The value of diverting loop ileostomy on the high-risk colon and rectal anastomosis

Bax, Timothy; McNevin, Megan

doi:10.1016/j.amjsurg.2007.01.005

Cited by 69 publications

(40 citation statements)

References 19 publications

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“…DC can affect individuals undergoing diversion of fecal stream for various diseases, most frequently due to obstructive colorectal cancer of the sigmoid, complications of diverticular disease, inflammatory bowel diseases (IBDs), and colorectal trauma [5][6][7][8][9]. Because of the increasing incidence of colorectal cancer (CRC), IBD, diverticulitis, and violence in urban centers, the frequency of DC appears to be increasing in proportion to the prevalence of stomas [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

5-Aminosalicylic Acid (5-ASA) Can Reduce Levels of Oxidative DNA Damage in Cells of Colonic Mucosa With and Without Fecal Stream

et al. 2010

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Section: Introductionmentioning

confidence: 99%

5-Aminosalicylic Acid (5-ASA) Can Reduce Levels of Oxidative DNA Damage in Cells of Colonic Mucosa With and Without Fecal Stream

et al. 2010

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“…Diverting loop ileostomies are widely used by colorectal surgeons for the protection of low rectal anastomoses, as they can reduce the morbidity and rate of reintervention if an anastomotic leak occurs [1] . The use of a protective ileostomy is specially indicated in very low rectal resections, coloanal anastomosis and pouches [2,3] .…”

Section: Introductionmentioning

confidence: 99%

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Rubio-Perez¹,

León²,

Pastor³

et al. 2014

WJGS

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AIM:To study the morbidity and complications associated to ileostomy reversal in colorectal surgery patients, and if these are related to the time of closure. METHODS:A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance. RESULTS:The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy creation was rectal cancer (56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the patients, with 1% mortality. The most frequent were ileus (13%) and wound infection (13%). Pseudomembranous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomy closure (P = 0.041). Male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003). End-to-end intestinal anastomosis without resection was significantly associated with postoperative ileus (P = 0.037). CONCLUSION:Although closure of a protective ileostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Protective ileostomy; Stomas; Stoma-related complications; Surgical infections; Colorectal surgery Core tip: Protective ileostomies are widely used by surgeons for the protection of anastomoses, but they imply a second intervention for reversal. Despite being considered a minor intervention, ileostomy reversal does not lack complications. Adjuvant treatment, complications from the first intervention, or low-priority consideration can delay the closure of the stoma. In our study, we reviewed all complications following ileostomy reversal and found they were considerably high (40%), and increased as did the time (in months) until closure (P = 0.041). In multivariate analysis, male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003).Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R. Increased postoperative complications after protective ileostomy closure delay: An institutional study. World J Gastrointest Surg 2014; 6(9): 169-174 Available from:

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“…Nitekim TME yapılması, steroid kullanımı neoadjuvan tedavi, major intraoperatif hemoraji ve intrasfinkterik anastomoz yapılması anastomoz kaçağı için risk faktörleri olarak sayılabilir (17,18). Kliniğimizde rektum kanseri için koloanal anastomoz yaptığımız hastalara rutin olarak hava-su testi yapmaktayız.…”

Section: Discussionunclassified

Rektum kanserinde neoadjuvan tedavi alan hastalarda total mezorektal eksizyon sonrası koruyucu ileostomi gerekliliği

Kargın¹,

Çakır²,

Küçükkartallar³

et al. 2014

GenelTipDer

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Rektum kanseri tedavisinde koruyucu ileostomi -Kargın ve ark.Genel Tıp Derg 2014;24:105-108 105 GirişSon elli yıldır rektum kanseri tedavisinde cerrahi ve adjuvan kemoradyoterapi (KRT) kullanımındaki gelişmeler bu hastalığın tedavisinde büyük ilerlemeler sağlamıştır. Rektum kanseri için preoperatif KRT kullanımı ise hızla gelişmektedir. Neoadjuvan KRT'nin tümör regresyonu sağlaması, sfinkter koruyucu işlemlerde artışa yol açması ve evre küçültücü özelliği sayesinde tümör rezektabilitesinde artış gibi yararları kanıtlandı (1). Bununla birlikte ARAŞTIRMA Genel Tıp DergisiRektum kanserinde neoadjuvan tedavi alan hastalarda total mezorektal eksizyon sonrası koruyucu ileostomi gerekliliği* Amaç: Rektum kanseri için neoadjuvan kemoradyoterapi kullanımı hızla gelişmektedir. Neoadjuvan tedavilerdeki tüm gelişmelere karşın kemoradyoterapi alan hastalarda cerrahi sonrası komplikasyonlar ise hala tartışmalıdır. Çalışmamızın amacı rektum kanserinde neoadjuvan tedavi sonrası küratif cerrahi uygulanan hastalarda koruyucu ileostomi gerekliliğinin araştırılmasıdır. Gereç ve yöntemler: Kliniğimizde, neoadjuvan tedavi sonrası low anterior rezeksiyon ve total mezorektal eksizyon uygulanan rektum kanserli 19 hastanın verileri retrospektif olarak değerlendirildi. Ameliyat süresi, peroperatif ve postoperatif komplikasyonları, morbidite, mortalite ve hastade kalış süreleri ileostomi durumuna göre kıyaslandı. İstatistiksel analizde ki kare ve Mann Whitney U testleri kullanıldı. Bulgular: İleostomi açılan grupta anastomoz kaçağı 2 hastada görülürken açılmayan grupta 1 hastada anastomoz kaçağı gözlendi. Gruplar arasında postoperatif morbidite açısından anlamlı fark gözlenmedi. Komplikasyon ve hastanede kalış süreleri benzerdi. İleos-tomi açılmayan grupta ameliyat süresi daha kısaydı. Sonuç: Rektum kanserinde neoadjuvan tedavi sonrası küratif rezeksiyon yapılan hastalarda koruyucu ileostominin komplikasyonları ve morbiditeyi artırmadığını düşünmekteyiz. Ancak bu konunun daha geniş serilerde irdelenmesi gerekmektedir. Anahtar sözcükler: Neoadjuvan tedavi, rektum kanseri, koruyucu ileostomi Requirements of protective ileostomy after mesorectal excision in patients with rectal cancer who treated by adjuvant therapyObjectives: The use of neoadjuvant chemoradiation for rectal cancer is developing rapidly. Despite all the advances in neoadjuvant therapy, complications after surgery is still controversial in patients who receiving chemoradiation. The aim of our study is to investigate the necessity of protective ileostomy after neoadjuvant therapy in rectal cancer patients who undergoing curative surgery. Material and methods: Data of 19 rectal cancer patients who were treaded with low anterior resection and total mesorectal excision after neoadjuvant therapy were evaluated retrospectively. Surgical operation time, intraoperative and postoperative complications, morbidity, mortality and length of stay in hospital were compared according to ileostomy state. Chi-square and Mann-Whitney U tests were used as statistical analysis. Results: Anastom...

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The value of diverting loop ileostomy on the high-risk colon and rectal anastomosis

Cited by 69 publications

References 19 publications

5-Aminosalicylic Acid (5-ASA) Can Reduce Levels of Oxidative DNA Damage in Cells of Colonic Mucosa With and Without Fecal Stream

5-Aminosalicylic Acid (5-ASA) Can Reduce Levels of Oxidative DNA Damage in Cells of Colonic Mucosa With and Without Fecal Stream

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Rektum kanserinde neoadjuvan tedavi alan hastalarda total mezorektal eksizyon sonrası koruyucu ileostomi gerekliliği

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