Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection
Language English Country Germany Media print-electronic
Document type Journal Article
PubMed
26902615
DOI
10.1007/s00464-016-4811-3
PII: 10.1007/s00464-016-4811-3
Knihovny.cz E-resources
- Keywords
- Anastomotic leakage, Laparoscopy, Low anterior resection, Protective ileostomy, Stoma complications,
- MeSH
- Anastomosis, Surgical methods MeSH
- Time Factors MeSH
- Surgical Stomas MeSH
- Digestive System Surgical Procedures methods MeSH
- Length of Stay MeSH
- Ileostomy methods MeSH
- Cohort Studies MeSH
- Quality of Life MeSH
- Laparoscopy methods MeSH
- Laparotomy MeSH
- Middle Aged MeSH
- Humans MeSH
- Rectal Neoplasms surgery MeSH
- Anastomotic Leak epidemiology prevention & control MeSH
- Postoperative Complications epidemiology surgery MeSH
- Rectum surgery MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Intestinal Obstruction epidemiology surgery MeSH
- Case-Control Studies MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article 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.
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