The influence of diverting loop ileostomy vs. colostomy on postoperative morbidity in restorative anterior resection for rectal cancer: a systematic review and meta-analysis

Chudner, Alexandra; Gachabayov, Mahir; Dyatlov, Artem; Lee, Hanjoo; Essani, Rahila; Bergamaschi, Roberto

doi:10.1007/s00423-019-01758-1

Cited by 40 publications

(46 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1 ) [ 3 , 9 - 58 ] published between 2002 and 2020. These articles were distributed as follows: 44 reviews [ 3 , 9 - 19 , 21 - 28 , 30 - 35 , 40 - 44 , 46 - 56 ] including 33 meta-analysis ( Table 1 ) [ 10 , 11 , 16 - 19 , 21 , 23 - 28 , 30 , 31 , 33 - 35 , 40 , 42 - 44 , 46 - 52 , 54 - 56 ] and 7 RCTs ( Table 2 ) [ 20 , 29 , 36 - 39 , 45 ]. Table 3 summarizes included studies’ findings and evidence levels.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding the over mobility after the stoma was made or closed there was no superiority of 1 of the 2 procedures; however, the heterogeneity between the different studies included in this meta-analysis was high. Taking into account anterior resection only, a systematic review and meta-analysis (level 2A) [52] compared ileostomy and colostomy in terms of postoperative morbidity. Chudner et al [52] included 2 randomized trials and 1,063 patients and concluded that the overall morbidity (after making and closing the stoma) was not different between these 2 techniques.…”

Section: Diverting Stoma Diverting Stoma Versus No Stomamentioning

confidence: 99%

See 1 more Smart Citation

How to Prevent Anastomotic Leak in Colorectal Surgery? A Systematic Review

et al. 2020

View full text Add to dashboard Cite

Anastomosis leakage (AL) after colorectal surgery is an embarrassing problem. It is associated with poor consequence. This review aims to summarize published evidence on prevention of AL after colorectal surgery and provide recommendations according to the Oxford Centre for Evidence-Based Medicine. We conducted bibliographic research on January 15, 2020, of PubMed, Cochrane Library, Embase, Scopus, and Google Scholar. We retained meta-analysis, reviews, and randomized clinical trials. We concluded that mechanical bowel preparation did not reduce AL. It seems that oral antibiotic or oral antibiotic with mechanical bowel preparation could reduce the risk of AL. The surgical approach did not affect the AL rate. The low ligation of the inferior mesenteric artery could reduce the AL rate. The mechanical anastomosis is superior to handsewn anastomosis only in case of right colectomies, with similar results in rectal surgery between the 2 anastomosis techniques. In the case of right colectomies, this anastomosis could be performed intracorporeally or extracorporeally with similar outcomes. The air leak test did not reduce AL. There is no interest of external drainage in colonic surgery but drains reduced the rate of AL and rate of reoperation after low anterior resection. The transanal tube reduced the rate of AL.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Diverting Stoma Diverting Stoma Versus No Stomamentioning

confidence: 99%

How to Prevent Anastomotic Leak in Colorectal Surgery? A Systematic Review

et al. 2020

View full text Add to dashboard Cite

show abstract

“…We also identify the need for more studies investigating complications after reversal of colostomies, since most previous studies have either mixed populations or only ileostomies [32]. Further research is also needed on the prevention of hernias by use of mesh [33], especially in high-risk groups for hernia, such as obese men.…”

Section: Discussionmentioning

confidence: 99%

Hernia at the stoma site after loop ileostomy reversal

Eklöv

Viktorsson

Frosztega

et al. 2020

Int J Colorectal Dis

View full text Add to dashboard Cite

Purpose To estimate the incidence of and risk factors for stoma site hernia after closure of a temporary diverting ileostomy. Method In a non-comparative cohort study, charts (n = 216) and CT-scans (n = 169) from patients who had undergone loop ileostomy closure following low anterior resection for rectal cancer 2010-2015 (mainly open surgery) at three hospitals were evaluated retrospectively. Patients without hernia diagnosis were evaluated cross-sectionally through a questionnaire (n = 158), and patients with symptoms of bulging or pain were contacted and offered a clinical examination or a CT scan including Valsalva maneuver. Results In the chart review, five (2.3%) patients had a diagnosis of incisional hernia at the previous stoma site after 8 months (median). In 12 patients, the CT scan showed a hernia, of which 8 had not been detected previously. The questionnaire was returned by 130 (82%) patients, of which 31% had symptoms of bulging or pain. Less than one in five of patients who reported bulging were diagnosed with hernia, but the absolute majority of the radiologically diagnosed hernias reported symptoms. By combining clinical and radiological diagnosis, the cumulative incidence of hernia was 7.4% during a median follow up time of 30 months. Risk factors for stoma site hernia were male sex and higher BMI. Conclusion Hernia at the previous stoma site was underdiagnosed. Less than a third of symptomatic patients had a hernia diagnosis in routine follow up. Randomized studies are needed to evaluate if prophylactic mesh can be used to prevent hernias, especially in patients with risk factors.

show abstract

“…The fashioning of a stoma is not without risk. A meta-analysis comprising of 6 studies and 1063 patients demonstrated a complication rate of 18.2% for loop ileostomy and 30.6% for loop colostomy ( P = 0.001)[16]. The authors found that rates of clinical dehydration (3.1% vs 0%, P = 0.13) and post-operative ileus (5.2% vs 1.7%, P = 0.02) were greater in those patients with a loop ileostomy.…”

Section: Evolution Of Surgery In Management Of Rectal Cancermentioning

confidence: 99%

Neoadjuvant radiotherapy for rectal cancer management

Feeney

Sehgal

Sheehan

et al. 2019

WJG

163

103

View full text Add to dashboard Cite

Thirty per cent of all colorectal tumours develop in the rectum. The location of the rectum within the bony pelvis and its proximity to vital structures presents significant therapeutic challenges when considering neoadjuvant options and surgical interventions. Most patients with early rectal cancer can be adequately managed by surgery alone. However, a significant proportion of patients with rectal cancer present with locally advanced disease and will potentially benefit from down staging prior to surgery. Neoadjuvant therapy involves a variety of options including radiotherapy, chemotherapy used alone or in combination. Neoadjuvant radiotherapy in rectal cancer has been shown to be effective in reducing tumour burden in advance of curative surgery. The gold standard surgical rectal cancer management aims to achieve surgical removal of the tumour and all draining lymph nodes, within an intact mesorectal package, in order to minimise local recurrence. It is critically important that all rectal cancer cases are discussed at a multidisciplinary meeting represented by all relevant specialties. Pre-operative staging including CT thorax, abdomen, pelvis to assess for distal disease and magnetic resonance imaging to assess local involvement is essential. Staging radiology and MDT discussion are integral in identifying patients who require neoadjuvant radiotherapy. While Neoadjuvant radiotherapy is potentially beneficial it may also result in morbidity and thus should be reserved for those patients who are at a high risk of local failure, which includes patients with nodal involvement, extramural venous invasion and threatened circumferential margin. The aim of this review is to discuss the role of neoadjuvant radiotherapy in the management of rectal cancer.

show abstract

The influence of diverting loop ileostomy vs. colostomy on postoperative morbidity in restorative anterior resection for rectal cancer: a systematic review and meta-analysis

Cited by 40 publications

References 32 publications

How to Prevent Anastomotic Leak in Colorectal Surgery? A Systematic Review

How to Prevent Anastomotic Leak in Colorectal Surgery? A Systematic Review

Hernia at the stoma site after loop ileostomy reversal

Neoadjuvant radiotherapy for rectal cancer management

Contact Info

Product

Resources

About