Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer

Tan, Wei; Tang, Choong Leong; Shi, Li; Eu, Kong‐Weng

doi:10.1002/bjs.6594

Cited by 424 publications

(300 citation statements)

References 40 publications

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“…This statement is supported by data from various randomized studies that have been subjected to meta-analysis, showing an improvement in outcome associated with protective stoma with LAR. (11,12) In our study, twelve cases of LAR with ileostomy were performed in which anastomotic leakage were present in 2(7%) cases. In one of the study, Matthiessen P et al anastomotic leakage was present in 12 (10.17%).…”

Section: Discussionmentioning

confidence: 78%

Ostomy in Acute Abdominal Conditions: A Study of 30 Cases

Prabhat¹

2017

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Section: Discussionmentioning

confidence: 78%

Ostomy in Acute Abdominal Conditions: A Study of 30 Cases

Prabhat¹

2017

jmscr

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“…In contrast, the Dutch TME trial revealed that the presence of drain was strongly associated with a lower leak rate (9.6%) compared with those without drain (23.5%) and this significance resulted in the relative risk of 2.5 (95%CI; 1.6 to 4.1) by the multivariate analysis, favoring the use of pelvic drain in reducing the anastomotic leak rate [15]. Besides, since this study provided supportive data to the clinical decision to construct covering stoma when performing TME, the main interest of the trials on TME has been shifted to whether to create defunctioning stoma or not at the time of initial surgery [16].…”

Section: Use Of Drain and The Incidence Of Anastomotic Leakmentioning

confidence: 76%

Drain vs No Drain After Colorectal Surgery

Tsujinaka

Konishi

2011

Indian J Surg Oncol

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In colorectal surgery, drains are expected to prevent hematoma, fluid collection, or abscess formation, to act as an indicator of postoperative complication, or to minimize the severity of complication-related symptoms. Routine drainage has not been advocated by meta-analyses as they failed to demonstrate any benefit in reducing anastomotic leak rate, minimizing symptoms, or serving as a warning function. Moreover, some reports even showed that drain itself is an independent risk factor of anastomosis. The introduction of total mesorectal excision (TME) for rectal cancer surgery has given further concern to this controversial issue, that the use of drain decreased anastomotic failure rate and the need for surgical re-intervention. While controversy still remains, the choice of using drain is left to the individual surgeon's preference in daily practice. Therefore, surgeons should be well acquainted with purpose of drainage (prophylaxis, information, or treatment), characteristics (materials), clinical application of drain (type of drainage system, timing of removal), surgical outcomes after using drain (incidence of postoperative complication), and drain-related complications. If drains are used, careful observation with proper use is crucial for the management. It is important that the duration of drainage should not be inadequately extended. Any complications directly associated with the use of drain should be avoided. New concepts of drain have been proposed as diagnostic tool using biomarkers, and as preventive device against anastomotic leak. This article overviews the available, published data on the use of drain in colorectal surgery.

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“…В публикации K. Beirens и соавт., в которой обобщен собственный опыт лечения 1912 пациентов за 5 лет, показано досто-верное снижение частоты возникновения несостоя-тельности анастомоза с 10,2 до 4,3 % у больных со сформированными разгрузочными стомами и ле-тальности в послеоперационном периоде до уровня 0 % против 4,8 % у пациентов без стом соответствен-но [38]. Целесообразность формирования стом при низких передних резекциях прямой кишки под-тверждается и метаанализами опубликованных дан-ных [39]. С другой стороны, формирование разгрузоч-ной стомы сопряжено с рядом нежелательных явлений (в первую очередь с дегидратацией), а реконструктив-ный этап хирургического лечения может иметь свои осложнения.…”

Section: результатыunclassified