Loop ileostomy in rectal cancer surgery: factors predicting reversal and stoma related morbidity

Ourô, Susana; Ferreira, Marisa Peralta; Albergaria, Diogo; Maio, Rui

doi:10.1007/s00423-021-02169-x

Cited by 15 publications

(11 citation statements)

References 36 publications

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“…This relationship may be related to the general condition of the patient because age and obesity are risk factors for the occurrence of diabetes 42 . In the study of Ourô et al, 43 the reduction of fibroblast production in diabetic patients led to a significant increase in the incidence of stoma‐related complications. Some studies have included diabetes as one of the risk factors for postoperative PSH, 31 which is consistent with the results of this study.…”

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for parastomal hernia with a permanent colostomy

Liu

Zheng

Zhang

et al. 2022

Journal of Surgical Oncology

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Aim This study aims to explore the incidence and risk factors for permanent colostomy complicated with a parastomal hernia (PSH) after rectal cancer resection. Methods This was a retrospective study of gastrointestinal surgery performed from January 2013 to December 2017 in patients with colorectal cancer treated at the Affiliated Hospital of Qingdao University. The relevant clinical variables of the patient were analyzed. Kaplan–Meier, univariate, and Cox multivariate analyses were used to evaluate the influencing factors and morbidity of PSH. Results Among the 211 patients, 65 developed PSH. The cumulative incidence reached 33.5% at 62 months. In the multivariate Cox survival analysis, the results showed that being a woman, aged ≥65 years, having a body mass index (BMI) ≥ 25 kg/m2, diabetes, and Clavien–Dindo Grade III and IV complications were risk factors for the occurrence of PSH. Conclusion In our study, the incidence of PSH increased annually and reached a maximum of 33.5% after 62 months. Among the patient‐related factors, female sex, age ≥65 years, BMI ≥ 25 kg/m2, diabetes, and postoperative Clavien–Dindo Grade III and IV complications were significantly associated with the development of PSH. Therefore, intervention measures to prevent patients with this risk factor are advisable.

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Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for parastomal hernia with a permanent colostomy

Liu

Zheng

Zhang

et al. 2022

Journal of Surgical Oncology

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“…A PI is conceived to reduce the rate of AL, symptomatic dehiscence and the overall postoperative morbidity and mortality rates [30,36,37]. However, the real impact on the reduction of incidence of AL is not clear, and some authors advocate that the effective utility of PI is to reduce the morbidity related to AL, not the AL rate [36][37][38].…”

Section: Discussion and Con Clus Ionsmentioning

confidence: 99%

“…Also, PI closure can be the source of postoperative complications itself, with an overall postoperative complication rate of up to 20%, including AL, surgical site infection, postoperative ileus and even death [36,49,50].…”

Section: Discussion and Con Clus Ionsmentioning

confidence: 99%

“…Lastly, independently from the indication to create a PI, it is important to underline that in the literature the real utility and advantages of a stoma are still under debate [28][29][30][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51].…”

Section: Discussion and Con Clus Ionsmentioning

confidence: 99%

“…Moreover, PI creation is itself responsible for morbidity, including intestinal atrophy, leakage from the stoma appliance, skin irritation, bowel obstruction, enterocutaneous fistula, high-output stoma, renal impairment, parastomal hernia or prolapse and hospital readmission, so in the case of patients without AL its utility should be balanced with its complications [36,[39][40][41][42].…”

Section: Discussion and Con Clus Ionsmentioning

confidence: 99%

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Protective ileostomy creation after anterior resection of the rectum: Shared decision‐making or still subjective?

et al. 2022

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Aim:The choice of whether to perform protective ileostomy (PI) after anterior resection (AR) is mainly guided by risk factors (RFs) responsible for the development of anastomotic leakage (AL). However, clear guidelines about PI creation are still lacking in the literature and this is often decided according to the surgeon's preferences, experiences or feelings. This qualitative study aims to investigate, by an open-ended question survey, the individual surgeon's decision-making process regarding PI creation after elective AR. Method: Fifty four colorectal surgeons took part in an electronic survey to answer the questions and describe what usually led their decision to perform PI. A content analysis was used to code the answers. To classify answers, five dichotomous categories (In favour/Against PI, Listed/Unlisted RFs, Typical/Atypical, Emotions/Non-emotions, Personal experience/No personal experience) have been developed.Results: Overall, 76% of surgeons were in favour of PI creation and 88% considered listed RFs in the question of whether to perform PI. Atypical answers were reported in 10% of cases.Emotions and personal experience influenced surgeons' decision-making process in 22% and 49% of cases, respectively. The most frequently considered RFs were the distance of the anastomosis from the anal verge (96%), neoadjuvant chemoradiotherapy (88%), a positive intraoperative leak test (65%), blood loss (37%) and immunosuppression therapy (35%). Conclusion:The indications to perform PI following rectal cancer surgery lack standardization and evidence-based guidelines are required to inform practice. Until then, expert opinion can be helpful to assist the decision-making process in patients who have undergone AR for adenocarcinoma.

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