Impacto del estoma derivativo en un protocolo de rehabilitación multimodal en cirugía de recto

Defunctioning Stomas Result in Significantly More Short‐Term Complications Following Low Anterior Resection for Rectal Cancer

“…It is clear that, in contemporary practice, the majority of patients undergoing anterior resection for rectal cancer receive an initial defunctioning stoma, making the practice almost routine in many centres [ 1 – 3 ]. Despite these high rates of defunctioning stoma use, there are very few studies comparing overall complication rates in patients who are managed with a defunctioning stoma to those without [ 8 – 10 ], and few of the RCTs or non-randomised studies examining the effect of defunctioning stomas on anastomotic leak report overall complications [ 18 , 27 , 29 ]. Evidence of the effect of forming a defunctioning stoma on overall short-term morbidity, which is currently lacking, may well influence a surgeon’s decision to create a stoma during anterior resection.…”

“…Overall post-operative complications are rarely reported in these studies. There are very few studies specifically comparing the overall complications in patients managed with and without defunctioning stomas [ 8 – 10 ] and these generally involve small numbers of patients and report conflicting results. Despite the paucity of comparative studies, a number of case series suggest that there is significant short-term morbidity associated with defunctioning stomas [ 11 – 13 ].…”

Comment on “Does a Combination of Laparoscopic Approach and Full Fast Track Multimodal Management Decrease Postoperative Morbidity?”

“…The role of fecal diversion using a diverting stoma in anterior rectal resection and anastomosis is, however, still controversial at present. 8 Gumbau et al 9 reported that the association of a loop ileostomy and multimodal FT care program did not extend the LOS nor increases the rate of complications in patients that underwent a rectal resection with anastomosis. The most important problem with the article is, however, the reported long LOS (approximately 8 days in the colonic cancer subgroup and approximately 10–11 days in the rectal group), which is impossible to interpret in relation to the information about the FFT programs, both regarding the theoretical LOS and the effective LOS.…”