoring System for Predicting the Risk of Surgical Site Infections Following Stoma Reversal. J Surg Res 2021; 267:350-357. [PMID: 34198111 DOI: 10.1016/j.jss.2021.05.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/31/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surgical site infections (SSI) are one of the most frequent complications following stoma reversal (SR-SSI) and lead to multiple problems such as decreased mobility of the patients or increased hospital costs. Several risk factors for SR-SSI have been reported, but there are no risk scoring systems for predicting SR-SSI. The current study aimed to analyze the risk factors for SR-SSI and develop a scoring system. MATERIALS AND METHODS Multivariate analysis of risk factors for SR-SSI was performed in patients who underwent elective SR and were followed-up during the first month after surgery. A logistic regression model was used to identify risk factors and construct a predictive score. RESULTS Of the 182 patients, 53 (29.1%) developed SSI. In multivariate analysis, three variables as preoperative risk factors were associated with increased SR-SSI incidence: subcutaneous fat thickness (≥ 20 mm) (odds ratio [OR]: 8.46 [95% confidence interval (CI): 3.45-20.7], P <0.001), period from stoma creation (≤ 20 weeks) (OR: 2.88 [95% CI: 1.14-7.28], P = 0.025), and SSI after the primary operation (OR: 3.06 [95% CI: 1.19-7.90], P = 0.021). Each of these variables contributed 2,1, and 1 points to the risk score, respectively. The SR-SSI rate was 2.9%, 20.3%, 34.2%, 54.5%, and 81.8% for the scores of 0,1,2,3, and 4 points, respectively. The area under the receiver operating characteristic curve was 0.773 (95% CI: 0.703-0.844). CONCLUSIONS A simple clinical scoring system based on three preoperative variables may be useful in predicting the risk of SR-SSI.
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Affiliation(s)
- Teppei Kamada
- Department of Surgery, International University of Health and Welfare Hospital, Tochigi, Japan.
| | - Eisaku Ito
- Department of Surgery, International University of Health and Welfare Hospital, Tochigi, Japan; Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Junji Takahashi
- Department of Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Hideyuki Takeuchi
- Department of Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Kazuo Kitagawa
- Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Tadashi Akiba
- Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
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13
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Kienle P, Magdeburg JR. [Chronic anastomotic leak after low rectal resection-an unsolved problem?]. Chirurg 2021; 92:605-611. [PMID: 33852017 DOI: 10.1007/s00104-021-01400-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 11/27/2022]
Abstract
There is no generally accepted definition of a chronic anastomotic leak, which often presents as a chronic sinus. The corresponding time interval required from primary anastomotic construction ranges from 2 months to 12 months. Between 2% and 16% of all patients develop this complication after low anterior rectal resection. Due to the heterogeneous presentation and configuration of chronic leaks there are no valid comparable data on how to manage this problem. A variety of therapeutic options are used, sometimes combined or additively. The choice of therapeutic option depends very much on the individual case. The following options are used: debridement of the persisting cavity/fistula system, wide deroofing of the cavity into the lumen, endosponge with vacuum, stent implantation, advancement flap with simultaneous drainage of the cavity, fibrin glue instillation and as a last resort a redo low anastomosis. The healing rate in the available literature is generally over 70%. In selected cases a stoma reversal can be done for persisting cavities (wide entry of the cavity into the neorectum, no relevant distal stenosis). Overall, the available poor to moderate evidence suggests that 70-85% of patients with a chronic anastomotic leak, defined as stoma reversal, are treated successfully; however, there is some concern of a relevant publication bias of the published data so that the results may be less impressive in the clinical reality.
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Affiliation(s)
- Peter Kienle
- Allgemein-und Viszeralchirurgie, Theresienkrankenhaus und St. Hedwig-Klinik gGmbH, Bassermannstraße 1, 68165, Mannheim, Deutschland.
| | - Jörn Richard Magdeburg
- Allgemein-und Viszeralchirurgie, Theresienkrankenhaus und St. Hedwig-Klinik gGmbH, Bassermannstraße 1, 68165, Mannheim, Deutschland
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14
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Peltrini R, Imperatore N, Altieri G, Castiglioni S, Di Nuzzo MM, Grimaldi L, D'Ambra M, Lionetti R, Bracale U, Corcione F. Prevention of incisional hernia at the site of stoma closure with different reinforcing mesh types: a systematic review and meta-analysis. Hernia 2021; 25:639-648. [PMID: 33713204 PMCID: PMC8197707 DOI: 10.1007/s10029-021-02393-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/08/2021] [Indexed: 12/31/2022]
Abstract
Purpose To evaluate safety and efficacy of a mesh reinforcement following stoma reversal to prevent stoma site incisional hernia (SSIH) and differences across the prostheses used. Methods A systematic search of PubMed/MEDLINE, EMBASE, SCOPUS and Cochrane databases was conducted to identify comparative studies until September 2020. A meta-analysis of postoperative outcomes and a network meta-analysis for a multiple comparison of the prostheses with each other were performed. Results Seven studies were included in the analysis (78.4% ileostomy and 21.6% colostomy) with a total of 1716 patients with (n = 684) or without (n = 1032) mesh. Mesh placement was associated with lower risk of SSIH (7.8%vs18.1%, OR0.266,95% CI 0.123–0.577, p < 0.001) than no mesh procedures but also with a longer operative time (SMD 0.941, 95% CI 0.462–1.421, p < 0.001). There was no statistically significant difference in terms of Surgical Site infection (11.5% vs 11.1%, OR 1.074, 95% CI 0.78–1.48, p = 0.66), seroma formation (4.4% vs 7.1%, OR 1.052, 95% CI 0.64–1.73, p = 0.84), anastomotic leakage (3.7% vs 2.7%, OR 1.598, 95% CI 0.846–3.019, p = 0.149) and length of stay (SMD − 0.579,95% CI − 1.261 to 0.102, p = 0.096) between mesh and no mesh groups. Use of prosthesis was associated with a significant lower need for a reoperation than no mesh group (8.1% vs 12.1%, OR 0.332, 95% CI 0.119–0.930, p = 0.036). Incidence of seroma is lower with biologic than polypropylene meshes but they showed a trend towards poor results compared with polypropylene or biosynthetic meshes. Conclusion Despite longer operative time, mesh prophylactic reinforcement at the site of stoma seems a safe and effective procedure with lower incidence of SSIH, need for reoperation and comparable short-term outcomes than standard closure technique. A significant superiority of a specific mesh type was not identified. Supplementary Information The online version contains supplementary material available at 10.1007/s10029-021-02393-w.
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Affiliation(s)
- Roberto Peltrini
- Department of Public Health, University of Naples Federico II, Naples, Italy.
| | - Nicola Imperatore
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.,Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli, Naples, Italy
| | - Gaia Altieri
- Departement of Gastroenterological, Endocrine-Metabolic and Nephrourological Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simone Castiglioni
- Department of Medical, Oral and Biotechnological Sciences, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | | | - Luciano Grimaldi
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Michele D'Ambra
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Ruggero Lionetti
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Umberto Bracale
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Francesco Corcione
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Abstract
PURPOSE Patients scheduled for stoma closure may also have an incisional hernia. Studies have reported acceptable outcomes after contaminated ventral hernia repair, but whether stoma closure and incisional hernia repair should be performed as a combined procedure is unknown. This study examined combined stoma closure and incisional hernia repair compared with incisional hernia repair only. METHODS This was a nationwide propensity-score matched study. Patients who underwent elective incisional hernia repair from 2007-2017 were identified in the Danish Hernia Database. All patients who underwent concurrent stoma closure were matched 1:3 with patients who underwent incisional hernia repair only. The primary outcome was reoperation for hernia recurrence, whereas secondary outcomes included anastomotic leakage, length of hospital stay, and 30-day reoperation and readmission rates. RESULTS In total, 516 patients were included. The risk of reoperation for recurrence was increased after concurrent stoma closure compared with incisional hernia repair only (hazard ratio 1.69, 95% confidence interval 1.01-2.82, p = 0.044). Seven (5.4%) patients who underwent incisional hernia repair concurrent to stoma closure were reoperated for anastomotic leakage. Length of hospital stay and reoperation rates within 30 days were increased after concurrent stoma closure compared with incisional hernia repair only (median 8 versus 3 days, p < 0.001 and 29.5% versus 18.6%, p = 0.013), whereas there was no difference in 30-day readmission rates (p = 0.251). CONCLUSIONS Stoma closure and incisional hernia repair should be performed as a dual-stage procedure to decrease the risk of hernia recurrence.
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Affiliation(s)
- E Oma
- Digestive Disease Center, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
| | - N N Baastrup
- Digestive Disease Center, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
| | - K K Jensen
- Digestive Disease Center, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark
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16
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Mohamedahmed AYY, Stonelake S, Zaman S, Hajibandeh S. Closure of stoma site with or without prophylactic mesh reinforcement: a systematic review and meta-analysis. Int J Colorectal Dis 2020; 35:1477-1488. [PMID: 32588121 DOI: 10.1007/s00384-020-03681-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 02/04/2023]
Abstract
AIMS To evaluate comparative outcomes of the closure of temporary stoma site with or without prophylactic mesh reinforcement METHODS: A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Studies comparing the reversal of stoma with and without prophylactic mesh reinforcement were included. Stoma site incisional hernia (SSIH), surgical site infection (SSI), operative time, seroma formation, haematoma formation, bowel obstruction, anastomosis leak, length of hospital stay (LOS) and secondary operation to repair the SSIH were the evaluated outcome parameters. RESULTS Six comparative studies reporting a total of 1683 patients who underwent closure of stoma with (n = 669) or without (n = 1014) prophylactic mesh reinforcement were included. Use of mesh was associated with a significantly lower risk of SSIH (OR 0.22, P = 0.003) and need for surgical intervention to repair SSIH (OR 0.32, P = 0.04) compared with no use of mesh. However, it was associated with significantly longer operative time (MD 47.78, P = 0.02). There was no significant difference in SSI (OR 1.09, P = 0.59), bowel obstruction (OR 1.11, P = 0.74), seroma formation (OR 2.86, P = 0.19), anastomosis leak (OR 1.60, P = 0.15), haematoma formation (OR 1.25, P = 0.75) or LOS (MD - 0.45, P = 0.31) between two groups. CONCLUSION Prophylactic mesh reinforcement during the closure of temporary stoma may significantly reduce the risk of SSIH and surgical intervention to repair the hernia without increasing the risk of SSI or other morbidities. However, it may increase the procedure time. Future higher-quality randomised evidence is required.
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Affiliation(s)
- Ali Yasen Y Mohamedahmed
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
| | - Stephen Stonelake
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Shafquat Zaman
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Shahin Hajibandeh
- Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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17
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Schwandner F, Klimars U, Gock M, Schiffmann L, Witte M, Schiergens T, Rentsch M, Klar E, Kühn F. The Water-Holding Procedure for Ensuring Postoperative Continence Prior Restoring Intestinal Continuity. J Gastrointest Surg 2020; 24:411-417. [PMID: 30825120 DOI: 10.1007/s11605-019-04171-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 02/13/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND A defunctioning stoma can become necessary in a relevant number of patients undergoing gastrointestinal surgery. As a matter of course, patients seek an early closure of the stoma. However, preoperative management of these patients varies and the prediction of continence after stoma removal can become challenging. Patients might be fully continent despite low manometric pressures and vice versa. An easy and reliable way to predict continence after stoma reversal would improve patients' management and outcome. Although frequently performed in various surgical centers in Germany, there is no published data on the water-holding test. Hence, this is the first study evaluating the role of the test in clinical practice. METHOD We performed a prospective pilot study to evaluate the role of anorectal manometry and the water-holding procedure as a predictor of postoperative continence prior to stoma reversal. Inclusion criteria were a successfully passed water-holding test, any type of fecal diversion and the possibility of restoring intestinal continuity. Preoperative low manometric pressure levels were not an exclusion criteria for stoma reversal. Fifty-two patients with ostomy were consecutively enrolled in this study between October 2013 and February 2016. Anorectal manometry was performed in all patients prior to stoma reversal. After stoma removal, patients were followed-up for 6 months. Postoperative incontinence was determined using the Wexner incontinence score. RESULTS A total of 52 patients (38 males, 14 females) were included at an average age of 59 (range 33-83) years. Most frequent indications for intestinal diversion were rectal cancer surgery, IBD-related surgery, or surgery for diverticular disease. Low anterior rectal resection was performed in 17 patients (32.7%), followed by a proctocolectomy in 9 (17.3%), colectomy in 9 (17.3%), and recto-sigmoid resection in 7 patients (13.5%). Median time from stoma creation to reversal was 206 days (range 48-871 days). All patients had successfully passed the standardized water-holding test. At the same time, the majority of patients had low preoperative manometric pressure values and would normally not have been reversed at that point. The median postoperative Wexner incontinence score was at 1.5 (range 0-20), 0.5 (range 0-14), and 0 (range 0-11) at 14, 60, and 180 days after stoma reversal. Low preoperative manometric squeeze and/or resting pressure levels were not associated with a higher postoperative incontinence score at 14, 60, or 180 days after stoma reversal. CONCLUSION A standardized water-holding test can function as an easy and reliable method before stoma reversal to predict sufficient postoperative fecal continence. In case of a sufficient water-holding test despite low manometric pressure levels, the risk for postoperative anal incontinence seems to be low. Preoperative manometric pressure levels do not appear to predict postoperative continence.
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Affiliation(s)
- Frank Schwandner
- Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Ulrich Klimars
- Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Michael Gock
- Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Leif Schiffmann
- Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Maria Witte
- Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Tobias Schiergens
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Markus Rentsch
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Ernst Klar
- Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Florian Kühn
- Department of General, Visceral and Transplant Surgery, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany.
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18
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Kim S, Kang SI. The effectiveness of negative-pressure wound therapy for wound healing after stoma reversal: a randomised control study (SR-PICO study). Trials 2020; 21:24. [PMID: 31907033 PMCID: PMC6945515 DOI: 10.1186/s13063-019-3925-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/21/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although the wound-healing period for purse-string closure (PSC) after stoma reversal is longer than that required for the primary closure method, the rate of wound infection is reduced. The application of negative-pressure wound therapy (NPWT) can reduce the healing period for many types of wounds. Herein, we describe a planned trial to test the hypothesis that NPWT can reduce the healing period for PSC after stoma reversal. METHODS/DESIGN Patients undergoing stoma reversal will be recruited and allocated into intervention and control groups, with 1:1 randomisation. Patients in the control group will receive standard postsurgical wound care; patients in the intervention group will receive NPWT using the PICO™ system. The target sample size will be 38 patients, as this will provide 80% power at the 5% level of significance to detect a 7-day reduction in the wound-healing period in the intervention group compared to that in the control group. The primary endpoint will be the duration to wound healing, defined as the time to nearly complete epithelisation of the wound, without any discharge or surgical site infection (SSI). Secondary endpoints will be the SSI rate, length of postoperative hospital stay, number of wound dressings and visits to the hospital for wound dressing after discharge, total cost of wound dressings, and patient and observer scar assessment scale scores. DISCUSSION The results of this planned randomised controlled study will clarify the role of NPWT in patients undergoing stoma reversal and strengthen the rationale for choosing a dressing technique. TRIAL REGISTRATION Clinical Research Information Service (CRIS), KCT0004063. Registered on 6 June 2019.
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Affiliation(s)
- Sohyun Kim
- Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea
| | - Sung Il Kang
- Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea.
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19
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van Ommeren–Olijve SJ, Burbach JPM, Furnée EJB. Risk factors for non-closure of an intended temporary defunctioning stoma after emergency resection of left-sided obstructive colon cancer. Int J Colorectal Dis 2020; 35:1087-1093. [PMID: 32211956 PMCID: PMC7245586 DOI: 10.1007/s00384-020-03559-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE A substantial part (21-35%) of defunctioning stomas created during resection for colorectal cancer will never be reversed. Known risk factors for non-closure are age, peri- or postoperative complications, comorbidity, and tumor stage. However, studies performed to identify these risk factors mostly focus on rectal cancer and include both preoperative and postoperative factors. This study aims to identify preoperative risk factors for non-reversal of intended temporary stomas created during acute resection of left-sided obstructive colon cancer (LSOCC) with primary anastomosis. METHODS All patients who underwent emergency resection for LSOCC with primary anastomosis and a defunctioning stoma between 2009 and 2016 were selected from the Dutch ColoRectal Audit, and additional data were collected in the local centers. Multivariable analysis was performed to identify independent preoperative factors for non-closure of the stoma. RESULTS A total of 155 patients underwent acute resection for LSOCC with primary anastomosis and a defunctioning stoma. Of these, 51 patients (32.9%) did not have their stoma reversed after a median of 53 (range 7-104) months of follow-up. In multivariable analysis, hemoglobin < 7.5 mmol/L (odds ratio (OR) 4.79, 95% confidence interval (95% CI) 1.60-14.38, p = 0.005), estimated glomerular filtration rate (eGFR) ≤ 45 mL/min/1.73 m2 (OR 4.64, 95% CI 1.41-15.10, p = 0.011), and metastatic disease (OR 6.12, 95% CI 2.35-15.94, p < 0.001) revealed to be independent predictors of non-closure. CONCLUSIONS Anemia, impaired renal function, and metastatic disease at presentation were found to be independent predictors for non-reversal of intended temporary stomas in patients who underwent acute resection for LSOCC. In patients who have an increased risk of non-reversal, the surgeon should consider a Hartmann's procedure.
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Affiliation(s)
| | - J. P. M. Burbach
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - E. J. B. Furnée
- Department of Surgery, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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Matsuda K, Hashiguchi Y, Tsukamoto M, Ohno K, Okada Y, Yagi T, Fukushima Y, Horiuchi A, Shimada R, Ozawa T, Hayama T, Tsuchiya T, Tamura J, Iinuma H, Nozawa K, Sasajima Y, Kondo F. A case report of successful management of fulminant Clostridium difficile colitis post-ileostomy reversal with administration of vancomycin through a transverse colostomy. Surg Case Rep 2019; 5:181. [PMID: 31776700 PMCID: PMC6881489 DOI: 10.1186/s40792-019-0744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/30/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Keiji Matsuda
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan.
| | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Mitsuo Tsukamoto
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Kohei Ohno
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Yuka Okada
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Takahiro Yagi
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Yoshihisa Fukushima
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Atsushi Horiuchi
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Ryu Shimada
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Tsuyoshi Ozawa
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Tamuro Hayama
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Takeshi Tsuchiya
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Junko Tamura
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Hisae Iinuma
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Keijiro Nozawa
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Yuko Sasajima
- Department of Pathology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Fukuo Kondo
- Department of Pathology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
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van den Hil LCL, van Steensel S, Schreinemacher MHF, Bouvy ND. Prophylactic mesh placement to avoid incisional hernias after stoma reversal: a systematic review and meta-analysis. Hernia 2019; 23:733-741. [PMID: 31302788 PMCID: PMC6661031 DOI: 10.1007/s10029-019-01996-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/20/2019] [Indexed: 12/13/2022]
Abstract
Purpose To provide an overview of the available literature on prevention of incisional hernias after stoma reversal, with the use of prophylactic meshes. Methods A literature search of Pubmed, MEDLINE and EMBASE was performed. Search terms for stoma, enterostomy, mesh, prophylaxis and hernia were used. Search was updated to December 31th 2018. No time limitations were used, while English, Geman, Dutch and French were used as language restrictions. The primary outcome was the incidence of incisional hernia formation after stoma reversal. Secondary outcomes were mesh-related complications. Data on study design, sample size, patient characteristics, stoma and mesh characteristics, duration of follow-up and outcomes were extracted from the included articles. Results A number of 241 articles were identified and three studies with 536 patients were included. A prophylactic mesh was placed in 168 patients to prevent incisional hernias after stoma reversal. Follow-up ranged from 10 to 21 months. The risk of incisional hernia in case of prophylactic mesh placement was significantly lower in comparison to no mesh placement (OR 0.10, 95% CI 0.04–0.27, p < 0.001, I2 = 0%, CI 0–91.40%). No differences in surgical site infections were detected between the groups. Conclusions The use of a prophylactic mesh seems to reduce the risk on incisional hernias after stoma reversal and therefore mesh reinforcement should be considered after stoma reversal. Electronic supplementary material The online version of this article (10.1007/s10029-019-01996-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L C L van den Hil
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, 6202 AZ, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, 6200 MD, The Netherlands.
- Department of General Surgery, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - S van Steensel
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, 6202 AZ, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - M H F Schreinemacher
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, 6202 AZ, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, 6200 MD, The Netherlands
| | - N D Bouvy
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, 6202 AZ, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, 6200 MD, The Netherlands
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Lorenz A, Kogler P, Kafka-Ritsch R, Öfner D, Perathoner A. Incisional hernia at the site of stoma reversal-incidence and risk factors in a retrospective observational analysis. Int J Colorectal Dis 2019; 34:1179-1187. [PMID: 31065787 DOI: 10.1007/s00384-019-03310-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The closure of a stoma site has a high incidence of incisional hernia (IH) development, reaching 30% in some studies. Location and defect size in the abdominal wall depend on the type of stoma formed, most commonly a loop ileostomy or terminal sigmoid colostomy. METHODS The retrospective single-centre study includes all consecutive patients who underwent stoma reversal between 2010 and 2016 at the Department of Visceral, Transplant and Thoracic Surgery in Innsbruck. Patient characteristics and follow-up examinations were evaluated for IH at both the stoma reversal site and at any other surgical access sites. RESULTS A total of 181 patients (49% female, 51% male) had a stoma reversal operation. A parastomal hernia was present in 5% (n = 9). Follow-up data was available for 140 patients (77%). A postoperative IH at the stoma reversal site developed in 15.7% (n = 22) and in 18.6% (n = 26) at other surgical wounds to the abdominal wall during a median follow-up of 136 weeks. The combination of a preoperative parastomal hernia and a postoperative IH was observed in 2.8% (n = 5). Parastomal herniation, male sex, body mass index over 25, arterial hypertension and concomitant ventral hernia were associated with IH formation at the stoma reversal. CONCLUSION The rate of IH at the stoma reversal site was lower than expected from the literature, whereas the rate of IH at other surgical wounds to the abdominal wall was within the expected range.
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Affiliation(s)
- Andreas Lorenz
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Pamela Kogler
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Reinhold Kafka-Ritsch
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Alexander Perathoner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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Näverlo S, Strigård K, Gunnarsson U. Long distance to hospital is not a risk factor for non-reversal of a defunctioning stoma. Int J Colorectal Dis 2019; 34:993-1000. [PMID: 30747282 DOI: 10.1007/s00384-019-03258-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE To see if road distance to hospital influences stoma reversal rate, time from index operation to stoma reversal, and occurrence of permanent stoma. METHODS Data from all diagnosed cases of rectal cancer from three counties in northern Sweden were extracted from the Swedish Rectal Cancer Registry. The three counties are sparsely populated, with a population density roughly one fifth the average density in Sweden. Distances to nearest, operating, and largest hospital were obtained using Google Maps™. Matched data on socioeconomic variables were retrieved from Statistics Sweden. RESULTS In univariate logistic regression analysis, patients living closer to the operating hospital had a higher likelihood of non-reversal than those living farther away (OR 0.3; 95% CI 0.12-0.76). However, no difference was seen in the multivariate analysis. Of the 717 cases included, 54% received a permanent stoma and 38% a defunctioning stoma at index surgery. The reversal rate of a defunctioning stoma was 83%. At follow-up, 61% still had a stoma, 89% of these were permanent, and 11% non-reversed defunctioning stomas. Median time to stoma reversal was 287 days (82-1557 days). Of all 227 stoma reversals, 77% were done more than 6 months after index surgery. CONCLUSIONS Longer distance to hospital is not a risk factor for non-reversal of a defunctioning stoma. Only 23% had their defunctioning stoma reversed within 6 months after index surgery. Future studies aiming to determine reversal rate need to extend their follow-up time in order to receive accurate results.
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Lalezari S, Caparelli ML, Allamaneni S. Use of biologic mesh at ostomy takedown to prevent incisional hernia: A case series. Int J Surg Case Rep 2017; 41:107-9. [PMID: 29059608 DOI: 10.1016/j.ijscr.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 11/24/2022] Open
Abstract
The placement of biologic mesh at ostomy takedown is a safe technique. Biologic mesh use at ostomy takedown may prevent the development of incisional hernia. Biologic mesh placed in a retrorectus fashion has prevented incisional hernia in patients with significant risk factors.
Introduction Incisional hernias are a relatively common occurrence after ostomy takedown with a incidence of 30–35%. The use of biologic mesh offers a means to bolster the stoma incision site with a lower risk of infection than synthetic mesh. Methods This study represents a retrospective chart review of six patients who underwent stoma takedown and had biologic mesh placed in the retrorectus position during repair from March 2015 until March 2016. Results There has been a zero-rate of hernia occurrence for the six patients who underwent stoma takedown. No incisional hernias were noted on physical exam with follow up ranging from 11 to 25 months. Conclusion We conclude that placement of biologic mesh is a safe and effective way of preventing incisional hernias at stoma sites.
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Banerjee DB, Vithana H, Sharma S, Tsang TTM. Outcome of stoma closure in babies with necrotising enterocolitis: early vs late closure. Pediatr Surg Int 2017; 33:783-6. [PMID: 28434039 DOI: 10.1007/s00383-017-4084-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2017] [Indexed: 01/26/2023]
Abstract
UNLABELLED Newborns undergoing surgery for necrotizing enterocolitis (NEC) often require a stoma. Currently, there is no consensus regarding the best time for stoma closure (SC). Our aim was to determine the outcomes of early versus late closure. METHODS Retrospective analysis of patients who underwent SC following stoma formation for NEC between Jan 2009 and July 2015 was done. Early (EC) versus late closure (LC) was defined as less than 10 weeks versus at or after 10 weeks of stoma formation. RESULTS Of 36 patients, M:F was 23:13. Indications for laparotomy were pneumoperitoneum (30) and gangrene (6). Postoperatively, 9/15 (60.0%) of EC group required ventilator support versus none in LC group (p < 0.05). It took longer to establish full feeds following EC (12 days) versus LC (8 days). Median duration of postoperative hospital stay following EC was 31 days (18-35) versus 7 days (4-54) following LC. Three patients were re-operated for intestinal obstruction (two following EC, one following LC). Three patients developed incisional hernia after EC versus none after LC (p < 0.05). One patient died after EC due to staphylococcus septicaemia. CONCLUSION Early closure before 10 weeks of formation for NEC patients is associated with significant morbidity, increased ventilator requirements and chances of developing incisional hernia.
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Oriel BS, Chen Q, Itani KMF. Incidence, recurrence and risk factors of hernias following stoma reversal. Am J Surg 2017; 214:232-8. [PMID: 28596044 DOI: 10.1016/j.amjsurg.2017.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 04/06/2017] [Accepted: 04/29/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND To determine the incidence and risk factors for stoma site (SSH) and incisional (IH) hernias following stoma reversal as well as their recurrence following repair. METHODS A cohort of VA Surgical Quality Improvement Program patients undergoing stoma reversal from 2002 to 2014 were evaluated at a single institution. Variables were selected a priori and evaluated by univariate analyses. RESULTS Of 114 stoma reversals, 63 utilized a midline approach. The incidence of SSH and IH was 9.6% and 31.7% over a median follow-up of 5.7 (0.5-14) and 4.0 (0.1-14) years, respectively. Five SSH and 10 IH were repaired with no recurrences. Myofascial release and superficial surgical site infections (SSI) were associated with SSH while body mass index, preoperative radiotherapy, American Society of Anesthesiologists classification ≥3, operative duration ≥2.5 h and deep SSIs were associated with IH. CONCLUSIONS Incisional hernia incidence after stoma reversal is high for both the stoma site and midline. Risk factors differ for each hernia type. A low recurrence rate exists in short term follow-up following repair of a hernia occurrence.
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Zafar SN, Changoor NR, Williams K, Acosta RD, Greene WR, Fullum TM, Haider AH, Cornwell EE, Tran DD. Race and socioeconomic disparities in national stoma reversal rates. Am J Surg 2016; 211:710-5. [PMID: 26852146 DOI: 10.1016/j.amjsurg.2015.11.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/01/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Many temporary stomas are never reversed leading to significantly worse quality of life. Recent evidence suggests a lower rate of reversal among minority patients. Our study aimed to elucidate disparities in national stoma closure rates by race, medical insurance status, and household income. METHODS Five years of data from the Nationwide Inpatient Sample (2008 to 2012) was used to identify the annual rates of stoma formation and annual rates of stoma closure. Stomas labeled as "permanent" or those created secondary to colorectal cancers were excluded. Temporary stoma closure rates were calculated, and differences were tested with the chi-square test. Separate analyses were performed by race/ethnicity, insurance status, and household income. Nationally representative estimates were calculated using discharge-level weights. RESULTS The 5-year average annual rate of temporary stoma creation was 76,551 per year (46% colostomies and 54% ileostomies). The annual rate of stoma reversal was 50,155 per year that equated to an annual reversal rate of 65.5%. Reversal rates were higher among white patients compared with black patients (67% vs 56%, P < .001) and among privately insured patients compared with uninsured patients (88% vs 63%, P < .001). Reversal rates increased as the household income increased from 61% in the lowest income quartile to 72% in the highest quartile (P < .001). CONCLUSIONS Stark disparities exist in national rates of stoma closure. Stoma closure is associated with race, insurance, and income status. This study highlights the lack of access to surgical health care among patients of minority race and low-income status.
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Affiliation(s)
- Syed Nabeel Zafar
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA.
| | - Navin R Changoor
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Kibileri Williams
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Rafael D Acosta
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Wendy R Greene
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Terrence M Fullum
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Adil H Haider
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Edward E Cornwell
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Daniel D Tran
- Department of Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
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Yetişir F, Şarer A, Acar HZ, Çiftciler E. The Reversal of Stoma Following Open Abdomen Management. Indian J Surg 2016; 78:182-6. [PMID: 27358511 DOI: 10.1007/s12262-015-1336-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/26/2015] [Indexed: 01/19/2023] Open
Abstract
Bowel stoma formation is very often required during open abdomen (OA) management; we aim to report our stoma reversal series following OA management retrospectively. A retrospective analysis of 31 patients who underwent the reversal of the stoma created during OA management between January 2008 and September 2014 was performed. Twenty-eight of these 31 patients were included in this study. The stoma-related complications are more common after OA management during waiting time interval for reversal. At this time interval, patients with jejunostomy had more stoma-related complications than patients with ileostomy (p = 0.008) and colostomy. (p = 0.001). Waiting time interval was shorter for reversal of jejunostomy than reversal of ileostomy (p = 0.014) and colostomy (p = 0.001). Operation time for jejunostomy (p = 0.016) and colostomy reversal (p = 0.001) were significantly longer than the ileostomy reversal. There was no difference between early and late reversal of stoma regarding morbidity and mortality. The stoma-related complications are more common following OA management during waiting time interval for stoma reversal. The reversal time is more critical for this kind of patients especially with life-threatening complicated jejunostomy. For loop stoma created during OA management, the reversal may be performed after average 50 days without increasing morbidity and mortality. The reversal of end stoma created during OA management has high morbidity. If it is possible, loop stoma should be preferred during OA management.
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Hodgson R, An V, Stupart DA, Guest GD, Watters DAK. Who gets Hartmann's reversed in a regional centre? Surgeon 2015; 14:184-9. [PMID: 25630375 DOI: 10.1016/j.surge.2014.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 11/09/2014] [Accepted: 11/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Many patients who undergo a Hartmann's procedure do not have their stoma reversed. We analysed parameters and co-morbidity scales to assess their accuracy in predicting likelihood of undergoing reversal. MATERIAL AND METHODS Retrospective analysis of 165 patients from a prospective colorectal database who were discharged home following a Hartmann's procedure at Barwon Health (Geelong, Australia), a regional centre, between 2002 and 2010. Parameters measured included age, sex, time to reversal, ICU admission and pathology results were recorded. Patients' ASA, POSSUM and Elixhauser co-morbidity scales were retrospectively analysed. RESULTS Reversal of Hartmann's was performed in 74/165 (45%) patients after a median of 294 days (range 70-902). Age (mean 58.5 vs 72.9 years, p < 0.001), ICU stay (34/74 vs 66/91, p < 0.001), ASA (p < 0.002), Elixhauser co-morbidity count (mean 1.14 vs 1.92, p < 0.002) and a malignant diagnosis (9/74 vs 31/91, p < 0.002) were all associated with a decreased reversal rate on univariate analysis. Age was the only parameter found to be significant on multivariate analysis. The complication rate was 23/74, with 7/74 noted to have major complications (Clavian-Dindo III-IV). Reasons for not reversing patients included age and co-morbidities, patient refusal, and malignant disease progression. CONCLUSIONS More than half the patients undergoing a Hartmann's procedure did not proceed to a closure of their stoma. Age was the only parameter significant in predicting those patients undergoing reversal.
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Affiliation(s)
- R Hodgson
- Department of Surgery, Barwon Health, Geelong, Australia; Department of Surgery, University of Melbourne, Austin Health, Heidelberg, Australia.
| | - V An
- Department of Surgery, Barwon Health, Geelong, Australia
| | - D A Stupart
- Department of Surgery, Barwon Health, Geelong, Australia
| | - G D Guest
- Department of Surgery, Barwon Health, Geelong, Australia
| | - D A K Watters
- Department of Surgery, Barwon Health, Geelong, Australia
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Bruns BR, DuBose J, Pasley J, Kheirbek T, Chouliaras K, Riggle A, Frank MK, Phelan HA, Holena D, Inaba K, Diaz J, Scalea TM. Loop versus end colostomy reversal: has anything changed? Eur J Trauma Emerg Surg 2014; 41:539-43. [PMID: 26037983 DOI: 10.1007/s00068-014-0444-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Though primary repair of colon injuries is preferred, certain injury patterns require colostomy creation. Colostomy reversal is associated with significant morbidity and healthcare cost. Complication rates may be influenced by technique of diversion (loop vs. end colostomy), though this remains ill-defined. We hypothesized that reversal of loop colostomies is associated with fewer complications than end colostomies. METHODS This is a retrospective, multi-institutional study (four, level-1 trauma centers) of patients undergoing colostomy takedown for trauma during the time period 1/2006-12/2012. Data were collected from index trauma admission and subsequent admission for reversal and included demographics and complications of reversal. Student's t test was used to compare continuous variables against loop versus end colostomy. Discrete variables were compared against both groups using Chi-squared tests. RESULTS Over the 6-year study period, 218 patients underwent colostomy takedown after trauma with a mean age of 30; 190 (87%) were male, 162 (74%) had penetrating injury as their indication for colostomy, and 98 (45%) experienced at least one complication. Patients in the end colostomy group (n = 160) were more likely to require midline laparotomy (145 vs. 18, p < 0.001), had greater intra-operative blood loss (260.7 vs. 99.4 mL, p < 0.001), had greater hospital length of stay (8.4 vs. 5.5 days, p < 0.001), and had more overall complications (81 vs. 17, p = 0.005) than patients managed with loop colostomy (n = 58). CONCLUSIONS Local takedown of a loop colostomy is safe and leads to shorter hospital stays, less intra-operative blood loss, and fewer complications when compared to end colostomy.
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Affiliation(s)
- B R Bruns
- R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA.
| | - J DuBose
- The University of Texas Health Science Center, Houston, TX, USA.
| | - J Pasley
- R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA.
| | - T Kheirbek
- Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
| | - K Chouliaras
- Department of Surgery, University of Southern California, Los Angeles, CA, USA.
| | - A Riggle
- Parkland Memorial Hospital, The University of Texas Southwestern, Dallas, TX, USA.
| | - M K Frank
- R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA.
| | - H A Phelan
- Parkland Memorial Hospital, The University of Texas Southwestern, Dallas, TX, USA.
| | - D Holena
- Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
| | - K Inaba
- Department of Surgery, University of Southern California, Los Angeles, CA, USA.
| | - J Diaz
- R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA.
| | - T M Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St S4D07, Baltimore, MD, 21201, USA.
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