Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch–anal anastomosis

Dehni, Nidal; Schlegel, Rodolfo Daniel; Cunningham, Christopher; Guiguet, Marguerite; Tiret, Emmanuel; Parc, R

doi:10.1046/j.1365-2168.1998.00790.x

Cited by 244 publications

(189 citation statements)

References 15 publications

Supporting

Mentioning

168

Contrasting

Unclassified

Order By: Relevance

“…The use of a protective stoma should be considered in relation to specific conditions involving the operation (low tumor, narrow male pelvis or complications during construction of the anastomosis), or other situations such as: when the patient's initial condition is poor, after neoadjuvant radio chemotherapy, after total mesorectal excision, with preoperative steroid use, or with long-duration op-erations 2,3 . The proximal diversion, by means of either a colostomy or an ileostomy, minimizes the consequences of anastomotic leakage by preventing faecal flow through the anastomosis [4][5][6][7][8] . In a randomized multicenter trial 9 it was shown that the defunctioning loop stoma decreased the rate of symptomatic anastomotic leakage.…”

Section: Introductionmentioning

confidence: 99%

Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis

et al. 2008

View full text Add to dashboard Cite

Purpose:The controversy regarding whether loop ileostomy or loop transverse colostomy is a better method for temporary decompression of colorectal anastomosis motivated this review. Methods: Five randomized trials were included, with 334 patients: 168 in the loop ileostomy group and 166 in the loop transverse colostomy group. The outcomes analyzed were: 1. Mortality; 2. Wound infection; 3. Time of stoma formation; 4. Time of stoma closure; 5. Time interval between stoma formation and closure; 6. Stoma prolapse; 7. Stoma retraction; 8. Parastomal hernia; 9. Parastomal fistula; 10. Stenosis; 11. Necrosis; 12. Skin irritation; 13. Ileus; 14. Bowel leakage; 15. Reoperation; 16. Patient adaptation; 17. Length of hospital stay; 18. Colorectal anastomotic dehiscence; 19. Incisional hernia; 20. Postoperative bowel obstruction. Results: Stoma prolapse was statistically significant (p = 0.00001), but with statistical heterogeneity; the sensitive analysis was applied, excluding the trials that included emergency surgery, and this showed: p = 0.02, with I 2 = 0% for the heterogeneity test. Conclusions: The outcomes reported were not statistically or clinically significant except for stoma prolapse. Better evidence for making the choice between loop ileostomy or loop colostomy requires large-scale randomized controlled trials. Key words: Ileostomy. Colostomy. Colorectal surgery. Systematic review. Meta-analysis. RESUMO Objetivo:A controvérsia entre ileostomia em alça ou colostomia em alça como a melhor forma para a descompressão temporária da anastomose colorretal motivou a realização desta revisão. Métodos: Cinco ensaios clínicos casualizados foram incluídos com 334 pacientes: 168 no grupo de ileostomia e 166 no grupo de colostomia. Os resultados analisaram: 1. Mortalidade; 2. Infecção da ferida; 3. Tempo de formação do estoma; 4. Tempo de fechamento do estoma; 5. Intervalo de tempo entre a formação e o fechamento do estoma; 6. Prolapso do estoma; 7. Retração do estoma; 8. Hérnia parastomal; 9. Fistula parastomal; 10. Estenose; 11. Necrose; 12. Irritação de pele; 13. Íleo; 14. Fístula entérica; 15. Reoperação; 16. Adaptação do paciente; 17. Tempo de internação hospitalar; 18. Deiscência da anastomose colorretal; 19. Hérnia de Incisional; 20. Obstrução intestinal pós-operatória. Resultados: Prolapso do estoma: p = 0.00001, mas com heterogeneidade estatística; a análise de sensibilidade foi aplicada excluindo os estudos que incluíram cirurgias de emergência: p = 0.02 e teste de heterogeneidade: I 2 =0%. Conclusões: Os resultados encontrados não foram estatística ou clinicamente significantes, exceto prolapso do estoma. A melhor evidência para a escolha entre ileostomia em alça ou colostomia em alça necessita de maior número de ensaios clínicos.

show abstract

Section: Introductionmentioning

confidence: 99%

Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis

et al. 2008

View full text Add to dashboard Cite

show abstract

“…As some surgeons believe that "the lesser anastomotic site fecal contamination, the lesser chance of anastomotic site leakage", using diverting ileostomy or colostomy would be a constant part of their low or ultralow anterior resection [1][2][3][4][5][6][7][8]; although several recent studies have not confirmed this idea, and only persisted on less complication of the possible leakage such as the pelvic sepsis [11,19] or and less operational needs for further possible leakages [23,28,29].…”

Section: Discussionmentioning

confidence: 97%

“…Diverting stomas for low and ultralow rectal anastomosis are being constructed routinely in some colorectal centers [1][2][3][4][5][6][7][8] based on crediting the fact that creating route diverting stomas, and thereby making a space from the anastomosis, lowers the anastomotic leakage incidence; whereas, some other centers have shown the reverse [9][10][11][12][13]. Furthermore, the stoma itself would increase the morbidity in construction time, life period, and closure time, which also in its place needs reoperation and hospitalization, and so has its own morbidity and mortality [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Low or Ultralow Anterior Resection of Rectal Cancer Without Diverting Stoma: Experience with 28 Patients

2013

View full text Add to dashboard Cite

A diverting temporary stoma is frequently used to decrease the chance of anastomosis leakage in the middle and lower rectum cancer surgeries, but its role in preventing the leakage is still doubtful. This study has been designed to evaluate any possible anastomosis complications after a rectum resection and a low or ultralow anastomosis when no diverting stoma is applied in patients with rectal cancer. Twenty-eight patients suffering from rectal cancer were treated by a low anterior resection between the years 2005 and 2008 in Imam Reza University Hospital, Mashhad, Iran. Out of the 28 patients, 6 patients had already undergone a course of neoadjuvant radiotherapy. Anastomosis was performed manually in 23 patients, using a stapler in 5 of them. None of the patients had a diverting stoma. Then, the outcome was evaluated. Fecal incontinence occurred in one of the patients (6.7 %) who had already undergone a course of radiotherapy preoperatively and had a stapler used for anastomosis. No leakage was detected in any of them. The very low incidence of complications in this study, such as those not preventable by a diverting stoma, suggest a very low chance of leakage in low or ultralow anastomosis in patients with rectal cancer and in those who were treated with neoadjuvant radiotherapy.

show abstract

“…Temporary proximal diversion in the form of ileostomy or colostomy is generally used to avoid major morbidity of leak following colorectal surgery. Dehni et al [26] in a retrospective analysis of 258 consecutive patients with midrectal cancers found that in the low rectal resection group without a defunctioning stoma, a clinical leak occurred in 17.0 % whereas leak rate was 6.6 % in the group with a defunctioning stoma. In general a temporary faecal diversion is indicated in old age, low rectal anastomoses, pre operative radio/chemoradiotherapy and sub-optimal anastomoses.…”

Section: A) Mechanical Bowel Preparationmentioning

confidence: 99%

A Review of Controversies in the Management of Colorectal Cancers

et al. 2012

View full text Add to dashboard Cite

Colorectal cancer (CRC) is one of the most common malignancies worldwide. Due to a higher incidence of CRC in the western hemisphere a significant amount of research was carried out and majority of the controversies could be resolved as far as management of CRC is concerned. Recently a number of significant advances were made in the field of CRC related to surgery, systemic therapy and radiotherapy. During the last decade we have witnessed introduction of minimally invasive surgery, incorporation of more effective newer chemotherapeutic regimes and targeted therapies and refinements in radiotherapy protocols. The demographics and clinical picture of CRC seems to be different in developing countries and there is paucity of CRC related studies from developing countries. In-order to update the practicing surgeons a review of conventional controversies of CRC surgery was performed and an update on the recent developments in the field of CRC was also presented in this article.

show abstract

Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch–anal anastomosis

Abstract: The use of a protective defunctioning stoma is advocated in conjunction with LCRAs.

Cited by 244 publications

References 15 publications

Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis

Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis

Low or Ultralow Anterior Resection of Rectal Cancer Without Diverting Stoma: Experience with 28 Patients

A Review of Controversies in the Management of Colorectal Cancers

Contact Info

Product

Resources

About