scholarly journals Closure of loop ileostomy after low anterior rectal resection and restorative proctocolectomy

2008 ◽  
Vol 55 (3) ◽  
pp. 67-71 ◽  
Author(s):  
Z. Krivokapic ◽  
S. Bilali
Keyword(s):  
Restorative Proctocolectomy ◽  
Rectal Resection ◽  
Loop Ileostomy ◽  
Operative Management ◽  
Abdominal Sepsis ◽  
Fecal Diversion ◽  
Ileostomy Closure ◽  
Single Institution ◽  
Anterior Rectal Resection ◽  
The Common

Objective: Low pelvic anastomoses are associated with a high leak rate. Loop ileostomies are commonly performed during ileoanal and coloanal anastomoses. This study was undertaken to review our experience with loop ileostomy closure after low anterior rectal resection and restorative proctocolectomy. Patients and methods: One hundred sixty five patients undergoing loop ileostomy closure at a single institution after coloanal and ileoanal anastomoses for rectal carcinoma (n=148) ulcerative colitis (n=9) and FAP (n=8) from January 2003 to December 2006. Fecal diversion was maintained for a mean 13,5 weeks. Results: Of the 165 patients, 100 were male and 65 female with mean age 59 (range 23-83 years). Overall, complication rate was 10,9 per cent. The common complication were sub occlusion six patients, occlusion three patients, wound infection eight patients and abdominal sepsis one patient. Complications required operative management in four cases. There was no mortality related to ileostomy. Conclusion: The study shown that ileostomy closure is a safe and effective with generally minor complications and should be considered as a safe alterative for fecal diversion.

scholarly journals Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients

2020 ◽  
Author(s):  
Marcin Zeman ◽  
Marek Czarnecki ◽  
Andrzej Chmielarz ◽  
Adam Idasiak ◽  
Maciej Grajek ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Rectal Resection ◽  
Loop Ileostomy ◽  
Significant Risk ◽  
Plasma Fibrinogen ◽  
Fibrinogen Concentration ◽  
Permanent Stoma ◽  
Anterior Rectal Resection ◽  
The Impact

Abstract Background: One of the most severe complications of low anterior rectal resection is anastomotic leakage (AL). The creation of a loop ileostomy (LI) reduces the prevalence of AL requiring surgical intervention. However, up to one-third of temporary stomas may never be closed.The first aim of the study was to perform a retrospective assessment of the impact of LI on the risk of permanent stoma (PS) and symptomatic AL. The second aim of the study was to assess preoperative PS risk factors in patients with LI.Methods: A total of 286 consecutive patients who underwent low anterior rectal resection were subjected to retrospective analysis. In 101 (35.3%) patients, diverting LI was performed due to low anastomosis, while in the remaining 185 (64.7%) patients, no ileostomy was performed. LIs were reversed after adjuvant treatment. Analyses of the effect of LI on symptomatic AL and PS were performed. Among the potential risk factors for PS, clinical factors and the values ​​of selected peripheral blood parameters were analysed.Results: PS occurred in 37.6% and 21.1% of the patients with LI and without LI, respectively (p <0.01). Symptomatic ALs were significantly more common in patients without LI. In this group, symptomatic ALs occurred in 23.8% of patients, while in the LI group, they occurred in 5% of patients (p <0.001). In the LI group, the only significant risk factor for PS in the multivariate analysis was preoperative plasma fibrinogen concentration (OR = 1.007, 97.5% CI 1.002-1.013, p = 0.013).Conclusions: Although protective LI may reduce the incidence of symptomatic AL, it can be related to a higher risk of PS in this group of patients. The preoperative plasma fibrinogen concentration can be a risk factor for PS in LI patients and may be a useful variable in decision-making models.

scholarly journals Ghost ileostomy versus conventional loop ileostomy in patients undergoing low anterior resection for rectal cancer (DRKS00013997): protocol for a randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038930
Author(s):  
Felix J Hüttner ◽  
Pascal Probst ◽  
André Mihaljevic ◽  
Pietro Contin ◽  
Colette Dörr-Harim ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Loop Ileostomy ◽  
Pilot Trial ◽  
Ileostomy Closure ◽  
Ghost Ileostomy ◽  
Anterior Rectal Resection ◽  
Randomised Controlled

IntroductionAnastomotic leakage is the most important complication in colorectal surgery occurring in up to 20% after low anterior rectal resection. Therefore, a diverting ileostomy is usually created during low anterior resection to protect the anastomosis or rather to diminish the consequences in case of anastomotic leakage. The so-called virtual or ghost ileostomy is a pre-stage ostomy that can be easily exteriorised, if anastomotic leakage is suspected, in order to avoid the severe consequences of anastomotic leakage. On the other hand, an actual ileostomy can be avoided in patients, who do not develop anastomotic leakage.Methods and analysisThe GHOST trial is a randomised controlled pilot trial comparing ghost ileostomy with conventional loop ileostomy in patients undergoing low anterior resection with total mesorectal excision for rectal cancer. After screening for eligibility and obtaining informed consent, a total of 60 adult patients are included in the trial. Patients are intraoperatively randomised to the trial groups in a 1:1 ratio after assuring that none of the intraoperative exclusion criteria are present. The main outcome parameter is the comprehensive complication index as a measure of safety. Further outcomes include specific complications, stoma-related complications, complications of ileostomy closure, frequency of transformation of ghost ileostomy into conventional ileostomy, frequency of terminal ostomy creation, proportion of patients with an ostomy at 6 months after index surgery, anorectal function (Wexner score) and quality of life assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and CR29 questionnaires. Follow-up for each individual patient will be 6 months.Ethics and disseminationThe GHOST trial has been approved by the Medical Ethics Committee of Heidelberg University (reference number S-694/2017). If the intervention proves to be safe, loop ileostomy could be spared in a large proportion of patients, thus also avoiding stoma-related complications and a second operation (ileostomy closure) with its inherent complications in these patients.Trial registration numberGerman Clinical Trials Registry (DRKS00013997); Universal Trial Number: U1111-1208-9742.

Loop Ileostomy Closure After Restorative Proctocolectomy: Outcome in 1,504 Patients

2005 ◽  
Vol 48 (2) ◽  
pp. 243-250 ◽  
Author(s):  
Kutt-Sing Wong ◽  
Feza H. Remzi ◽  
Emre Gorgun ◽  
Susana Arrigain ◽  
James M. Church ◽  
...  
Keyword(s):  
Restorative Proctocolectomy ◽  
Loop Ileostomy ◽  
Ileostomy Closure

scholarly journals Postoperative Ileus after Stimulation with Probiotics before Ileostomy Closure

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 626
Author(s):  
Ángela Rodríguez-Padilla ◽  
Germán Morales-Martín ◽  
Rocío Pérez-Quintero ◽  
Juan Gómez-Salgado ◽  
Rafael Balongo-García ◽  
...  
Keyword(s):  
Colorectal Carcinoma ◽  
Postoperative Ileus ◽  
Loop Ileostomy ◽  
Bowel Function ◽  
Ileostomy Closure ◽  
Controlled Study ◽  
Control Group ◽  
Double Blind ◽  
Colorectal Cancer Surgery ◽  
Stimulation Of

Loop ileostomy closure after colorectal surgery is often associated with Postoperative ileus, with an incidence between 13–20%. The aim of this study is to evaluate the efficacy and safety of preoperative stimulation of the efferent loop with probiotics prior to ileostomy closure in patients operated on for colorectal carcinoma. For this, a prospective, randomized, double-blind, controlled study is designed. All patients who underwent surgery for colorectal carcinoma with loop ileostomy were included. Randomized and divided into two groups, 34 cases and 35 controls were included in the study. Postoperative ileus, the need for nasogastric tube insertion, the time required to begin tolerating a diet, restoration of bowel function, and duration of hospital stay were evaluated. The incidence of Postoperative ileus was similar in both groups, 9/34 patients stimulated with probiotics and 10/35 in the control group (CG) with a p = 0.192. The comparative analysis showed a direct relationship between Postoperative ileus after oncological surgery and Postoperative ileus after reconstruction surgery, independently of stimulation. Postoperative ileus after closure ileostomy is independent of stimulation of the ileostomy with probiotics through the efferent loop. There seem to be a relationship between Postoperative ileus after reconstruction and the previous existence of Postoperative ileus after colorectal cancer surgery.

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