The incidence and causes of permanent stoma after anterior resection

Abstract

Anterior resection is being performed for very low rectal tumours in order to avoid a permanent stoma. However we have found that 8% of patients who are defunctioned with a stoma at anterior resection will not have their stoma closed, and conclude that patients should be warned of this pre-operatively.

Low or Ultralow Anterior Resection of Rectal Cancer Without Diverting Stoma: Experience with 28 Patients

“…At the time of making and consequently taking down the diverting stoma there are 5.2-23.3 % and 9.5-18.3 % chances of complications, respectively [21]; the overall morbidity and mortality rates for this procedure are 33.8 % and 6.4 %, respectively [30]. Although 6.3-19.2 % of temporary stomas have never been closed and remained forever [17][18][19]21], some studies showed that the quality of life would be bad with stoma and generally improved after ileostomy closure [31]. So a temporary stoma should be created in selected patients with highest risk anastomotic leakage [23,26,31].…”

“…Furthermore, the stoma itself would increase the morbidity in construction time, life period, and closure time, which also in its place needs reoperation and hospitalization, and so has its own morbidity and mortality [14][15][16]. In some instances, the stoma cannot be closed in the patient's entire lifetime [17][18][19]. Some articles have mentioned no decrease of fistula, but less leakage complications, and so the necessity of operation [20].…”

Do older Americans undergo stoma reversal following low anterior resection for rectal cancer?

“…Since the majority of patients with temporary stomas undergo reversal by 18 months, 7,8,10,12,17,18 all patients who did not undergo reversal by 18 months after LAR were excluded from this analysis. Patients who died before reversal or were lost to follow up were included in the analysis and censored.…”

“…6 Prior studies suggest that up to 32% of patients who undergo "temporary" diverting stoma during their resection for rectal cancer never undergo reversal. 5,[7][8][9][10] Previously identified predictors of delay or failure in reversal include post-operative chemotherapy, 7,10 increasing age, 7 metastatic disease, 8 comorbidities 7 and perioperative complications 8,9,11,12 , but only two studies have reported factors associated with ileostomy reversal failure after multivariable adjustment. 7,9 Additionally, while higher volume hospitals have been associated with decreased rates of permanent colostomy in rectal cancer patients, 13 little is known about the role of institution in reversal of temporary stoma patients.…”

Treatment of Colorectal Stricture After Circular Stapling Anastomoses

“…Once, however, it occurs, granulation tissue followed by firm fibrosis surrounding the anastomosis contributes the formation of severe and long narrowing of the anastomosis. Accordingly, this type of stricture is usually resistant to conventional treatment, resulted in surgical reoperation or the need for permanent stoma (Bailey et al, 2003;Köhler et al, 2000;Ohman & Svenberg, 1983). Recent advances in fluoroscopic and endoscopic modalities enable us to perform an effective, relatively safe, and less invasive treatment such as fluoroscopically guided bougienage, balloon dilation or endoscopic modalities for these patients who experience acute, recurrent, or chronic stricture of the alimentary tract (Garcea et al, 2003;Johansson, 1996;Kozarek, 1986;Lange & Shaffer, 1991;Oz & Forde, 1990;Werre et al, 2000).…”