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

Abstract

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.

Does temporary ileostomy via specimen extraction site affect the short outcomes and complications after laparoscopic low anterior resection in rectal cancer patients? A propensity score matching analysis

“…In this study, we found that the SSES group had smaller intraoperative blood loss, shorter operation time and shorter post-operative hospital stay than the SNS group before PSM, and the SSES group had shorter operation time after PSM. These results were similar with previous studies [13][14][15][16], the possible reason was that the SSES group omitted the step of suturing the incision, which greatly reduced the operation time.…”

“…We summarize the detailed viewpoints in Table 5 concerning the difference between SSES and SNS. Some studies reported that there was no statistically significant difference between the SSES group and SNS group in all stoma related complications [13,14,17]. However, Li W et al [15] reported the SSES had group had a lower parastomal hernia rate.…”

“…Karakayali FY et al [16] reported the SNS group had lower parastomal hernia rate than the SSES group. As for other surgical outcomes including operation time, post-operative hospital stay, it remained controversial as well [13][14][15][16][17]. Therefore, it is important to analyze the surgical outcomes and stoma related complications elaborately.…”

“…However, it remained controversial which site of temporary ileostomy was better [13][14][15][16][17]. Some studies reported there was no difference between SSES and SNS [17], however, other studies reported SSES was a better method [13][14][15]. Therefore, the purpose of the current study aims to compare the outcomes of temporary ileostomy through SSES and SNS after laparoscopic low anterior resection.…”

“…There were two methods in terms of the site of temporary ileostomy: temporary ileostomy through the specimen extraction site (SSES) and stoma through a new site (SNS) after laparoscopic low anterior resection. However, it remained controversial which site of temporary ileostomy was better [13][14][15][16][17]. Some studies reported there was no difference between SSES and SNS [17], however, other studies reported SSES was a better method [13][14][15].…”