Protective loop ileostomy increases the risk for prolonged postoperative paralytic ileus after open oncologic rectal resection

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.

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Loop ileostomy reversal after laparoscopic versus open rectal resection

ANZ Journal of Surgery ◽

10.1111/ans.14879 ◽

2018 ◽

Vol 89 (3) ◽

pp. E52-E55 ◽

Cited By ~ 1

Author(s):

Arie Sebastian ◽

Douglas Stupart ◽

David A. Watters

Keyword(s):

Rectal Resection ◽

Loop Ileostomy ◽

Ileostomy Reversal

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Readmission after rectal resection in the ERAS-era: is a loop ileostomy the Achilles heel?

BMC Surgery ◽

10.1186/s12893-021-01242-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Johanna Van Butsele ◽

Gabriele Bislenghi ◽

André D’Hoore ◽

Albert M. Wolthuis

Keyword(s):

Risk Factors ◽

Creatinine Level ◽

Enhanced Recovery ◽

Rectal Resection ◽

Loop Ileostomy ◽

Study Endpoint ◽

Primary Study ◽

Patient Profile ◽

Eras Protocol ◽

High Output

Abstract Background Rectal resection surgery is often followed by a loop ileostomy creation. Despite improvements in surgical technique and development of enhanced recovery after surgery (ERAS) protocols, the readmission-rate after rectal resection is still estimated to be around 30%. The purpose of this study was to identify risk factors for readmission after rectal resection surgery. This study also investigated whether elderly patients (≥ 65 years old) dispose of a distinct patient profile and associated risk factors for readmission. Methods This is a retrospective study of prospectively collected data from patients who consecutively underwent rectal resection for cancer within an ERAS protocol between 2011 and 2016. The primary study endpoint was 90-day readmission. Patients with and without readmission within 90 days were compared. Additional subgroup analysis was performed in patients ≥ 65 years old. Results A total of 344 patients were included, and 25% (n = 85) were readmitted. Main reasons for readmission were acute renal insufficiency (24%), small bowel obstruction (20%), anastomotic leakage (15%) and high output stoma (11%). In multivariate logistic regression, elevated initial creatinine level (cut-off values: 0.67–1.17 mg/dl) (OR 1.95, p = 0.041) and neoadjuvant radiotherapy (OR 2.63, p = 0.031) were significantly associated with readmission. For ileostomy related problems, elevated initial creatinine level (OR 2.76, p = 0.021) was identified to be significant. Conclusion Recovery after rectal resection within an ERAS protocol is hampered by the presence of a loop ileostomy. ERAS protocols should include stoma education and high output stoma prevention.

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

10.21203/rs.3.rs-32646/v2 ◽

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.

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