Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection
Jazyk angličtina Země Německo Médium print-electronic
Typ dokumentu časopisecké články
PubMed
26902615
DOI
10.1007/s00464-016-4811-3
PII: 10.1007/s00464-016-4811-3
Knihovny.cz E-zdroje
- Klíčová slova
- Anastomotic leakage, Laparoscopy, Low anterior resection, Protective ileostomy, Stoma complications,
- MeSH
- anastomóza chirurgická metody MeSH
- časové faktory MeSH
- chirurgické stomie MeSH
- chirurgie trávicího traktu metody MeSH
- délka pobytu MeSH
- ileostomie metody MeSH
- kohortové studie MeSH
- kvalita života MeSH
- laparoskopie metody MeSH
- laparotomie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory rekta chirurgie MeSH
- netěsnost anastomózy epidemiologie prevence a kontrola MeSH
- pooperační komplikace epidemiologie chirurgie MeSH
- rektum chirurgie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- střevní obstrukce epidemiologie chirurgie MeSH
- studie případů a kontrol MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
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.
Zobrazit více v PubMed
Ann Surg Oncol. 2015 Oct;22(11):3582-9 PubMed
Int J Colorectal Dis. 2009 Jun;24(6):711-23 PubMed
Ann Surg. 2011 May;253(5):890-9 PubMed
World J Surg. 1999 May;23(5):463-7; discussion 467-8 PubMed
Br J Surg. 2004 Sep;91(9):1111-24 PubMed
Ann Surg. 2010 May;251(5):807-18 PubMed
Ann R Coll Surg Engl. 2005 Nov;87(6):427-31 PubMed
Acta Chir Iugosl. 2002;49(2):67-71 PubMed
World J Surg. 2015 Jan;39(1):259-65 PubMed
Lancet. 2005 May 14-20;365(9472):1718-26 PubMed
Ann Surg. 2008 Jul;248(1):52-60 PubMed
Colorectal Dis. 2005 May;7(3):279-85 PubMed
Cochrane Database Syst Rev. 2010 May 12;(5):CD006878 PubMed
Dis Colon Rectum. 2005 Nov;48(11):2076-9 PubMed
Scand J Surg. 2013;102(4):246-50 PubMed
Dis Colon Rectum. 1998 Dec;41(12):1562-72 PubMed
Dig Surg. 2014;31(3):161-8 PubMed
J Clin Med Res. 2015 Sep;7(9):685-9 PubMed
Am Surg. 2013 Oct;79(10):1034-9 PubMed
Br J Surg. 1998 Mar;85(3):355-8 PubMed
J Surg Res. 2012 Dec;178(2):708-14 PubMed
Ann Coloproctol. 2013 Apr;29(2):66-71 PubMed
Surg Oncol. 2011 Dec;20(4):e149-55 PubMed
Colorectal Dis. 2013 Jun;15(6):e309-16 PubMed
Br J Surg. 2005 Sep;92(9):1137-42 PubMed
Br J Surg. 2010 Dec;97(12):1885-9 PubMed
Int J Colorectal Dis. 2012 Dec;27(12):1619-23 PubMed
Eur J Med Res. 2010;15:292-6 PubMed
Surgery. 2010 Mar;147(3):339-51 PubMed
Langenbecks Arch Surg. 2015 Feb;400(2):145-52 PubMed
Ann Surg. 2004 Aug;240(2):205-13 PubMed
Surg Endosc. 2007 May;21(5):747-53 PubMed
Colorectal Dis. 2004 Nov;6(6):462-9 PubMed
Dis Colon Rectum. 2002 Sep;45(9):1164-71 PubMed
Ann Surg Oncol. 2014 Feb;21(2):507-12 PubMed
Int J Colorectal Dis. 2015 Sep;30(9):1185-92 PubMed
Medical Image Retrieval Using Vector Quantization and Fuzzy S-tree
