O23 SURGICAL REPAIR OF PARASTOMAL BULGING - A REGISTER-BASED STUDY

Aim To examine the incidence of primary and recurrent repair and types of repair performed in patients with parastomal bulging. Material and Methods We linked prospectively collected data on parastomal bulging from the Danish Stoma Database to surgical data on repair of parastomal bulging from the Danish National Patient Register. Survival statistics provided cumulative incidences and time until primary and recurrent repair Results Of 1016 patients, registered from 2010-2017 with a permanent stoma and a parastomal bulge, 180 (18%) underwent surgical repair. The cumulative incidence of a primary repair was 9% (95% CI [8%; 11%]) within 1 year and 19% (95% CI [17%; 22%]) within 5 years after the occurrence of a parastomal bulge. For colostomies and ileostomies, we found similar probability of undergoing primary repair. For recurrent repair, the 5-year cumulative incidence was 5% (95% CI [3%; 7%]). The probability of undergoing further recurrent repair was 33% (95% CI [21%; 46%]) within 5 years. For primary repair, open or laparoscopic repair with mesh (43%) and stoma revision (39%) were performed almost equally frequent. Stoma revision and repair with mesh could precede and follow one another as primary and recurrent repair. Stoma reversal was performed in 17% of patients. Conclusions Our data offered a new and comprehensive view of the course of surgical treatment of parastomal bulging. Five years after the occurrence of a parastomal bulge the estimated probability of undergoing a repair was 19%. The probability of undergoing recurrent repair was high and stoma reversal more common than expected.

O30 THE INCIDENCE OF INCISIONAL HERNIA AT OSTOMY-REVERSAL SITE

Aim The purpose of this study was to evaluate the rate of incisional hernias at the ostomy site after reversal of the ostomy. Material and Methods We used retrospectively compiled database of patients who had undergone ostomy formation and ist reversal. All patients had their surgery performed between Jan. 2011 and December 2019. Patients history, added by clinical examination and CT-scan were performed in order to identify the incidence of incisional hernias. Different variables, like gender, surgical site infection (SSI) and BMI were evaluated as possible risk factors for hernia occurrence. Results Among totally included 224 patients in the study, 190 of all patients had reversal after loop-ileostomy (85%) and 34 patients had reversal after loop-colostomy (15%). Among all stoma reversal patients, 12,8 % developed incisional hernia at the stoma reversal site (n = 28). The incisional hernia occurrence at the ostomy reversal site was present in 20,0% in patients with clinically relevant SSI and only in 9,4% in patients where SSI was absent (p = 0,03). There was no statistical significance in hernia occurrence between both genders and among patients with low, normal and high BMI in our cohort of patients. Conclusions Incisional hernia after ostomy reversal is a common late surgical complication. All measurements that reduce SSI at the reversal site are important for lower hernia incidence. Prophylactic mesh implantation at stoma reversal sites may be considered in these patients.

P104 POSTOPERATIVE OUTCOME AND COMPLICATIONS AFTER STOMA REVERSAL SURGERY WITH CICATRIAL HERNIA HERNIA PROPHYLAXIS BY MESH AUGMENTATION IN SUBLAY TECHNIQUE USING GORE® BIO A® MESH

Aim At the surgery hospital of Klinikum Mittelbaden in Baden-Baden (Prof. Dr. Dieter Berger) stoma reversal surgery was performed on 127 patients in the time from Nov. 15, 2010 to Mar. 11, 2015. All 127 patients were treated with a resorbable synthetic mesh (GORE® BIO-A® mesh) in sublay technique to close abdominal wall incisions. Primary wound closure was carried out in all cases. In order to evaluate the rate of postoperative hernias, which literature reports to be over 30 percent and a common complication, all 127 patients were included in a prospective study. Material and Methods In total, 104 of the included patients (n = 127) took part in the follow-up examinations. 72 patients underwent clinical examinations and imaging diagnostics, 21 were surveyed on the telephone whenever their presentation at a follow-up exam was impossible, whereas 11 patients deceased during the follow-up period. These cases were analyzed on the basis of the previous examinations which had been part of the respective health records. The follow-up examination took place after a median time span of 87 weeks (8 -218 weeks). Results The total herniation rate of 7.7 percent (n = 8/104) in the examined patient population was thus much lower than described in the literature. Conclusions According to our own prospective analysis, we were able to register a very low herniation rate compared to the literature when the resorbable synthetic mesh (GORE® BIO-A®) was applied in sublay technique for stoma reversal. One disadvantage could lie in the increased perioperative wound infection rate. 5/8 hernias were observed after the occurrence of perioperative wound infections.

TP9.2.8Conservative versus surgical management of complicated diverticulitis - a retrospective study of long-term outcomes

Introduction The management of complicated diverticulitis has evolved over the years, with a shift towards a conservative approach. The aim of this study was to evaluate the feasibility and long-term outcomes of conservative management of an episode of complicated diverticulitis. Method We retrospectively evaluated patients presenting with perforated colonic diverticulitis between 2013 and 2017. Demographic, presentation and management data was recorded. CT grading system and Clavien-Dindo classification of complications was used. Results Ninety-two patients were included, with a male-to-female ratio of 1:2. Forty patients had a Hartmann’s procedure on the first admission (Group A), the remaining 52 patients were managed conservatively with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years). CT Grade 3 and 4 disease was observed in 65% of Group A and in 40.4% of Group B patients. 14 (26.9%) patients re-presented with recurrent diverticulitis in Group B, 12 (23.1%) of whom required surgical resection in the course of follow-up. Group A had significantly increased morbidity and poorer outcomes compared to Group B with a longer median length of stay (23.5 vs 10.2 days). Post-operative complications affected 72.5% (29 patients), with 40% being grade III or higher. Stoma reversal was performed in 10 (25.8%). Conclusion In carefully selected cases, complicated diverticulitis including CT grade 3 and 4, can be managed conservatively with acceptable rates of recurrence. Better overall outcomes were observed compared to surgical intervention, which is associated with high rates of post-operative complications (72.5%) and low stoma reversal rates 25.8%.

Early same admission closure of temporary bowel stomas: pros and cones

Background: Early closure of a temporary stoma is usually associated with low morbidity and mortality. However, some cases of stoma reversal may develop complications which may need surgical correction with subsequent major complications. We aim to evaluate early bowel stoma closure; de-functioning diversion stoma closure within the same admission (8-15 days) and study morbidity, health related quality of life (QOL) and length of stay at hospital (LOH). Methods: This study was done at general surgery department, Sohag faculty of medicine; in the period between March 2020 and March2021, 28 patients were closed early (at the same admission). Which are chosen randomly. The 28 patients who underwent early temporary stoma reversal following bowel surgery and abdominal exploration between March 2020 and March 2021 were included. The rate of complications (medical and surgical) following early stoma closure were assessed. Health-related QoL and LoH were assessed.Results: Total 28 patients were taken up for early stoma closure, reversal of stoma occurred between 8-15 days following its creation. Postoperative complications occurred in 53% of our patients, skin excoriation the commonest (28%). No difficulty was encountered during stoma closure surgery. Post-operative complications occurred in 53% of patients. 5 patients develop Ileus which were managed conservatively and one patient (3.5%) develop intra-abdominal abscess and treated with aspiration under sonographic guided. In our study no mortality occurred.Conclusions: Early stoma closure is feasible in selected patients, with reduced hospital stay, adhesions, bowel obstruction and medical complications and leads to better QOL, but a higher wound complication rate.