Morbidity of Ileostomy and Colostomy Closure: Impact of Surgical Technique and Perioperative Treatment

Abstract

The operative results and complications after stoma closure in 548 patients operated on between 1972 and 1993 are described in this retrospective study. The patients were divided into three groups (group I,n = 74, 1972-1976; group II,n = 256, 1977-1985; group III,n = 218, 1986-1993) according to the year of operation and changing concepts in colorectal surgery. The overall mortality rate was 2.0%. The morbidity rate including minor complications was significantly reduced from 70.3% in group I to 27.1% in group III. Postoperative wound infections and fever were the most common complications. The location of the stoma and the operative technique did not markedly influence the morbidity rate. The most striking decrease in complications was achieved by the combined usage of orthograde lavage and perioperative antibiotic treatment (14.6% wound infections, 6.9% postoperative fever). In conclusion, a standardized perioperative treatment protocol including orthograde lavage and antibiotics is recommended.

Morbimortalidade da reconstrução de transito intestinal colônica em hospital universitário: análise de 42 casos

“…Outros fatores considerados importantes na diminuição de complicações pós-operatórias, como a antibioticoprofilaxia e preparo mecânico do cólon (22) são realizados de maneira rotineira e uniforme em nosso serviço.…”

“…Esses dados são questionados por alguns centros, que preconizam uma reconstrução mais precoce sem um aumento significativo nas taxas de complicações (10,11,22,25) . Os trabalhos ainda não demonstram claramente uma diferença significativa nos dois tipos de abordagem, levando ainda em consideração a diferença de reconstrução de uma colostomia terminal ou em alça em relação ás complicações (26,27) .…”

A Comparative Study between Santulli Ileostomy and Loop Ileostomy

“…A need for second surgery for closure of stoma adds on to financial burden and unnecessary delays due to non prioritization of stoma closure due to high case volume. The closure of the intestinal stoma is also frequently followed by complications in 17%-27% of patients [2,3].…”

Anastomotic leakage after laparoscopic total mesorectal excision for low rectal cancer

“…The ileostomy could be cancelled in only 90.7% of patients and in 10.2% of them it was associated with postoperative complications. According to published studies in this field, morbidity related to protective ileostomy cancellation occurs in 8.7-30% of patients [25][26][27]. Other risk factors of anastomotic healing after TME mentioned in the literature include smoking, male sex, BMI, anastomotic distance from the anocutaneous edge, difficulties in anastomotic construction [8,10,12,13,28], the quantity of staplers used in rectal transection [21] and preoperative radiochemotherapy [22].…”