Does stoma site specimen extraction increase postoperative ileostomy complication rates?

Li, Wanglin; Benlice, Çiğdem; Stocchi, Luca; Keßler, Hermann; Görgün, Emre; Costedio, Meagan

doi:10.1007/s00464-016-5384-x

Cited by 28 publications

(34 citation statements)

References 18 publications

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“…According to Li W Fig. 1 Flow-chart of evaluation of outcome et al, 2017, more complications with parastomal hernias were seen if the specimen was extracted at the stoma site in laparoscopic surgery, but no increase in stoma site hernia after stoma reversal [28]. In the present study, the hernia incidence was low, even though the majority of primary surgeries were performed by open surgery.…”

Section: Discussionmentioning

confidence: 43%

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Hernia at the stoma site after loop ileostomy reversal

Eklöv

Viktorsson

Frosztega

et al. 2020

Int J Colorectal Dis

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Purpose To estimate the incidence of and risk factors for stoma site hernia after closure of a temporary diverting ileostomy. Method In a non-comparative cohort study, charts (n = 216) and CT-scans (n = 169) from patients who had undergone loop ileostomy closure following low anterior resection for rectal cancer 2010-2015 (mainly open surgery) at three hospitals were evaluated retrospectively. Patients without hernia diagnosis were evaluated cross-sectionally through a questionnaire (n = 158), and patients with symptoms of bulging or pain were contacted and offered a clinical examination or a CT scan including Valsalva maneuver. Results In the chart review, five (2.3%) patients had a diagnosis of incisional hernia at the previous stoma site after 8 months (median). In 12 patients, the CT scan showed a hernia, of which 8 had not been detected previously. The questionnaire was returned by 130 (82%) patients, of which 31% had symptoms of bulging or pain. Less than one in five of patients who reported bulging were diagnosed with hernia, but the absolute majority of the radiologically diagnosed hernias reported symptoms. By combining clinical and radiological diagnosis, the cumulative incidence of hernia was 7.4% during a median follow up time of 30 months. Risk factors for stoma site hernia were male sex and higher BMI. Conclusion Hernia at the previous stoma site was underdiagnosed. Less than a third of symptomatic patients had a hernia diagnosis in routine follow up. Randomized studies are needed to evaluate if prophylactic mesh can be used to prevent hernias, especially in patients with risk factors.

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Section: Discussionmentioning

confidence: 43%

“…Median BMI in patients with stoma site hernia was 28 (IQR: 25-29) kg/m 2 versus 25 (22)(23)(24)(25)(26)(27)(28) in patients without hernia (p = 0.026) ( Table 4). Of the 16 patients with hernia, 14 (88%) were men and 2 (12%) were women, versus 116 (58%) men and 84 (42%) women in patients without hernia (p = 0.031).…”

Section: Risk Factorsmentioning

confidence: 99%

Hernia at the stoma site after loop ileostomy reversal

Eklöv

Viktorsson

Frosztega

et al. 2020

Int J Colorectal Dis

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“…However, Li et al . reported that ileostomy formation at the SES should be performed with caution because of increased incidence of stoma site complications 8 . In this study, temporary ileostomy formation at the SES was associated with a shorter operation time and less wound complication rate than the control group, which is similar to that reported by Karakayali et al .…”

Section: Discussionmentioning

confidence: 99%

“…Li et al . claimed that forming a stoma at the SES can increase the risk of stoma-related complications and that it is safe to perform ileostomy at a different location 8 . However, research on complication rates when a stoma is formed at the SES in patients with rectal cancer is lacking.…”

Section: Introductionmentioning

confidence: 99%

Safety of temporary ileostomy via specimen extraction site in rectal cancer patients who underwent laparoscopic low anterior resection

Lee

Park

Lee

et al. 2019

Sci Rep

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If anastomotic site leakage is expected after laparoscopic low anterior resection (LAR), de-functioning ileostomy is required. However, there is controversy about the consequence of stoma formation via the specimen extraction site (SES). Therefore, we aimed to investigate stoma-related complication according to stoma formation via the SES. We enrolled rectal cancer patients who underwent laparoscopic LAR with temporary ileostomy between January 2013 and December 2017. Patients were divided into two groups: stoma through the SES (SES) and stoma through a new site (NS). The difference in the incidence of stoma-related complications was analysed. In total, 198 patients underwent laparoscopic LAR (SES = 141 patients, NS = 57 patients). The SES group had a shorter operation time (204.7 ± 74.4 min vs 229.5 ± 90.5 min, p = 0.049) and was associated with fewer cases of wound infection (0% vs 7%, p = 0.006) than the NS group. There was no statistically significant difference between the SES group and NS group in all-stoma complications (22.7% vs 12.3%, p = 0.095). The incidence of parastomal hernia also was not significantly different (11.3% vs 5.3%, p = 0.286). Stoma via the SES is feasible after laparoscopic LAR with temporary ileostomy, although stoma-related complication rate was higher, without a significant difference. It can shorten the operation time and reduce wound infection rate.

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“…Li et al have shown that stoma site specimen extraction is associated with an increased risk of parastomal hernia, but not with need for further surgeries, and this technique is therefore still a reasonable option in patients requiring temporary stomas. 34 Extraperitoneal tunneling, an alternative technique for stoma creation first described by Goligher in 1958, has been shown to be associated with a lower rate of parastomal hernia formation particularly in patients undergoing laparoscopic abdominoperineal resection with end colostomy. 3,32,35,36 Further prospective randomized studies are needed to better define which subset of patients benefit most from this technique given the increases in operative time and postoperative complications associated with its use.…”

Section: Parastomal Herniamentioning

confidence: 99%

Ostomy-Related Complications

Murken

Bleier

2019

Clinics in Colon and Rectal Surgery

108

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Ileostomy or colostomy formation is an important component of many surgical procedures performed for a wide range of disorders of the gastrointestinal tract. Despite the frequency with which intestinal stomas are created, stoma-related complications remain common and are associated with significant morbidity as well as cost. Some of the most prevalent complications of stoma formation which will be detailed in this article include peristomal skin complications, retraction, stomal necrosis, stomal stenosis, prolapse, bleeding, dehydration from high ostomy output, and parastomal hernia. The authors will review these common complications, detail means to avoid or prevent them, and outline recommendations for management.

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Does stoma site specimen extraction increase postoperative ileostomy complication rates?

Cited by 28 publications

References 18 publications

Hernia at the stoma site after loop ileostomy reversal

Hernia at the stoma site after loop ileostomy reversal

Safety of temporary ileostomy via specimen extraction site in rectal cancer patients who underwent laparoscopic low anterior resection

Ostomy-Related Complications

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