Morbidity of Temporary Loop Ileostomies

Bakx, Roel; Busch, Olivier R.; Bemelman, Willem A.; Veldink, G J; Slors, J. F. M.; Lanschot, J. Jan B. van

doi:10.1159/000080201

Cited by 120 publications

(109 citation statements)

References 42 publications

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“…Some surgeons use a protective stoma after LAR to prevent anastomotic leakage in the hope that by diverting the fecal stream and keeping the anastomosis free of material, leakage will be less likely. While other surgeons have reported that covering the protective stoma had no influence on anastomotic leakage and reoperation rates, the further complications that can be caused by the stoma itself should not be ignored, as they include discomfort and inconvenience, high output with consequent dehydration, and anastomotic complications at the stoma closure site [12][13][14][15][16][17][18] . Although protective stomas are widely used in LAR for rectal cancer, it remains unclear whether such protective stomas are useful for patients.…”

Section: Introductionmentioning

confidence: 99%

Role of protective stoma in low anterior resection for rectal cancer: A meta-analysis

Wu¹,

Ma²,

Yu³

2014

WJG

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AIM:To provide a comprehensive evaluation of the role of a protective stoma in low anterior resection (LAR) for rectal cancer. METHODS:The PubMed, EMBASE, and MEDLINE databases were searched for studies and relevant literature published between 2007 and 2014 regarding the construction of a protective stoma during LAR. A pooled risk ratio (RR) with 95% confidence intervals (CIs) was used to assess the outcomes of the studies, including the rate of postoperative anastomotic leakage and reoperations related to leakage. Funnel plots and Egger's tests were used to evaluate the publication biases of the studies. P values < 0.05 were considered statistically significant. RESULTS:A total of 11 studies were included in the meta-analysis. In total, 5612 patients were examined, 2868 of whom had a protective stoma and 2744 of whom did not. The sample size of the studies varied from 34 to 1912 patients. All studies reported the number of patients who developed an anastomotic leakage and required a reoperation related to leakage. A random effects model was used to calculate the pooled RR with the corresponding 95%CI because obvious heterogeneity was observed among the 11 studies (I 2 = 77%). The results indicated that the creation of a protective stoma during LAR significantly reduces the rate of anastomotic leakage and the number of reoperations related to leakage, with pooled RRs of 0.38 (95%CI: 0.30-0.48, P < 0.00001) and 0.37 (95%CI: 0.29-0.48, P < 0.00001), respectively. The shape of the funnel plot did not reveal any evidence of obvious asymmetry. CONCLUSION:The presence of a protective stoma effectively decreased the incidences of anastomotic leakage and reoperation and is recommended in patients undergoing low rectal anterior resections for rectal cancer.

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Section: Introductionmentioning

confidence: 99%

Role of protective stoma in low anterior resection for rectal cancer: A meta-analysis

Wu¹,

Ma²,

Yu³

2014

WJG

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“…These complications were diagnosed according to standard predefined criteria and were based on those occurring most frequently2, 4, 16, 17, 18, 19, 20, 21, 22. General postoperative complications were recorded, including surgical‐site infection, abdominal abscess, ileus, abdominal fascia dehiscence, anastomotic leakage, pneumonia, urinary tract infection and a miscellaneous (other) group.…”

Section: Methodsmentioning

confidence: 99%

“…The morbidity rate is high, ranging from 21 to 60 per cent2. This results in decreased quality of life (QoL), and disturbed physical and psychological well‐being3, 4, 5, 6, 7, 8, 9, 10.…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of intracutaneouslyversustranscutaneously sutured ileostomy to prevent stoma-related complications (ISI trial)

Sier¹,

Wisselink²,

Ubbink³

et al. 2018

British Journal of Surgery

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BackgroundIleostomy construction is a common procedure but can be associated with morbidity. The stoma is commonly secured to the skin using transcutaneous sutures. It is hypothesized that intracutaneous sutures result in a tighter adherence of the peristomal skin to the stoma plate to prevent faecal leakage. The study aimed to compare the effect of intracutaneous versus transcutaneous suturing of ileostomies on faecal leakage and quality of life.MethodsThis randomized trial was undertaken in 11 hospitals in the Netherlands. Patients scheduled to receive an ileostomy for any reason were randomized to intracutaneous or transcutaneous suturing (IC and TC groups respectively). The primary outcome was faecal leakage. Secondary outcomes were stoma‐related quality of life and costs of stoma‐related materials and reinterventions.ResultsBetween April 2011 and February 2016, 339 patients were randomized to the IC (170) or TC (169) group. Leakage rates were higher in the IC than in the TC group (52·4 versus 41·4 per cent respectively; risk difference 11·0 (95 per cent c.i. 0·3 to 21·2) per cent). Skin irritation rates were high (78·2 versus 72·2 per cent), but did not differ significantly between the groups (risk difference 6·1 (95 per cent c.i. –3·2 to 15·10) per cent). There were no significant differences in quality of life or costs between the groups.ConclusionIntracutaneous suturing of an ileostomy is associated with more peristomal leakage than transcutaneous suturing. Overall stoma‐related complications did not differ between the two techniques. Registration number: NTR2369 ( http://www.trialregister.nl).

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“…1 Recent literature shows the overall stoma-related morbidity in such patients, may vary between 17 and 45 %. [1][2] It also reflects adversely with body image and quality of life. 3 The intension of the stoma creation is primarily a temporary one.…”

Section: Introductionmentioning

confidence: 99%

Analysis of factors influencing colostomy closure after low anterior resection for cancer rectum

Das

Satpathy

2017

Int J Res Med Sci

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Background: De-functioning colostomy or ileostomy is a procedure known worldwide as a protection measure to the rectal anatomises in low anterior resections and even some of anterior resections. Though the primary intention is a temporary one, many a times they end up in a permanent stoma. As the patients with stomas with attached bag appliances to their abdominal wall go through a lot of stress related to the quality of life and body image, they are always keen to get it closed as early as possible. Unfortunately, many factors come into play during and after the indexed surgery till the closure of stoma without any complication, prohibiting their early or even delayed closure.Methods: Authors here conducted a cohort study with retrospective data analysis and a prospective follow up patients in a tertiary care regional cancer centre from April 2011 to mid-June 2017. Statistical analysis was used by mean and percentage method.Results: Temporary colostomy was required in 88.37% of low anterior resections and some anterior resections. Most of those (92.11%) were transverse colostomy. Only 36.86% of those stomata were reversed. Four (10.83%) patients were dead by the end of the study. Twenty patients of stoma (52.63%) were not yet reversed and were deemed to continue with a permanent colostomy. This was found to be a very high figure as opposed to the literature of 9-25%. The reason behind this high figure was probably due to low general condition, lower socio-economic status, and low literacy prevailing in our patient population group. Moreover, the patient attendants and the surgeon himself also had played some role responsible for this situation.Conclusions: Patients should be told before initial rectal surgery that there is a risk of non-closure and possible complications associated with permanent stoma.

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Morbidity of Temporary Loop Ileostomies

Cited by 120 publications

References 42 publications

Role of protective stoma in low anterior resection for rectal cancer: A meta-analysis

Role of protective stoma in low anterior resection for rectal cancer: A meta-analysis

Randomized clinical trial of intracutaneouslyversustranscutaneously sutured ileostomy to prevent stoma-related complications (ISI trial)

Analysis of factors influencing colostomy closure after low anterior resection for cancer rectum

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