Polish Consensus Statement On The Protective Stoma

Szczepkowski, Marek; Banasiewicz, Tomasz; Krokowicz, Piotr; Dziki, Adam; Wallner, Grzegorz; Drews, M; Herman, R. M.; Lorenc, Z. Paul; Richter, Piotr; Bielecki, Krzysztof; Tarnowski, Wiesław; Kruszewski, Jan; Kładny, Józef; Głuszek, Stanisław; Zegarski, Wojciech; Kielan, Wojciech; Paśnik, Krzysztof; Jackowski, Marek; Wyleżoł, Mariusz; Stojčev, Zoran; Przywózka, Alicja

doi:10.2478/pjs-2014-0071

Cited by 11 publications

(5 citation statements)

References 52 publications

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“…DC is still a problem and probably will remain so in the future [6]. However, many patients need to maintain a colostomy for long periods, and some will never attain the reconstruction of intestinal continuity.…”

Section: Discussionmentioning

confidence: 99%

Diversion colitis 25 years later: the phenomenon of the disease

Szczepkowski¹,

Banasiewicz

Kobus³

2017

Int J Colorectal Dis

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BackgroundDiversion colitis (DC) seems to be common in stoma patients, and the restoration of the continuity of the digestive tract is crucial for relief from the inflammatory process. No prospective studies of the late effects of DC on the lower gastrointestinal (GI) tract mucosa and the clinical condition of patients have been reported.MethodsData from 23 patients who underwent stoma creation were analysed during the reversal period (A) and at an average of 3 months (B1) and 5.6 years (B2) after restoration of GI tract continuity. Every monitoring visit included endoscopy, histology and assessment of the clinical condition of patients.ResultsShortly after GI tract restoration (B1), a significant decrease in inflammation was observed. The Ki67 positivity percentage increased, but this was not significant. At an average of 5.6 years after restoration (group B2), the clinical symptoms were mild. More patients presented with endoscopically detected inflammation of the mucosa, but its severity was not significantly higher than that at 3 months after reversal. Histological inflammation was more common, and its severity was significantly higher than that shortly after reversal but similar to that before reversal. The Ki67 positivity percentage decreased at the last examination (B2).ConclusionsThe results of this study show a complex recurrence of histological inflammation several years after GI tract restoration but without clinical and endoscopic inflammation and with good clinical condition. DC can potentially have a late influence on the rectal mucosa, even after stoma closure.

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Section: Discussionmentioning

confidence: 99%

Diversion colitis 25 years later: the phenomenon of the disease

Szczepkowski¹,

Banasiewicz

Kobus³

2017

Int J Colorectal Dis

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“…Un estudio retrospectivo japonés realizado sobre 1014 pacientes estimó como factores más relacionados con la intraoperatorio, ligadura alta de la arteria mesentérica inferior, linfadenectomía lateral, cirugía abierta, rodete anastomótico incompleto y test de estanqueidad de anastomosis positivos [18]. En la reunión de consenso polaca se incluyen como indicaciones para el EP: anastomosis a < 3cm de la línea pectínea, neoadyuvancia, inmunosupresión, test de estanqueidad positivo y/o rodetes de anastomosis incompletos, IMC < 19, ASA III/IV y dificultados intraoperatorias significativas (pelvis estrecha) [25]. En una encuesta realizada a los miembros de la Sociedad Americana de Cirujanos Colorrectales la irradiación pélvica, los niveles bajos de albúmina/desnutrición y el uso de corticoides/inmunosupresión fueron los factores considerados más importantes en la decisión de confeccionar un EP tras una anastomosis no óptima a nivel de recto medio-bajo [26].…”

Section: Indicaciones Del Estoma De Protecciónunclassified

Actualización sobre el estoma de protección tras resección anterior baja o ultrabaja por cáncer de recto. Revisión sistemática y nuevas tendencias.

Córdoba¹

2019

Arch. coloproctol.

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El estándar para el tratamiento del cáncer de recto es la resección anterior baja o ultrabaja con escisión total del mesorrecto. Técnicas cada vez menos invasivas unidas a un mayor interés por la preservación de esfínteres han llevado a realizar resecciones rectales con anastomosis cada vez más próximas al margen anal. Una de las complicaciones más importantes y más temidas por sus graves consecuencias es la fuga anastomótica. Con intención de prevenir la dehiscencia anastomótica o aliviar sus consecuencias se realizan tradicionalmente estomas derivativos tras la resección rectal con anastomosis de riesgo. Sin embargo el estoma de protección presenta morbilidad asociada, afecta a la calidad de vida del paciente, y precisa una nueva intervención para la reconstrucción del tránsito, que asocia a su vez una morbi-mortalidad significativa. Incluso uno de cada 4-6 estomas queda sin cerrar. Por todo ello el papel de los estomas de protección sigue siendo controvertido, sin encontrar respuestas con suficiente evidencia en la literatura. Este estudio tiene como objetivo hacer una revisión de la literatura para establecer el rol actual del estoma de protección. Además analizamos la corriente que boga por el cierre precoz del estoma (en los primeros 15 días tras la cirugía) y las alternativas a los estomas de protección tradicionales que han aparecido en los últimos años, como la ileostomía virtual, el tubo ileal y el dispositivo de derivación fecal.

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“…Nowadays, it is known that a stoma not only minimizes consequences of anastomotic dysfunction, but also decreases the rate of anastomotic leaks [39]. Detailed discussion of indications for protective stoma formation and the recommended management are beyond the scope of this article, however, they constitute the basis for Polish consensus on protective stoma [40] and the monograph on stoma [41].…”

Section: -Protective Stomamentioning

confidence: 99%

Anastomotic leaks in gastrointestinal surgery and their prevention

Banasiewicz¹,

Dziki²,

Lampe

et al. 2017

Pol Przegl Chir

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Anastomotic leak in the gastrointestinal tract is one of the most important complications of resection. They are the main cause of reoperation, their occurrence worsens the prognosis of the patient, increasing the proportion of direct mortality, as well as being a significant risk factor for recurrence of cancer. The risk of leaks within the gastrointestinal tract is greatly varied, depending on the location and extent of the resection, but also on patient, disease or a surgical procedure, including surgeon. To determine the potential risk of leakage can be significant for introduction some prophylactic actions. Some of them have the character of general recommendations, as proper nutrition of the patient in the perioperative period, while another part is directly connected to the surgical procedure. The second group includes protective stoma, the use of tissue glues, insertion transrectal drain for rectal anastomosis decompression, the use of stents or the use of collagen matrix coated with fibrinogen and thrombin. Important to reduce the proportion of leaks can be more precise and targeted prophylactic recommendations, based on the individualized determination of risk factors leaks. Further research for this purpose are necessary for this purpose, the big hope can be associated with data obtained through mobile applications.

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Polish Consensus Statement On The Protective Stoma

Cited by 11 publications

References 52 publications

Diversion colitis 25 years later: the phenomenon of the disease

Diversion colitis 25 years later: the phenomenon of the disease

Actualización sobre el estoma de protección tras resección anterior baja o ultrabaja por cáncer de recto. Revisión sistemática y nuevas tendencias.

Anastomotic leaks in gastrointestinal surgery and their prevention

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