Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection
Background Anastomotic leakage presents the most feared complication after low anterior resection (LAR). A proximal diversion of the gastrointestinal tract is recommended to avoid septic complications of anastomotic leakage. The aim of the present study was to evaluate the benefits and risks of dive...
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| Veröffentlicht in: | Surgical endoscopy 2016-11, Vol.30 (11), p.4809-4816 |
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| creator | Ihnát, Peter Guňková, Petra Peteja, Matúš Vávra, Petr Pelikán, Anton Zonča, Pavel |
| description | Background
Anastomotic leakage presents the most feared complication after low anterior resection (LAR). A proximal diversion of the gastrointestinal tract is recommended to avoid septic complications of anastomotic leakage. The aim of the present study was to evaluate the benefits and risks of diverting ileostomy (DI) created during laparoscopic LAR because of low rectal cancer.
Methods
This was a retrospective clinical cohort study conducted to assess outcomes of laparoscopic LAR with/without DI in a single institution within a 6-year period.
Results
In total, 151 patients were enrolled in the study (73 patients without DI, 78 patients with DI). There were no significant differences between both groups regarding demographic and clinical features. Overall 30-day morbidity rates were significantly lower in patients without DI (23.3 vs. 42.3 %,
P
= 0.013). Symptomatic anastomotic leakage occurred more frequently in patients without DI (9.6 vs. 2.5 %,
P
= 0.090); surgical intervention was needed in 6.8 % of patients without DI. Post-operative hospital stay was significantly longer in the group of patients with DI (11.3 ± 8.5 vs. 8.1 ± 6.9 days,
P
= 0.013). Stoma-related complications occurred in 42 of 78 (53.8 %) patients with DI; some patients had more than one complication. Acute surgery was needed in 9 patients (11.5 %) because of DI-related complications. Small bowel obstruction due to DI semi-rotation around its longitudinal axis was seen in 3 patients (3.8 %) and presents a distinct complication of DI laparoscopic construction. The mean interval between LAR and DI reversal was more than 8 months; only 19.2 % of patients were reversed without delay (≤4 months). Morbidity after DI reversal was 16.6 %; re-laparotomy was necessary in 2.5 % of patients.
Conclusions
The present study indicates that DI protects low rectal anastomosis from septic complications at a cost of many stoma-related complications, substantial risk of acute surgery necessity and long stoma periods coupled with decreased quality of life. |
| doi_str_mv | 10.1007/s00464-016-4811-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1826656076</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4228481331</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-d59e83e96cd1256ad51cf23b2768218cbc0337070992299c7d512eeb4781859d3</originalsourceid><addsrcrecordid>eNp1kE1LxDAQhoMo7vrxA7xIwIuXajJp08abrJ-w4EE9h26a7mZpmzVphf33zrKriOApA3nmnZmHkDPOrjhj-XVkLJVpwrhM0oLzROyRMU8FJAC82CdjpgRLIFfpiBzFuGSIK54dkhFIxUDybExe79ynDb3r5tQ11sfet2vqOtqUqzL4aPzKGRqs6cuGmrIzNtA4hLkN6xu6cPMFXQVnLPU1Fr5HzvnuhBzUZRPt6e49Ju8P92-Tp2T68vg8uZ0mJhVFn1SZsoWwSpqKQybLKuOmBjGDXBa4v5kZJkTOcqYUgFImRwCsnaV5wYtMVeKYXG5zcfTHYGOvWxeNbZqys36ImhcgZSZZLhG9-IMu_RA63A4pARlIYBwpvqUMnh6DrTVe15ZhrTnTG-N6a1yjcb0xrgX2nO-Sh1lrq5-Ob8UIwBaI-NWhuV-j_039Aneoiko</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1832526201</pqid></control><display><type>article</type><title>Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Ihnát, Peter ; Guňková, Petra ; Peteja, Matúš ; Vávra, Petr ; Pelikán, Anton ; Zonča, Pavel</creator><creatorcontrib>Ihnát, Peter ; Guňková, Petra ; Peteja, Matúš ; Vávra, Petr ; Pelikán, Anton ; Zonča, Pavel</creatorcontrib><description>Background
Anastomotic leakage presents the most feared complication after low anterior resection (LAR). A proximal diversion of the gastrointestinal tract is recommended to avoid septic complications of anastomotic leakage. The aim of the present study was to evaluate the benefits and risks of diverting ileostomy (DI) created during laparoscopic LAR because of low rectal cancer.
Methods
This was a retrospective clinical cohort study conducted to assess outcomes of laparoscopic LAR with/without DI in a single institution within a 6-year period.
Results
In total, 151 patients were enrolled in the study (73 patients without DI, 78 patients with DI). There were no significant differences between both groups regarding demographic and clinical features. Overall 30-day morbidity rates were significantly lower in patients without DI (23.3 vs. 42.3 %,
P
= 0.013). Symptomatic anastomotic leakage occurred more frequently in patients without DI (9.6 vs. 2.5 %,
P
= 0.090); surgical intervention was needed in 6.8 % of patients without DI. Post-operative hospital stay was significantly longer in the group of patients with DI (11.3 ± 8.5 vs. 8.1 ± 6.9 days,
P
= 0.013). Stoma-related complications occurred in 42 of 78 (53.8 %) patients with DI; some patients had more than one complication. Acute surgery was needed in 9 patients (11.5 %) because of DI-related complications. Small bowel obstruction due to DI semi-rotation around its longitudinal axis was seen in 3 patients (3.8 %) and presents a distinct complication of DI laparoscopic construction. The mean interval between LAR and DI reversal was more than 8 months; only 19.2 % of patients were reversed without delay (≤4 months). Morbidity after DI reversal was 16.6 %; re-laparotomy was necessary in 2.5 % of patients.
Conclusions
The present study indicates that DI protects low rectal anastomosis from septic complications at a cost of many stoma-related complications, substantial risk of acute surgery necessity and long stoma periods coupled with decreased quality of life.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-016-4811-3</identifier><identifier>PMID: 26902615</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Aged ; Anastomosis, Surgical - methods ; Anastomotic Leak - epidemiology ; Anastomotic Leak - prevention & control ; Cancer surgery ; Cancer therapies ; Case-Control Studies ; Cohort analysis ; Cohort Studies ; Colorectal cancer ; Digestive System Surgical Procedures - methods ; Female ; Gastroenterology ; Gynecology ; Hepatology ; Hospitals ; Humans ; Ileostomy - methods ; Intestinal Obstruction - epidemiology ; Intestinal Obstruction - surgery ; Laparoscopy ; Laparoscopy - methods ; Laparotomy ; Length of Stay ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Morbidity ; Ostomy ; Postoperative Complications - epidemiology ; Postoperative Complications - surgery ; Proctology ; Quality of Life ; Radiation ; Rectal Neoplasms - surgery ; Rectum - surgery ; Retrospective Studies ; Surgery ; Surgical anastomosis ; Surgical Stomas ; Time Factors</subject><ispartof>Surgical endoscopy, 2016-11, Vol.30 (11), p.4809-4816</ispartof><rights>Springer Science+Business Media New York 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-d59e83e96cd1256ad51cf23b2768218cbc0337070992299c7d512eeb4781859d3</citedby><cites>FETCH-LOGICAL-c438t-d59e83e96cd1256ad51cf23b2768218cbc0337070992299c7d512eeb4781859d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-016-4811-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-016-4811-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26902615$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ihnát, Peter</creatorcontrib><creatorcontrib>Guňková, Petra</creatorcontrib><creatorcontrib>Peteja, Matúš</creatorcontrib><creatorcontrib>Vávra, Petr</creatorcontrib><creatorcontrib>Pelikán, Anton</creatorcontrib><creatorcontrib>Zonča, Pavel</creatorcontrib><title>Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
Anastomotic leakage presents the most feared complication after low anterior resection (LAR). A proximal diversion of the gastrointestinal tract is recommended to avoid septic complications of anastomotic leakage. The aim of the present study was to evaluate the benefits and risks of diverting ileostomy (DI) created during laparoscopic LAR because of low rectal cancer.
Methods
This was a retrospective clinical cohort study conducted to assess outcomes of laparoscopic LAR with/without DI in a single institution within a 6-year period.
Results
In total, 151 patients were enrolled in the study (73 patients without DI, 78 patients with DI). There were no significant differences between both groups regarding demographic and clinical features. Overall 30-day morbidity rates were significantly lower in patients without DI (23.3 vs. 42.3 %,
P
= 0.013). Symptomatic anastomotic leakage occurred more frequently in patients without DI (9.6 vs. 2.5 %,
P
= 0.090); surgical intervention was needed in 6.8 % of patients without DI. Post-operative hospital stay was significantly longer in the group of patients with DI (11.3 ± 8.5 vs. 8.1 ± 6.9 days,
P
= 0.013). Stoma-related complications occurred in 42 of 78 (53.8 %) patients with DI; some patients had more than one complication. Acute surgery was needed in 9 patients (11.5 %) because of DI-related complications. Small bowel obstruction due to DI semi-rotation around its longitudinal axis was seen in 3 patients (3.8 %) and presents a distinct complication of DI laparoscopic construction. The mean interval between LAR and DI reversal was more than 8 months; only 19.2 % of patients were reversed without delay (≤4 months). Morbidity after DI reversal was 16.6 %; re-laparotomy was necessary in 2.5 % of patients.
Conclusions
The present study indicates that DI protects low rectal anastomosis from septic complications at a cost of many stoma-related complications, substantial risk of acute surgery necessity and long stoma periods coupled with decreased quality of life.</description><subject>Abdominal Surgery</subject><subject>Aged</subject><subject>Anastomosis, Surgical - methods</subject><subject>Anastomotic Leak - epidemiology</subject><subject>Anastomotic Leak - prevention & control</subject><subject>Cancer surgery</subject><subject>Cancer therapies</subject><subject>Case-Control Studies</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Colorectal cancer</subject><subject>Digestive System Surgical Procedures - methods</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Ileostomy - methods</subject><subject>Intestinal Obstruction - epidemiology</subject><subject>Intestinal Obstruction - surgery</subject><subject>Laparoscopy</subject><subject>Laparoscopy - methods</subject><subject>Laparotomy</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Ostomy</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - surgery</subject><subject>Proctology</subject><subject>Quality of Life</subject><subject>Radiation</subject><subject>Rectal Neoplasms - surgery</subject><subject>Rectum - surgery</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgical anastomosis</subject><subject>Surgical Stomas</subject><subject>Time Factors</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kE1LxDAQhoMo7vrxA7xIwIuXajJp08abrJ-w4EE9h26a7mZpmzVphf33zrKriOApA3nmnZmHkDPOrjhj-XVkLJVpwrhM0oLzROyRMU8FJAC82CdjpgRLIFfpiBzFuGSIK54dkhFIxUDybExe79ynDb3r5tQ11sfet2vqOtqUqzL4aPzKGRqs6cuGmrIzNtA4hLkN6xu6cPMFXQVnLPU1Fr5HzvnuhBzUZRPt6e49Ju8P92-Tp2T68vg8uZ0mJhVFn1SZsoWwSpqKQybLKuOmBjGDXBa4v5kZJkTOcqYUgFImRwCsnaV5wYtMVeKYXG5zcfTHYGOvWxeNbZqys36ImhcgZSZZLhG9-IMu_RA63A4pARlIYBwpvqUMnh6DrTVe15ZhrTnTG-N6a1yjcb0xrgX2nO-Sh1lrq5-Ob8UIwBaI-NWhuV-j_039Aneoiko</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>Ihnát, Peter</creator><creator>Guňková, Petra</creator><creator>Peteja, Matúš</creator><creator>Vávra, Petr</creator><creator>Pelikán, Anton</creator><creator>Zonča, Pavel</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20161101</creationdate><title>Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection</title><author>Ihnát, Peter ; Guňková, Petra ; Peteja, Matúš ; Vávra, Petr ; Pelikán, Anton ; Zonča, Pavel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-d59e83e96cd1256ad51cf23b2768218cbc0337070992299c7d512eeb4781859d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Abdominal Surgery</topic><topic>Aged</topic><topic>Anastomosis, Surgical - methods</topic><topic>Anastomotic Leak - epidemiology</topic><topic>Anastomotic Leak - prevention & control</topic><topic>Cancer surgery</topic><topic>Cancer therapies</topic><topic>Case-Control Studies</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Colorectal cancer</topic><topic>Digestive System Surgical Procedures - methods</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Ileostomy - methods</topic><topic>Intestinal Obstruction - epidemiology</topic><topic>Intestinal Obstruction - surgery</topic><topic>Laparoscopy</topic><topic>Laparoscopy - methods</topic><topic>Laparotomy</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Morbidity</topic><topic>Ostomy</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - surgery</topic><topic>Proctology</topic><topic>Quality of Life</topic><topic>Radiation</topic><topic>Rectal Neoplasms - surgery</topic><topic>Rectum - surgery</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgical anastomosis</topic><topic>Surgical Stomas</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ihnát, Peter</creatorcontrib><creatorcontrib>Guňková, Petra</creatorcontrib><creatorcontrib>Peteja, Matúš</creatorcontrib><creatorcontrib>Vávra, Petr</creatorcontrib><creatorcontrib>Pelikán, Anton</creatorcontrib><creatorcontrib>Zonča, Pavel</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ihnát, Peter</au><au>Guňková, Petra</au><au>Peteja, Matúš</au><au>Vávra, Petr</au><au>Pelikán, Anton</au><au>Zonča, Pavel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>30</volume><issue>11</issue><spage>4809</spage><epage>4816</epage><pages>4809-4816</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
Anastomotic leakage presents the most feared complication after low anterior resection (LAR). A proximal diversion of the gastrointestinal tract is recommended to avoid septic complications of anastomotic leakage. The aim of the present study was to evaluate the benefits and risks of diverting ileostomy (DI) created during laparoscopic LAR because of low rectal cancer.
Methods
This was a retrospective clinical cohort study conducted to assess outcomes of laparoscopic LAR with/without DI in a single institution within a 6-year period.
Results
In total, 151 patients were enrolled in the study (73 patients without DI, 78 patients with DI). There were no significant differences between both groups regarding demographic and clinical features. Overall 30-day morbidity rates were significantly lower in patients without DI (23.3 vs. 42.3 %,
P
= 0.013). Symptomatic anastomotic leakage occurred more frequently in patients without DI (9.6 vs. 2.5 %,
P
= 0.090); surgical intervention was needed in 6.8 % of patients without DI. Post-operative hospital stay was significantly longer in the group of patients with DI (11.3 ± 8.5 vs. 8.1 ± 6.9 days,
P
= 0.013). Stoma-related complications occurred in 42 of 78 (53.8 %) patients with DI; some patients had more than one complication. Acute surgery was needed in 9 patients (11.5 %) because of DI-related complications. Small bowel obstruction due to DI semi-rotation around its longitudinal axis was seen in 3 patients (3.8 %) and presents a distinct complication of DI laparoscopic construction. The mean interval between LAR and DI reversal was more than 8 months; only 19.2 % of patients were reversed without delay (≤4 months). Morbidity after DI reversal was 16.6 %; re-laparotomy was necessary in 2.5 % of patients.
Conclusions
The present study indicates that DI protects low rectal anastomosis from septic complications at a cost of many stoma-related complications, substantial risk of acute surgery necessity and long stoma periods coupled with decreased quality of life.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>26902615</pmid><doi>10.1007/s00464-016-4811-3</doi><tpages>8</tpages></addata></record> |
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| subjects | Abdominal Surgery Aged Anastomosis, Surgical - methods Anastomotic Leak - epidemiology Anastomotic Leak - prevention & control Cancer surgery Cancer therapies Case-Control Studies Cohort analysis Cohort Studies Colorectal cancer Digestive System Surgical Procedures - methods Female Gastroenterology Gynecology Hepatology Hospitals Humans Ileostomy - methods Intestinal Obstruction - epidemiology Intestinal Obstruction - surgery Laparoscopy Laparoscopy - methods Laparotomy Length of Stay Male Medicine Medicine & Public Health Middle Aged Morbidity Ostomy Postoperative Complications - epidemiology Postoperative Complications - surgery Proctology Quality of Life Radiation Rectal Neoplasms - surgery Rectum - surgery Retrospective Studies Surgery Surgical anastomosis Surgical Stomas Time Factors |
| title | Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection |
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