Safety of the temporary loop ileostomy

Hallböök, Olof; Matthiessen, Peter; Leinsköld, Ted; Nyström, Per‐Olof; Sjödahl, Rune

doi:10.1046/j.1463-1318.2002.00398.x

Cited by 81 publications

(63 citation statements)

References 10 publications

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“…The 30-day mortality rate after elective reversal of electively and urgently defunctioned patients was 0.9% (1 of 111), which compares to 0.5% recently described. 16,20 This additional risk of mortality should be included in the total early mortality.…”

Section: Matthiessen Et Almentioning

confidence: 99%

Defunctioning Stoma Reduces Symptomatic Anastomotic Leakage After Low Anterior Resection of the Rectum for Cancer

Matthiessen

Hallböök²,

Rutegård³

et al. 2007

Annals of Surgery

972

327

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Objective: The aim of this randomized multicenter trial was to assess the rate of symptomatic anastomotic leakage in patients operated on with low anterior resection for rectal cancer and who were intraoperatively randomized to a defunctioning stoma or not. Summary Background Data: The introduction of total mesorectal excision surgery as the surgical technique of choice for carcinoma in the lower and mid rectum has led to decreased local recurrence and improved oncological results. Despite these advances, perioperative morbidity remains a major issue, and the most feared complication is symptomatic anastomotic leakage. The role of the defunctioning stoma in regard to anastomotic leakage is controversial and has not been assessed in any randomized trial of sufficient size. Methods: From December 1999 to June 2005, a total of 234 patients were randomized to a defunctioning loop stoma or no loop stoma. Loop ileostomy or loop transverse colostomy was at the choice of the surgeon. Inclusion criteria for randomization were expected survival Ͼ6 months, informed consent, anastomosis Յ7 cm above the anal verge, negative air leakage test, intact anastomotic rings, and absence of major intraoperative adverse events. Results: The overall rate of symptomatic leakage was 19.2% (45 of 234). Patients randomized to a defunctioning stoma (n ϭ 116) had leakage in 10.3% (12 of 116) and those without stoma (n ϭ 118) in 28.0% (33 of 118) (odds ratio ϭ 3.4; 95% confidence interval, 1.6 -6.9; P Ͻ 0.001). The need for urgent abdominal reoperation was 8.6% (10 of 116) in those randomized to stoma and 25.4% (30 of 118) in those without (P Ͻ 0.001). After a follow-up of median 42 months (range, 6 -72 months), 13.8% (16 of 116) of the initially defunctioned patients still had a stoma of any kind, compared with 16.9% (20 of 118) those not defunctioned (not significant). The 30-day mortality after anterior resection was 0.4% (1 of 234) and after elective reversal a defunctioning stoma 0.9% (1 of 111). Median age was 68 years (range, 32-86 years), 45.3% (106 of 234) were females, 79.1% (185 of 234) had preoperative radiotherapy, the level of anastomosis was median 5 cm, and intraoperative blood loss 550 mL, without differences between the groups. Conclusion: Defunctioning loop stoma decreased the rate of symptomatic anastomotic leakage and is therefore recommended in low anterior resection for rectal cancer.

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Section: Matthiessen Et Almentioning

confidence: 99%

Defunctioning Stoma Reduces Symptomatic Anastomotic Leakage After Low Anterior Resection of the Rectum for Cancer

Matthiessen

Hallböök²,

Rutegård³

et al. 2007

Annals of Surgery

972

327

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“…However, diverting loop‐ileostomy potentially increases the risks for stoma‐related complications including small bowel obstruction (SBO), stoma prolapse, stoma retraction, parastomal hernia, parastomal dermatitis, and mucocutaneous dehiscence. Risks for stoma‐related complications are reportedly 5‐46% 6, 7, 8, 9…”

Section: Introductionmentioning

confidence: 99%

Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch anal anastomosis with diverting loop‐ileostomy for ulcerative colitis

Mizushima

Kameyama

Watanabe

et al. 2017

Annals of Gastroent Surgery

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Small bowel obstruction (SBO) often occurs after total proctocolectomy and ileal pouch anal anastomosis with diverting loop‐ileostomy for ulcerative colitis. Little is known about the association between SBO and surgical procedures for diverting loop‐ileostomy. We conducted a multicenter, retrospective questionnaire survey. Unlinkable anonymized data on ileostomy procedures and ileostomy‐related complications including SBO were collected from institutions specializing in surgery for inflammatory bowel disease. In total, 515 patients undergoing total proctocolectomy and ileal pouch anal anastomosis with loop‐ileostomy among 1022 patients with ulcerative colitis undergoing surgery during a 3‐year period between 2012 and 2014 were analyzed. Twenty‐nine patients without information on complications were excluded. Incidence of ileostomy‐related complications and factors associated with the development of small bowel obstruction were determined in 486 patients. The most common complications were parastomal dermatitis (n=169, 34.8%), SBO (n=111, 22.8%), mucocutaneous dehiscence (n=59, 12.1%), stoma prolapse (n=21, 4.3%), parastomal hernia (n=12, 2.5%), and stoma retraction (n=11, 2.3%). Incidence of small bowel obstruction was significantly higher in patients with distance from the ileal pouch to the ileostomy of less than 30 cm and in patients undergoing laparoscopic surgery. Procedures for diverting loop‐ileostomy after surgery for ulcerative colitis varied among institutions. Incidence of small bowel obstruction was high after total proctocolectomy and ileal pouch anal anastomosis with diverting loop‐ileostomy. Shorter distance between the pouch and the stoma and the laparoscopic surgery were risk factors for SBO in univariate analysis.

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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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Safety of the temporary loop ileostomy

Cited by 81 publications

References 10 publications

Defunctioning Stoma Reduces Symptomatic Anastomotic Leakage After Low Anterior Resection of the Rectum for Cancer

Defunctioning Stoma Reduces Symptomatic Anastomotic Leakage After Low Anterior Resection of the Rectum for Cancer

Risk factors of small bowel obstruction following total proctocolectomy and ileal pouch anal anastomosis with diverting loop‐ileostomy for ulcerative colitis

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

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