Risk factors and management of stoma-related obstruction after laparoscopic colorectal surgery with diverting ileostomy

Maemoto, Ryo; Tsujinaka, Shingo; Miyakura, Yasuyuki; Fukuda, Ryosuke; Kakizawa, Nao; Takenami, Tsutomu; Machida, Erika; Kikuchi, Nozomi; Kanemitsu, Rina; Tamaki, Sawako; Ishikawa, Hideki; Rikiyama, Toshiki

doi:10.1016/j.asjsur.2021.01.002

Cited by 6 publications

(10 citation statements)

References 22 publications

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“…Forced stoma rotation by 180-degree with IPAA significantly increases the incidence of SBO; bowel kinking at or below the fascia is presumably responsible for the obstruction[ 21 ]. In contrast, recent reports have shown that stoma rotation did not increase the incidence of SOO/SRO[ 11 , 12 , 15 , 18 , 20 ]. The reason for the SOO/SRO associated with high output from the stoma has already been described in the Etiology section.…”

Section: Obstructive Complicationsmentioning

confidence: 68%

“…Okita et al [ 11 ] proposed a definition of SBO at the stoma site that has the following criteria: (1) Radiographically confirmed dilatation of the oral stoma limb; (2) Increase in stomal output and relief of symptoms after trans-stomal tube decompression; and (3) Exclusion of SBO other than that at the stoma site. Some of the subsequent reports have followed these criteria for diagnosis[ 10 , 12 - 14 ], while others have used more simplified criteria, such as SBO at the stoma site with radiographic confirmation excluding paralytic ileus[ 15 - 17 ].…”

Section: Obstructive Complicationsmentioning

confidence: 99%

“…SOO/SRO occurs in 5.4%-27.3% of patients with DI[ 10 - 18 ]. Risk factors are classified into the following categories: patient characteristics[ 10 , 11 , 13 , 16 , 19 ] (young age, low body mass index, thick subcutaneous fat, thick RAM, and long distance between the superior mesenteric artery root and the bottom of the external anal sphincter), disease[ 15 ] (ulcerative colitis), surgical factors[ 12 , 14 , 20 - 22 ] (laparoscopic surgery, rotation of stoma limb, IPAA, two-stage surgery for ulcerative colitis, and short distance from the anastomosis to the stoma site), and stoma functions[ 10 , 17 ] (high output from stoma). The risk factors are summarized in Table 1 .…”

Section: Obstructive Complicationsmentioning

confidence: 99%

“…As a disease-related factor, ulcerative colitis has been reported as an independent risk factor for SOO/SRO, but the specific reason remains unclear[ 15 ]. It is speculated that the risk may not be due to the disease itself; rather, it refers to the surgical procedure of total proctocolectomy with IPAA with DI (also known as the first of the two-stage surgery)[ 12 , 20 ]. If the length of the diverted bowel (between the stoma and pouch) is too short, strong tension in the mesentery may occur, and it is difficult to revert if bowel twisting or mesenteric torsion occurs.…”

Section: Obstructive Complicationsmentioning

confidence: 99%

“…If the length of the diverted bowel (between the stoma and pouch) is too short, strong tension in the mesentery may occur, and it is difficult to revert if bowel twisting or mesenteric torsion occurs. If the length is too long, bowel twisting, kinking, or angulation may occur; however, a spontaneous resolution is expected in such cases[ 12 , 18 ]. Several studies have shown an increased risk of SOO/SRO in laparoscopic surgery[ 18 , 22 ].…”

Section: Obstructive Complicationsmentioning

confidence: 99%

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Obstructive and secretory complications of diverting ileostomy

Tsujinaka¹,

Suzuki²,

Miura³

et al. 2022

World J Gastroenterol

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This review aimed to highlight the etiology, diagnosis, treatment, and prevention of obstructive and secretory complications associated with diverting ileostomy (DI). Obstructive complications at the stoma site are termed stoma outlet obstruction (SOO) or stoma-related obstruction (SRO). The incidence of SOO/SRO is 5.4%-27.3%, and the risk factors are multifactorial; however, the configuration of the stoma limb and the thickness of the rectus abdominis muscle (RAM) may be of particular concern. Trans-stomal tube decompression is initially attempted with a success rate of 33%-86%. A thick RAM may carry the risk of recurrence. Surgical refinement, including a wider incision of the anterior sheath and adequate stoma limb length, avoids tension and immobility and may decrease SOO/SRO. Secretory complications of DI are termed high output stoma (HOS). Persistent HOS lead to water and sodium depletion, and secondary hyperaldosteronism, resulting in electrolyte imbalances, such as hypomagnesemia. The incidence of HOS is 14%-24%, with an output of 1000-2000 mL/d lasting up to three days. Treatment of HOS is commenced after excluding postoperative complications or enteritis and includes fluid intake restriction, antimotility and antisecretory drug therapies, and magnesium supplementation. Intensive monitoring and surveillance programs have been successful in decreasing readmissions for dehydration.

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Section: Obstructive Complicationsmentioning

confidence: 68%

Section: Obstructive Complicationsmentioning

confidence: 99%

Section: Obstructive Complicationsmentioning

confidence: 99%

Section: Obstructive Complicationsmentioning

confidence: 99%

Section: Obstructive Complicationsmentioning

confidence: 99%

See 3 more Smart Citations

Obstructive and secretory complications of diverting ileostomy

Tsujinaka¹,

Suzuki²,

Miura³

et al. 2022

World J Gastroenterol

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Research Progress of Preventive Ileostomy and Rehabilitation Surgery

韩¹

2023

ACM

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Longitudinal analysis of long-term outcomes of colorectal cancer after laparotomy and laparoscopic surgery: The Shizuoka study

Kojimahara,

Sato,

Sato

et al. 2023

PLoS ONE

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Background Long-term cancer prognosis after initial surgical procedures is an unlikely endpoint for clinical trials. Medical claim databases may aid in addressing this issue regardless of limited information on disease and patient background. However, the long-term prognosis (especially regarding long-term care needs) following surgical procedures remains unclear. This study aimed to assess whether long-term outcomes, such as the exacerbation of long-term care needs and mortality, differ with surgical methods. Methods Using a longitudinal study with linkage between medical claim and long-term care database, patients with primary colorectal cancer who underwent initial colonoscopies were identified through anonymized data in Japan (Shizuoka Kokuho Database, 2012–2018). Odds ratios (ORs) for long-term outcomes (long-term care needs and all-cause mortality during a 6.5-year follow-up period) were analyzed using logistic regression to compare laparoscopy and endoscopic surgery to laparotomy. Results Overall, 3,744 primary colorectal cancer cases (822 laparotomies, 705 laparoscopies, and 2,217 endoscopic surgeries) were included. Compared to the laparotomy group, the crude OR for exacerbation of long-term care needs in the laparoscopic surgery group was 0.376 (95% confidence interval, 0.227, 0.624), while the OR for all-cause mortality was 0.22 (0.329, 0.532). Conclusion This is the first study to analyze long-term prognosis after surgery for patients with colorectal cancer to combine medical and long-term needs data. As the national health insurance claim database rarely includes information on cancer stage and comorbidities, better prognosis on endoscopic surgery may need careful interpretation. Therefore, laparoscopy has superior outcomes in terms of long-term care needs and mortality compared to those of laparotomy.

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Risk factors and management of stoma-related obstruction after laparoscopic colorectal surgery with diverting ileostomy

Cited by 6 publications

References 22 publications

Obstructive and secretory complications of diverting ileostomy

Obstructive and secretory complications of diverting ileostomy

Research Progress of Preventive Ileostomy and Rehabilitation Surgery

Longitudinal analysis of long-term outcomes of colorectal cancer after laparotomy and laparoscopic surgery: The Shizuoka study

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