Complications of Diverting Ileostomy after Low Anterior Resection for Rectal Carcinoma

2016 ◽  
Vol 82 (10) ◽  
pp. 1033-1037 ◽  
Author(s):  
Sean Maroney ◽  
Carlos Chavez De Paz ◽  
Marjunphilip Duldulao ◽  
Tracey Kim ◽  
Mark E. Reeves ◽  
...  
Keyword(s):  
Rectal Carcinoma ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Medical Center ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Tumor Location ◽  
Diverting Ileostomy ◽  
Loma Linda University ◽  
The Difference

There have been few studies directly comparing the postoperative complications in patients with a diverting ileostomy to patients who were not diverted after low anterior resection (LAR) for rectal carcinoma. This study is a retrospective chart review of all rectal carcinoma patients (99) who underwent a LAR from January 2009 to December 2014 at Loma Linda University Medical Center and Veterans Affairs Loma Linda Healthcare System. A majority of patients were diverted (58% vs 42%). The diverted patients were more likely to have a low tumor location ( P < 0.01), preoperative chemoradiation ( P < 0.01), and more intraoperative blood loss ( P < 0.01). Our study shows a statistically significant higher overall complication rate among patients receiving a diverting ileostomy in the six months after LAR (61% vs 38%, P = 0.02). The difference is due to a higher rate of readmission (27% vs 14%) and acute kidney injury (14% vs 5%) in patients with a diverting ileostomy. It also shows that there is a higher rate of unplanned reoperation (11% vs 6%) due to anastomotic leak (17% vs 5%) in nondiverted patients. Further studies are needed to refine the specific indications to maximize the benefit of diverting ileostomy after LAR for rectal carcinoma.

scholarly journals Heterotopic Ossification in Rectal Carcinoma: Report of a Case and Review of the Literature

2016 ◽  
Vol 9 (3) ◽  
pp. 698-704 ◽  
Author(s):  
Jiro Shimazaki ◽  
Akira Takemura ◽  
Kiyotaka Nishida ◽  
Hideki Kajiyama ◽  
Mitsugi Shimoda ◽  
...  
Keyword(s):  
Heterotopic Ossification ◽  
Histological Examination ◽  
Rectal Carcinoma ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Virtual Colonoscopy ◽  
Rectal Wall ◽  
Medical Center ◽  
Uneventful Recovery ◽  
Spindle Cells

Heterotopic ossification in colorectal carcinoma is extremely rare. This report presents the case of a 57-year-old male who had undergone a low anterior resection following a diagnosis of rectal carcinoma. Histological examination showed heterotopic ossification in the tumor. The patient was referred to Ibaraki Medical Center, Tokyo Medical University, with a diagnosis of rectal carcinoma by a local physician. Abdominal computed tomography revealed thickening of the rectal wall with calcified deposits, and virtual colonoscopy showed stenosis with a mass in the rectum. The patient underwent a low anterior resection and diverting ileostomy in May 2014. Histological examination of the excised tumor showed moderately differentiated adenocarcinoma and an infiltration of spindle cells with numerous foci of osteoid and ossification, with osteoblastic rimming in the stroma. Immunohistochemical analysis of these spindle cells and osteoblasts revealed negative staining for AE1/AE3, suggesting a reactive change. There was metastasis in 1 of the 12 lymph nodes, and the tumor was diagnosed as stage IIIB (T4a, N1a, M0) rectal carcinoma. The patient had an uneventful recovery and was followed up at our outpatient clinic. In conclusion, the malignant potential of heterotopic ossification in rectal carcinoma has not been determined. However, heterotopic ossification is induced by tumor progression in a microenvironment, suggesting a high tumor malignity. The patient should be carefully monitored after surgery in terms of improved patient outcome.

scholarly journals 1310. Implementation of AUC:MIC Pharmacy to Dose in an Academic Medical Center: A Pilot Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S667-S668
Author(s):  
Ann-Marie Idusuyi ◽  
Maureen Campion ◽  
Kathleen Belusko
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Retrospective Chart Review ◽  
Total Daily Dose ◽  
Therapeutic Goals ◽  
Academic Medical ◽  
Progress Notes ◽  
Implementation Period

Abstract Background The new ASHP/IDSA consensus guidelines recommend area under the curve (AUC) monitoring to optimize vancomycin therapy. Little is known about the ability to implement this recommendation in a real-world setting. At UMass Memorial Medical Center (UMMMC), an AUC pharmacy to dose protocol was created to manage infectious diseases (ID) consult patients on vancomycin. The service was piloted by the pharmacy residents and 2 clinical pharmacists. The purpose of this study was to determine if a pharmacy to dose AUC protocol can safely and effectively be implemented. Methods A first-order kinetics calculator was built into the electronic medical record and live education was provided to pharmacists. Pharmacists ordered levels, wrote progress notes, and communicated to teams regarding dose adjustments. Patients were included based upon ID consult and need for vancomycin. After a 3-month implementation period, a retrospective chart review was completed. Patients in the pre-implementation group were admitted 3 months prior to AUC pharmacy to dose, had an ID consult and were monitored by trough (TR) levels. The AUC group was monitored with a steady state peak and trough level to calculate AUC. The primary outcome evaluated time to goal AUC vs. time to goal TR. Secondary outcomes included number of dose adjustments made, total daily dose of vancomycin, and incidence of nephrotoxicity. Results A total of 64 patients met inclusion criteria, with 37 patients monitored by TR and 27 patients monitored by AUC. Baseline characteristics were similar except for weight in kilograms (TR 80.0 ±25.4 vs AUC 92.0 ±26.7; p=0.049). The average time to goal AUC was 4.13 (±2.08) days, and the average time to goal TR was 4.19 (±2.30) days (p=0.982). More dose adjustments occurred in the TR group compared to the AUC (1 vs 2; p=0.037). There was no difference between the two groups in dosing (TR 15.8 mg/kg vs AUC 16.4 mg/kg; p=0.788). Acute kidney injury occurred in 5 patients in the AUC group and 11 patients in the TR group (p=0.765). Conclusion Fewer dose adjustments and less nephrotoxicity was seen utilizing an AUC based protocol. Our small pilot has shown that AUC pharmacy to dose can be safely implemented. Larger studies are needed to evaluate reduction in time to therapeutic goals. Disclosures All Authors: No reported disclosures

scholarly journals The association of age with decline in renal function after low anterior resection and loop ileostomy for rectal cancer: a retrospective cohort prognostic factor study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amal Rhemouga ◽  
Stefan Buettner ◽  
Wolf O. Bechstein ◽  
Guido Woeste ◽  
Teresa Schreckenbach
Keyword(s):  
Rectal Cancer ◽  
Rectal Carcinoma ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Older Patients ◽  
Retrospective Cohort ◽  
Loop Ileostomy ◽  
Linear Regression Analysis ◽  
Multivariate Linear Regression Analysis ◽  
Group B

Abstract Background Low anterior resection (LAR) is often performed with diverting loop ileostomy (DLI) for anastomotic protection in patients with rectal cancer. We aim to analyze, if older patients are more prone to a decline in kidney function following creation and closure of DLI after LAR for rectal carcinoma versus younger patients. Methods A retrospective cohort study from a database including 151 patients undergoing LAR for rectal carcinoma with DLI was used. Patients were divided in two age groups (Group A: <65 years, n = 79; Group B: ≥65 years, n = 72). For 123 patients undergoing DLI reversal prognostic factors for an impairment of serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) 3 months after DLI reversal was analyzed using a multivariate linear regression analysis. Results SCr before LAR(T0) was significant higher in Group B (P = 0.04). Accordingly, the eGFR at T0 in group B was significantly lower (P < 0.001). No patients need to undergo hemodialysis after LAR or DLI reversal. Age and SCr at T0were able to statistically significant predict an increase in SCr (P<0.001) and eGFR (P=0.001) three months after DLI reversal (The R² for the overall model was .82 (adjusted R² = .68). Conclusion DLI creation may result in a reduction of eGFR in older patients 3 months after DLI closure. Apart from this, patients do not have a higher morbidity after creation and closure of DLI resulting from LAR regardless of their age.

Modified Double-Stapling Technique in Low Anterior Resection for Lower Rectal Carcinoma

Surgery Today ◽  
2005 ◽  
Vol 36 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Harunobu Sato ◽  
Koutarou Maeda ◽  
Tsunekazu Hanai ◽  
Masahisa Matsumoto ◽  
Hiroyuki Aoyama ◽  
...  
Keyword(s):  
Rectal Carcinoma ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Double Stapling Technique ◽  
Stapling Technique ◽  
Double Stapling ◽  
Lower Rectal Carcinoma

scholarly journals Comparison of functional outcome of colonic J-pouch and latero-terminal anastomosis in low anterior resection for rectal cancer

2015 ◽  
Vol 143 (3-4) ◽  
pp. 158-161 ◽  
Author(s):  
Velimir Markovic ◽  
Ivan Dimitrijevic ◽  
Goran Barisic ◽  
Zoran Krivokapic
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Functional Results ◽  
Defecatory Function ◽  
Parallel Group ◽  
J Pouch ◽  
Colorectal Surgeons ◽  
The Difference ◽  
Continence Score

Introduction. Functional results after low anterior resection for rectal cancer are an issue of increasing attention among colorectal surgeons and others interested in this subject. The consensus on ideal reconstruction type has not been achieved to date, although the number of papers on this subject has been published in recent years. Objective. We conducted a prospective, parallel group study comparing latero-terminal with colonic J-pouch anastomosis in terms of defecatory function in patients undergoing stapled low colorectal/ coloanal anastomosis. Methods. A total of 80 patients were included in this study with either latero-terminal or colonic J-pouch anastomosis. Defecatory function was evaluated using the modified version of MSKCC questionnaire 6, 12 and 24 months after the operation. Fecal continence was evaluated using the Wexner continence score. Results. In both groups, trend towards improvement was registered in all measured variables in all three control intervals. This can apply to bowel frequency, urgency, night soiling, fragmentation and incomplete evacuation. However, the difference was not statistically significant, and when reviewing the trend of results we can note that in the J-pouch group steady state has not been reached even after 24 month control. Conclusion. This trial did not reveal any significant differences in defecatory function 6, 12 and 24 months after low anterior resection (LAR) between patients with a latero-terminal anastomosis and those with colonic J-pouch anastomosis. Our results did not confirm superiority of colonic J-pouch over the lateroterminal anastomosis.

scholarly journals Impact of Clinical Decision Support on Time to Order Resolution for Patients with Documented Allergies

Pharmacy ◽  
2018 ◽  
Vol 6 (3) ◽  
pp. 80 ◽  
Author(s):  
Tenielle Watkins ◽  
Sandra Aguero ◽  
Michael Jaecks
Keyword(s):  
Median Time ◽  
Medical Information ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Clinical Decision ◽  
Second Shift ◽  
The Difference ◽  
Verification Process ◽  
The Impact ◽  
Third Shift

Failure to appropriately document patient medical information, such as allergies, is an important cause of medication errors. Lack of allergy details in the electronic medical record (EMR) may prolong the pharmacist order verification process. A retrospective chart review was conducted in October 2017, to evaluate the impact of incomplete allergy details on time to antibiotic order resolution at the Einstein Medical Center Philadelphia. Details were present on 71% of orders. The difference in median time to order resolution, for orders with versus without details, was –21 min (95% CI (confidence interval), –39 to –2.9; p = 0.02). The difference in median time to order resolution for orders, based on pharmacist work shift was, –21 min for the first shift (95% CI, –41.2 to –0.8; p = 0.04), –50 min for the second shift (95% CI, –109.8 to 9.8; p = 0.10), and +3 min for the third shift (95% CI, –36.1 to 30.1; p = 0.85). Orders with an allergy intervention by a pharmacist were 2.75 times more likely (adjusted odds ratio = 2.75; 95% CI, 0.98 to 7.7; p = 0.06) to have a therapy change than orders without allergy interventions. Based on the results, when information about antibiotic allergies lacks details, it takes more time for pharmacists to resolve alerted orders.

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