Reversal of Diverting Loop Ileostomy Using Hand-Sewn Side-to-Side versus End-to-End Anastomosis after Low Anterior Resection for Rectal Cancer: A Single Center Experience

2018 ◽  
Vol 84 (11) ◽  
pp. 1741-1744 ◽  
Author(s):  
Dimitrios Prassas ◽  
Argyro Ntolia ◽  
Jan-Dirk Spiekermann ◽  
Thomas-Marten Rolfs ◽  
Franz-Josef Schumacher
Keyword(s):  
Length Of Stay ◽  
Bowel Obstruction ◽  
Low Anterior Resection ◽  
Loop Ileostomy ◽  
Ileostomy Reversal ◽  
Significant Difference ◽  
Postoperative Length ◽  
Diverting Loop Ileostomy ◽  
Secondary Outcomes ◽  
End To End

Construction of diverting loop ileostomy has become a common adjunct to low anterior resection for rectal cancer because it substantially reduces the severity of postoperative morbidity. Various trials have compared hand-sewn with stapled anastomotic techniques, but the existing evidence regarding different configurations of hand-sewn anastomoses is scarce. The aim of this study is to compare the early postoperative outcomes of loop ileostomy reversal using the hand-sewn end-to-end or side-to-side configuration. A retrospective review was conducted on 62 consecutive patients undergoing ileostomy reversal between January 2012 and June 2017. The main outcome measure was postoperative bowel obstruction within 30 days after ileostomy reversal. Secondary outcomes included rate of anastomotic insufficiency, wound infection, reoperation, postoperative length of stay, and overall morbidity. The end-to-end (EE) anastomosis group consisted of 32 cases, whereas the side-to-side (SS) group consisted of 30 cases. Patient demographics, comorbidities, and BMI were similar between the two groups. No statistically significant difference was noted regarding postoperative bowel obstruction between the two groups [EE vs SS: 4/32 vs 0, P = 0.11]. Postoperative length of stay was longer for the EE group ( P = 0.03). Overall, 30-days morbidity was higher for the EE group (EE vs SS: 11/32 vs 3/30, P = 0.03). All other secondary outcomes did not differ between the two groups. No statistically significant difference was observed with regard to postoperative bowel obstruction. Overall, 30-days morbidity and postoperative length of stay were significantly higher for the EE group. Further randomized trials are required to verify our findings.

scholarly journals Self-administered succus entericus reinfusion before ileostomy closure improves short-term outcomes

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhen Liu ◽  
Liang Fang ◽  
Liang Lv ◽  
Zhaojian Niu ◽  
Litao Hou ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Ileostomy Closure ◽  
Control Group ◽  
Short Term ◽  
Function Recovery ◽  
Significant Difference ◽  
Postoperative Length

Abstract Objective The study aims to assess whether reinfusion of succus entericus prior to ileostomy closure can decrease postoperative length of stay and ameliorate low anterior resection score. Methods This study is a retrospective analysis based on prospectively collected data. Patients were screened from May 2016 to November 2019. A total of 30 patients who underwent reinfusion with succus entericus (SER) were enrolled in the SER group and 42 patients without SER were enrolled in the non-SER group. Results There was no significant difference in the incidence of postoperative ileus between succus entericus reinfusion (SER) group and the control group. Time to first passage of flatus or stool after surgery in the SER group (27.9 ± 6.02 h) is significantly shorter than the control group (32.3 ± 6.26, hours p = 0.004). Compared with the control group (5.52 (4.0–7.0) days), postoperative length of stay in the SER group was 4.90 (3.0–7.0)days (p = 0.009). As for low anterior resection score(LARS), the SER group had a lower score 1 week after discharge than the control group (p = 0.034). However, 1 month after discharge, the LARS in the two groups had no significant difference. Conclusions Self-administered succus entericus reinfusion is a feasible prehabilitation management for outpatients and can improve better outcomes. Compared with non-reinfusion group, succus enterius reinfusion group displays significantly shorter time for gastrointestinal function recovery and postoperative hospital stay without increasing complication, and it can bring better quality of life in a short term.

scholarly journals Self-administered Succus Entericus Reinfusion before Ileostomy Closure improves short-term outcomes

2021 ◽  
Author(s):  
Zhen Liu ◽  
Liang Fang ◽  
Liang Lv ◽  
Zhaojian Niu ◽  
Litao Hou ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Ileostomy Closure ◽  
Control Group ◽  
Short Term ◽  
Function Recovery ◽  
Significant Difference ◽  
Postoperative Length

Abstract Objective: The study aims to assess whether reinfusion of succus entericus prior to ileostomy closure can decrease postoperative length of stay and ameliorate low anterior resection score. Methods: This study is a retrospective analysis based on prospectively collected data. Patients were screened from May 2016 to November 2019. A total of 30 patients who underwent Reinfusion with Succus Entericus (SER) were enrolled in the SER group and 42 patients without SER were enrolled in the non-SER group. Results: There was no significant difference in the incidence of postoperative ileus between Succus Entericus Reinfusion (SER) group and the control group. Time to first passage of flatus or stool after surgery in the SER group (27.9 ± 1.10 hours) is significantly shorter than the control group (32.3 ± 0.97, hours p= 0.004). Compared with the control group (5.52 (4.0-7.0)days), postoperative length of stay in the SER group was 4.90 (3.0-7.0)days (p= 0.009). As for low anterior resection score(LARS), the SER group had a lower score 1 week after discharge than the control group (p=0.034). However, 1 month after discharge, the LARS in the two groups had no significant difference. Conclusions: Self-administered succus entericus reinfusion is a feasible prehabilitation management for outpatients and can improve better outcomes. Compared with non-reinfusion group, succus enterius reinfusion group displays significantly shorter time for gastrointestinal function recovery and postoperative hospital stay without increasing complication, and it can bring better quality of life in a short term.

Diverting Loop Ileostomy for Clostridium Difficile Colitis: A Systematic Review and Meta-analysis

2020 ◽  
Vol 86 (10) ◽  
pp. 1269-1276
Author(s):  
Adam D. Shellito ◽  
Marcia M. Russell
Keyword(s):  
Clostridium Difficile ◽  
Meta Analysis ◽  
Loop Ileostomy ◽  
Patient Characteristics ◽  
Specific Patient ◽  
Entire Cohort ◽  
Significant Difference ◽  
Threatening Condition ◽  
Life Threatening ◽  
Diverting Loop Ileostomy

Diverting loop ileostomy (DLI) with colonic lavage has been proposed as an alternative to total abdominal colectomy (TAC) for fulminant Clostridium difficile infection (CDI). Controversy exists regarding the mortality benefit and outcomes of this surgical approach. We conducted a MEDLINE database search for articles between 1999 and 2019 pertaining to DLI for the surgical treatment of CDI. Five articles met the inclusion criteria. Four studies were retrospective and one was a prospective matched cohort study. 3683 patients were included in the 5 studies; 733 patients (20%) underwent DLI, while 2950 patients (80%) underwent TAC. The only shared outcome measure across all 5 studies was mortality. The overall mortality rate for the entire cohort undergoing both procedures was 30.3%. There was no statistically significant difference in pooled mortality between DLI and TAC (OR: .73; 95% CI, .45-1.2; P = .22). Reporting of other postoperative outcomes was variable. Fulminant CDI remains a life-threatening condition with high mortality. Loop ileostomy may be a viable surgical alternative to total colectomy with similar mortality; however, further work is needed to determine specific patient characteristics that warrant routine use of DLI.

scholarly journals P.099 Specialty centres for MVD surgery

2018 ◽  
Vol 45 (s2) ◽  
pp. S42-S42
Author(s):  
A Montazeripouragha ◽  
AM Kaufmann
Keyword(s):  
Length Of Stay ◽  
Trigeminal Neuralgia ◽  
Disease Onset ◽  
High Volume ◽  
Referral Process ◽  
Time Intervals ◽  
Patient’S Satisfaction ◽  
Significant Difference ◽  
Postoperative Length ◽  
Delays In Diagnosis

Background: The aim of this study is comparing the waiting time and patient’s satisfaction of microvascular decompression (MVD) surgery between local Manitoba (MB) and out of province (OOP) patients, treated at our Centre for Cranial Nerve Disorder (CCND). Methods: Data from 100 consecutive patients (average age: 56.8±10.6 years), undergoing MVD surgery for Trigeminal Neuralgia (TN) and Hemifacial Spasm (HFS) were reviewed. The outcome measures included the time intervals between disease onset, diagnosis and referral to CCND, postoperative discharge, satisfaction with surgical outcome and referral process. Results: The preoperative time leading to CCND referral were longer for OOP patients, (onset to diagnosis/diagnosis to referral: 2.6±3.8/4.2±4.7 (OOP) versus 1.2±2.1/2.5±4.1 (MB) years; p=0.04/0.04), and referrals were more likely self-directed in OOP patients (62% (OOP), 21% (MB); p=0.007). Postoperative satisfaction with MVD outcome were 8.6/10 for OOP and 8.3/10 for MB patients. There was no significant difference in postoperative length of stay (38±50 (OOP)/43±42 (MB) hours); however, OOP patients were more likely discharged on the first postoperative day (58% (OOP), 31% (MB); p=0.17). Conclusions: Delays in diagnosis and surgical referral of TN/HFS are common, and many patients seek specialist’s opinion in high volume surgical centers. For those OOP patients, travelling for treatment, MVD outcome were at least as good as for local patients.

Negative-Pressure Therapy to Reduce the Risk of Wound Infection Following Diverting Loop Ileostomy Reversal

2016 ◽  
Vol 29 (3) ◽  
pp. 114-118 ◽  
Author(s):  
Ramon Cantero ◽  
Ines Rubio-Perez ◽  
Miguel Leon ◽  
Mario Alvarez ◽  
Beatriz Diaz ◽  
...  
Keyword(s):  
Wound Infection ◽  
Negative Pressure ◽  
Loop Ileostomy ◽  
Negative Pressure Therapy ◽  
Pressure Therapy ◽  
Ileostomy Reversal ◽  
Diverting Loop Ileostomy

scholarly journals Hand-Sewn versus Stapled Closure of Loop Ileostomy: A Meta-Analysis

2018 ◽  
Vol 36 (3) ◽  
pp. 183-194 ◽  
Author(s):  
Rana Madani ◽  
Nigel Day ◽  
Lalit Kumar ◽  
Henry S. Tilney ◽  
Andrew Mark Gudgeon
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Anastomotic Leak ◽  
Bowel Obstruction ◽  
Group Performance ◽  
Bowel Resection ◽  
Loop Ileostomy ◽  
Complication Rates ◽  
Definitive Answer ◽  
Significant Difference

Background: Individual trials comparing hand-sewn with stapled closure of loop ileostomy show different outcomes due to lack of statistical power. A systematic review, with a pooled analysis of results, might provide a more definitive answer. This review aimed to compare hand-sewn with stapled anastomotic technique for closure of a loop ileostomy and looked at the effect of bowel resection on the complication rates. Methodology: Relevant studies were identified from MEDLINE, EMBASE and the Cochrane database. All randomised clinical trials, prospective and retrospective studies comparing hand-sewn with stapled closure of loop ileostomy were included. Results: Of the 4,917 patients in 15 identified studies, 3,406 had hand-sewn and 1,511 stapled anastomosis. There was no difference in the rate of anastomotic leak between the hand-sewn (2.93%, 55/1,877) and the stapled group (2.08%, 25/1,202) (OR 0.81, 95% CI 0.43–1.54, p = 0.52, I2 = 33%). The rate of small-bowel obstruction was higher in the hand-sewn group (7.03%, 231/3,284) compared to the stapled group (5.58%, 73/1,308; OR 0.69, 95% CI 0.51–0.92, p = 0.01, I2 = 0%). There was no difference in the incidence of anastomotic leak and small-bowel obstruction in the hand-sewn anastomosis between patients with or without bowel resection. Conclusions: There was no significant difference in the rate of anastomotic leakage between the hand-sewn and stapled techniques. The rate of small-bowel obstruction was higher in the hand-sewn group. Performance of bowel resection does not significantly increase the incidence of anastomotic leak or small-bowel obstruction.

scholarly journals Evaluation of an Initial Specimen Diversion Device (ISDD) on Rates of Blood Culture Contamination in the Emergency Department

2021 ◽  
Vol 14 ◽  
pp. 73-76
Author(s):  
Blake Buzard ◽  
Patrick Evans ◽  
Todd Schroeder
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Blood Culture ◽  
Blood Cultures ◽  
Contamination Rate ◽  
Total Hospital Cost ◽  
Initial Specimen ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact

Introduction: Blood cultures are the gold standard for identifying bloodstream infections. The Clinical and Laboratory Standards Institute recommends a blood culture contamination rate of <3%. Contamination can lead to misdiagnosis, increased length of stay and hospital costs, unnecessary testing and antibiotic use. These reasons led to the development of initial specimen diversion devices (ISDD). The purpose of this study is to evaluate the impact of an initial specimen diversion device on rates of blood culture contamination in the emergency department.  Methods: This was a retrospective, multi-site study including patients who had blood cultures drawn in an emergency department. February 2018 to April 2018, when an ISDD was not utilized, was compared with June 2019 to August 2019, a period where an ISDD was being used. The primary outcome was total blood culture contamination. Secondary outcomes were total hospital cost, hospital and intensive care unit length of stay, vancomycin days of use, vancomycin serum concentrations obtained, and repeat blood cultures obtained.  Results: A statistically significant difference was found in blood culture contamination rates in the Pre-ISDD group vs the ISDD group (7.47% vs 2.59%, p<0.001). None of the secondary endpoints showed a statistically significant difference. Conclusions: Implementation of an ISDD reduces blood culture contamination in a statistically significant manner. However, we were unable to capture any statistically significant differences in the secondary outcomes.

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