EP.TU.911Analysis of the outcomes following reversal of loop ileostomy

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Sawsan Lutfi ◽  
John Camilleri-Brennan
Keyword(s):  
Colorectal Resection ◽  
Loop Ileostomy ◽  
Length Of Hospital Stay ◽  
Bowel Function ◽  
Ileoanal Pouch ◽  
Rectal Perforation ◽  
Rectal Neoplasia ◽  
Colorectal Surgeon ◽  
Colorectal Surgeons ◽  
Attention To Detail

Abstract Aims A defunctioning loop ileostomy is constructed to reduce the incidence and the consequences of anastomotic leaks following sphincter-sparing colorectal resection. Its construction and reversal may be associated with complications. The aim of this study is to present a snapshot of the outcome of reversal of loop ileostomy in a teaching general hospital. Methods All patients whose loop ileostomy was reversed in 2018 were studied. Sociodemographic and clinical data were collected. The outcomes measured were length of hospital stay, return of bowel function, morbidity and mortality. Results Nine patients had reversal of ileostomy by experienced colorectal surgeons during this period. The patients, 5 males and 4 females, had a median age of 58 years (range 20 to 77 years). The main indications for construction of a loop ileostomy were low anterior resection for rectal neoplasia (7 patients) and iatrogenic rectal perforation during hysterectomy (1 patient), and total colectomy with ileoanal pouch reservoir for ulcerative colitis (1 patient). The ileostomies were reversed between 5 to 10 months following the main operations. The postoperative stay was between 2 to 12 days. The complications included one anastomotic leak, requiring immediate re-operation, 3 wound infections and 2 incisional hernias. There were no postoperative deaths. Conclusion In this study our overall complication rate was well within the range reported in the literature, with only one patient requiring immediate re-operation. The presence of a senior colorectal surgeon at operation as well as careful attention to detail is key to keeping complications to a minimum.

scholarly journals Postoperative management after loop ileostomy closure: are we keeping patients in hospital too long?

2010 ◽  
Vol 92 (1) ◽  
pp. 51-55 ◽  
Author(s):  
W Baraza ◽  
J Wild ◽  
W Barber ◽  
S Brown
Keyword(s):  
Length Of Stay ◽  
Enterocutaneous Fistula ◽  
Loop Ileostomy ◽  
Length Of Hospital Stay ◽  
Bowel Function ◽  
Postoperative Management ◽  
Day Case ◽  
Median Length ◽  
Admission Rates ◽  
Potential Factors

INTRODUCTION Recent studies have shown that closure of loop ileostomy can be performed in the day-case setting, reducing the length and cost of hospitalisation. By analysing our patients who have undergone reversal, we aimed to determine the length of hospital stay and potential factors behind stays beyond 24 h. PATIENTS AND METHODS A database of patients undergoing closure of loop ileostomy at one colorectal unit was examined. The times taken to discharge, morbidity and re-admission rates were recorded. RESULTS Eighty patients underwent reversal of ileostomy between January 2001 and January 2006. Median age was 63 years (range, 22–81 years). The median length of stay was 4 days (range, 2–32 days). The median length of stay in patients without complications was 4 days. Many appeared able to be discharged earlier. Seventy-two patients (90%) were able to tolerate a solid diet within 48 h and 54 (67.5%) had bowel function within 3 days. Six patients went home before bowel function; none of these were re-admitted. Twenty patients (25%) developed complications, which included wound infection (8%), small bowel obstruction/ileus (6%), enterocutaneous fistula (1%), anastomotic leak (1%), and late abdominal wall abscess (1%). Of the patients, 16% stayed longer than 5 days despite having no postoperative complications. CONCLUSIONS The majority of patients undergoing loop ileostomy reversal at our institution can be discharged earlier than they are at present. Support in the community and the implementation of modified UK day-case surgery protocols are suggested to help shorten patients' length of stay.

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.

scholarly journals Ileostomy or colostomy for temporary decompression of colorectal anastomosis: systematic review and meta-analysis

2008 ◽  
Vol 23 (3) ◽  
pp. 294-303 ◽  
Author(s):  
Katia Ferreira Güenaga ◽  
Suzana Angélica Silva Lustosa ◽  
Sarhan Sydney Saad ◽  
Humberto Saconato ◽  
Delcio Matos
Keyword(s):  
Large Scale ◽  
Loop Ileostomy ◽  
Skin Irritation ◽  
Colorectal Anastomosis ◽  
Length Of Hospital Stay ◽  
Transverse Colostomy ◽  
Time Interval ◽  
Stoma Formation ◽  
Statistical Heterogeneity ◽  
Stoma Prolapse

PURPOSE: The controversy regarding whether loop ileostomy or loop transverse colostomy is a better method for temporary decompression of colorectal anastomosis motivated this review. METHODS: Five randomized trials were included, with 334 patients: 168 in the loop ileostomy group and 166 in the loop transverse colostomy group. The outcomes analyzed were: 1. Mortality; 2. Wound infection; 3. Time of stoma formation; 4. Time of stoma closure; 5. Time interval between stoma formation and closure; 6. Stoma prolapse; 7. Stoma retraction; 8. Parastomal hernia; 9. Parastomal fistula; 10. Stenosis; 11. Necrosis; 12. Skin irritation; 13. Ileus; 14. Bowel leakage; 15. Reoperation; 16. Patient adaptation; 17. Length of hospital stay; 18. Colorectal anastomotic dehiscence; 19. Incisional hernia; 20. Postoperative bowel obstruction. RESULTS: Stoma prolapse was statistically significant (p = 0.00001), but with statistical heterogeneity; the sensitive analysis was applied, excluding the trials that included emergency surgery, and this showed: p = 0.02, with I² = 0% for the heterogeneity test. CONCLUSIONS: The outcomes reported were not statistically or clinically significant except for stoma prolapse. Better evidence for making the choice between loop ileostomy or loop colostomy requires large-scale randomized controlled trials.

EP.TH.959Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer surgery: An ongoing dilemma

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahin Hajibandeh ◽  
Shahab Hajibandeh ◽  
Pratik Bhattacharya ◽  
Reza Zakaria ◽  
Christopher Thompson ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Surgical Site Infection ◽  
Hospital Stay ◽  
Perioperative Complications ◽  
Loop Ileostomy ◽  
Length Of Hospital Stay ◽  
Ileostomy Closure ◽  
Site Infection ◽  
Cancer Resection

Abstract Aims To evaluate comparative outcomes of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection. Methods We systematic searched MEDLINE; EMBASE; CINAHL; CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. Overall perioperative complications, anastomotic leak, surgical site infection, ileus and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models. Results We identified 4 studies reporting a total of 436 patients comparing outcomes of temporary loop ileostomy closure during (n = 185) or after (n = 251) adjuvant chemotherapy following colorectal cancer resection. There was no significant difference in overall perioperative complications (OR 1.39; 95% CI 0.82-2.36, p = 0.22), anastomotic leak (OR 2.80; 95% CI 0.47-16.56, p = 0.26), surgical site infection (OR 1.97; 95% CI 0.80-4.90, p = 0.14), ileus (OR 1.22; 95% CI 0.50-2.96, p = 0.66) or length of hospital stay (MD 0.02; 95% CI -0.85-0.89, p = 0.97) between two groups. Between-study heterogeneity was low in all analyses. Conclusions The meta-analysis of best, albeit limited, available evidence suggests that temporary loop ileostomy closure during adjuvant chemotherapy following rectal cancer resection may be associated with comparable outcomes to closure of ileostomy after adjuvant chemotherapy. We encourage future research to concentrate on completeness of chemotherapy and quality of life which can determine appropriateness of either approach.

scholarly journals Isolated rectal buttonhole tears in obstetrics: case series and review of the literature

2020 ◽  
Author(s):  
Joanna C. Roper ◽  
Ranee Thakar ◽  
Abdul H. Sultan
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Operative Management ◽  
The Other ◽  
Uneventful Recovery ◽  
Repair Technique ◽  
Vaginal Deliveries ◽  
Colorectal Surgeon ◽  
Colorectal Surgeons ◽  
Repair Techniques

Abstract Introduction and hypothesis The management of isolated rectal buttonhole tears is not standardised and can be challenging in an acute obstetric setting. Our aim was to review the published literature and describe management and repair techniques in a case series. Methods A literature search was carried out. All results were screened and reviewed. Rectal buttonhole tears following vaginal delivery between April 2012 and January 2020 in our institution were identified. Repair technique and post-operative management were recorded. Results There were nine published case reports (four instrumental deliveries, two vaginal breech and three normal vaginal deliveries). Four case reports described a two-layer closure and five described a three-layer closure. Two cases were repaired in collaboration with colorectal surgeons. All nine cases made an uneventful recovery. We identified three patients with buttonhole tears all of whom had instrumental deliveries. A colorectal surgeon repaired the tear in two layers in one case, and an obstetrician performed the repair in the other two cases, one in three layers and the other in two layers. One patient had a de-functioning stoma at a later date due to a second breakdown of the recto-vaginal fistula repair. Conclusion Buttonhole tears are rare but techniques of repair vary. Most cases reviewed had an uneventful recovery after repair. We provide standardised steps for repair and management of isolated rectal buttonhole tears along with a video demonstrating the repair technique in an animal tissue (pig) model.

Complications of axial lumbar interbody fusion

2011 ◽  
Vol 15 (3) ◽  
pp. 273-279 ◽  
Author(s):  
Emily M. Lindley ◽  
Matthew A. McCullough ◽  
Evalina L. Burger ◽  
Courtney W. Brown ◽  
Vikas V. Patel
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Length Of Hospital Stay ◽  
General Surgeon ◽  
Presacral Space ◽  
Lumbar Interbody Fusion ◽  
Rectal Perforation ◽  
Superficial Infection ◽  
Invasive Approach ◽  
Proper Patient Selection

Object Axial lumbar interbody fusion (AxiaLIF) is a novel minimally invasive approach for fusion of L4–5 and L5–S1. This technique uses the presacral space for percutaneous access to the anterior sacrum. The AxiaLIF procedure has the potential to decrease patient recovery time, length of hospital stay, and overall occurrence of surgical complications. It can be used alone or in combination with minimally invasive or traditional open fusion procedures. The purpose of this study was to evaluate complications of the AxiaLIF procedure at the authors' institutions. Methods Patients who underwent AxiaLIF surgery between October 2005 and June 2009 at the authors' institutions were identified. The authors retrospectively reviewed these patients' charts, including operative reports and postoperative medical records, to determine what complications were encountered. Results A total of 68 patients underwent AxiaLIF surgery, with an average follow-up time of 34 months. Sixteen patients (23.5%) experienced a total of 18 complications (26.5%); this group included 8 men and 8 women (mean age 52.1 years). These complications included pseudarthrosis (8.8%), superficial infection (5.9%), sacral fracture (2.9%), pelvic hematoma (2.9%), failure of wound closure (1.5%), transient nerve root irritation (1.5%), and rectal perforation (2.9%). Conclusions The complication rate associated with AxiaLIF in the present study was relatively low (26.5%). The most common complications were superficial infection and pseudarthrosis. There were 2 cases of rectal perforation associated with AxiaLIF; one case was found intraoperatively and the other presented 4 days postoperatively. Both patients underwent emergency repair by a general surgeon and had no long-term sequelae as a result of the rectal injuries. It is important for surgeons to be aware of the potential for these complications. Many of these complications can probably be avoided with proper patient selection and operative planning. Preoperative MR imaging, a detailed patient physical examination and history, full bowel preparation, and the use of live fluoroscopy can all help to prevent complications with AxiaLIF surgery.

scholarly journals Adaptive Returns of Deficient Systemic Plasma Immunoglobulin G Levels as Rehabilitation Biomarker After Emergency Colectomy for Fulminant Ulcerative Colitis

2017 ◽  
Vol 10 ◽  
pp. 117955221774669
Author(s):  
Alexander T Hawkins ◽  
Jun W Um ◽  
Amosy E M’Koma
Keyword(s):  
Ulcerative Colitis ◽  
Immunoglobulin G ◽  
Elective Surgery ◽  
Loop Ileostomy ◽  
Ileoanal Pouch ◽  
Lymphoid Tissues ◽  
Emergency Colectomy ◽  
Terminal Ileostomy ◽  
Pouch Operation ◽  
Quiescent Disease

Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the standard surgical treatment for ulcerative colitis (UC). Emergency colectomies are performed for fulminant colitis (ie, toxic megacolon, profuse bleeding, perforation, or sepsis). The RPC and IPAA involve manipulation of the proximal ileum, which may influence the essential physiological function of gut-associated lymphoid tissues. Circulating plasma immunoglobulin G (p-IgG) deficiency is observed in patients with fulminant UC. In addition, increased levels have been reported in colonic tissues of active UC compared with quiescent disease. We aimed to examine levels of p-IgG for clinical evaluation following emergency colectomies in patients with fulminant UC compared with patients with quiescent disease having elective RPC operations. In total 45 patients received an ileoanal pouch (IAP) due to UC. In all, 27 patients were men and 18 were women. The mean age was 34 years (range: 18-55). Because of fulminant UC, 26 patients had emergency subtotal colectomies with terminal ileostomy (TI). During second operation, the rectum was excised, and an IAP with diverting loop ileostomy (DLI) was performed. Nineteen patients had elective operations and had colectomies performed in conjunction with the pouch operation. Mucosectomy was performed in all groups. As a last procedure, the DLI was closed. Blood samples for immunoglobulin G (IgG) analyses were collected from each patient before the colectomy, after the colectomy with TI (before construction of the pouch), during the period with pouches (prior to DLI closure), and at 1, 2, and 3 years and at mean 13.7 years (range: 10-20) after DLI closure. Immunoglobulin G was determined by immunonephelometric assay technique. The statistics were analyzed by analysis of variance and linear regression. Preoperatively, p-IgG was significantly lower in the patients who had emergency operations compared with the group that had elective operations, 9.9 ± 3.0 vs 11.5 ± 3.3 g/L ( P < .03). During the manipulative period with TI and/or DLI, the p-IgG levels were increased in both points, but the increase was not statistically significant ( P = .26 and P = .19). During functional IAP at 1, 2, and 3 years and at mean 13.7 years (range: 10-20), there was a statistical increase in p-IgG levels ( P < .002, P < .005, P < .005, and P < .0001) compared with preoperative levels. These changes did not correlate with episodes of pouchitis ( P = .51). In patients having elective operations, p-IgG did not change preoperatively. After 12 months with functional pouches, the p-IgG levels were similar in both groups to the elective patient group preoperatively. In conclusion, p-IgG was found to be significantly lower in the emergency surgery patients compared with the elective surgery group preoperatively. This difference was probably due to increased losses and impaired gut lymphoid tissue production of IgG in the acute fulminant phase of UC. After 12 months of DLI closure, significant differences were no longer found between the emergency and elective surgery groups. Restoration and increased p-IgG levels after RPC would be due to an exaggerated response to make up for lower precolectomy values and may be interpreted as a rehabilitation biomarker.

scholarly journals Subspecialisation and its Effect on the Management of Rectal Cancer

2006 ◽  
Vol 88 (2) ◽  
pp. 181-184 ◽  
Author(s):  
Vivien V Ng ◽  
Matthew G Tytherleigh ◽  
Lucy Fowler ◽  
Ridzuan Farouk
Keyword(s):  
Rectal Cancer ◽  
Cancer Surgery ◽  
Resection Margins ◽  
Rectal Cancer Surgery ◽  
Oncological Outcomes ◽  
Transfusion Requirements ◽  
Colorectal Surgeon ◽  
General Surgeons ◽  
Colorectal Surgeons ◽  
The Impact

INTRODUCTION To assess the impact of subspecialisation on surgical and oncological outcomes after rectal cancer surgery in a single surgical unit within a district general hospital. PATIENTS AND METHODS A total of 207 patients with rectal cancer treated surgically by two colorectal surgeons and four experienced general surgeons at the Royal Berkshire Hospital, Reading, England between January 1995 and December 1999 were studied. A retrospective case-note review of each patient's personal details, operative and histological findings, their subsequent clinical progress and oncological outcomes, including 5-year survival were recorded. RESULTS In the study group, 127 patients were treated by a colorectal surgeon and 80 by general surgeons. Pre-operative radiotherapy was more likely to be given to patients treated by a colorectal surgeon. Fewer permanent stomas were performed by colorectal surgeons. Postoperative morbidity, transfusion requirements, anastomotic leak rates and 30-day mortality were not significantly different. Tumour-involved circumferential resection margins, local recurrence rates and risk of distant metastases were similar between the two groups of surgeons. CONCLUSIONS Colorectal subspecialisation has resulted in an increased use of pre-operative radiotherapy and fewer permanent stomas. No significant improvement in surgical or oncological outcomes after rectal cancer surgery have been observed.

scholarly journals Oral mosapride can provide additional anti-emetic efficacy following total joint arthroplasty under general anesthesia: a randomized, double-blinded clinical trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jinwei Xie ◽  
Yingchun Cai ◽  
Jun Ma ◽  
Qiang Huang ◽  
Fuxing Pei
Keyword(s):  
Clinical Trial ◽  
Hospital Stay ◽  
Postoperative Nausea ◽  
Clinical Care ◽  
Length Of Hospital Stay ◽  
Bowel Function ◽  
Complete Response ◽  
Placebo Control ◽  
Anesthesia Induction ◽  
Patient Satisfaction Score

Abstract Background We sought to determine (1) whether the addition of prophylactic oral mosapride to a protocol including dexamethasone and ondansetron further reduces postoperative nausea and vomiting (PONV) compared with ondansetron alone or the combination of both; (2) whether preemptive application of oral mosapride provides additional clinical benefits for bowel function and appetite, thus improving functional recovery. Methods We randomized 240 patients undergoing total hip and knee arthroplasty to receive placebo (Control, n = 80), dexamethasone (10 mg) before anesthesia induction (Dexa, n = 82), or dexamethasone (10 mg) before anesthesia induction as well as oral mosapride (5 mg) before and after surgery (Mosa+Dexa, n = 78). Patients were assessed at 0–6, 6–12, 12–24, and 24–48 h postoperatively. Primary outcomes were incidence and severity of PONV as well as complete response. Secondary outcomes were appetite, time until first defecation and ambulation, patient satisfaction score, and length of hospital stay. Results Mosa+Dexa patients showed significantly lower incidence of nausea at 6–12 h (3.8%) and over the entire evaluation period (6.4%), as well as a higher rate of complete response (89.7%) than other patients. Mosa+Dexa patients required less time to achieve first defecation and ambulation, they were hospitalized for shorter time, and they were more satisfied with clinical care. Conclusion Addition of oral mosapride further reduced incidence of PONV, especially postoperative nausea, during 6–12 h postoperatively. Moreover, preemptive application of oral mosapride can further improve appetite, bowel function, ambulation and length of hospital stay. Trial registration The study protocol was registered at the Chinese Clinical Trial Registry (ChiCTR1800015896), prospectively registered on 27/04/2018.

scholarly journals Effectiveness of Acupuncture for Early Recovery of Bowel Function in Cancer: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-15 ◽  
Author(s):  
Yi-Hua Liu ◽  
Guang-Tong Dong ◽  
Yang Ye ◽  
Jia-Bin Zheng ◽  
Ying Zhang ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Bowel Function ◽  
Sham Acupuncture ◽  
Control Groups ◽  
Early Recovery ◽  
Randomized Controlled ◽  
Grade Approach

Objectives. The aim of this study was to evaluate the effects of acupuncture therapy to reduce the duration of postoperative ileus (POI) and to enhance bowel function in cancer patients. Methods. A systematic search of electronic databases for studies published from inception until January 2017 was carried out from six databases. Randomized controlled trials (RCTs) involving the use of acupuncture and acupressure for POI and bowel function in cancer patients were identified. Outcomes were extracted from each study and pooled to determine the risk ratio and standardized mean difference. Results. 10 RCTs involving 776 cancer patients were included. Compared with control groups (no acupuncture, sham acupuncture, and other active therapies), acupuncture was associated with shorter time to first flatus and time to first defecation. A subgroup analysis revealed that manual acupuncture was more effective on the time to first flatus and the time to first defecation; electroacupuncture was better in reducing the length of hospital stay. Compared with control groups (sham or no acupressure), acupressure was associated with shorter time to first flatus. However, GRADE approach indicated a low quality of evidence. Conclusions. Acupuncture and acupressure showed large effect size with significantly poor or inferior quality of included trials for enhancing bowel function in cancer patients after surgery. Further well-powered evidence is needed.

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