Application of a Temporary Ileostomy via Median Specimen Extraction Site in Laparoscopic Low Anterior Resection

Objective: To evaluate the feasibility and safety of temporary ileostomy via median specimen extraction site in the lower abdomen. Methods: Twenty-two patients who underwent laparoscopic radical resection for rectal cancer and needed temporary ileostomy were prospectively enrolled. Temporary ileostomy was placed on the median specimen extraction site of the lower abdomen. Intraoperative and postoperative conditions, stoma-related complications and ileostomy reversal surgery were observed. d. Results: Among the 22 patients, there were 14 female patients and 8 male patients: the average age was 56 ±14 years; the average body mass index was 22.0 ±3.4 kg/m2; the average tumour size was 4.4 ±2.2 cm; the average distance between the tumour and the dentate line was 5.9 ±2.3 cm; the average time of laparoscopic low anterior resection was 221 ±56 minutes; the average blood loss was 168 ±91 ml; and the average postoperative hospital stay was 9.9 ±3.9 days. The average ileostomy reversal surgery time was 72 ±15 minutes, the average blood loss was 50 ±27 ml, and the average postoperative hospital stay was 5.9 ±1.0 days. Stoma-related complications occurred in 5 patients, of which one was treated by emergency surgery. Conclusion: In laparoscopic low anterior resection, patients with temporary ileostomy via the median specimen extraction site did not have serious complications that required surgical intervention during hospitalization, and there was no mortality during the perioperative period. It is safe and feasible to perform temporary ileostomies via the median specimen extraction site in the lower abdomen, but for permanent ileostomies, the median site in the lower abdomen should be carefully selected as the ileostomy site.

Clinical Outcomes of Ileostomy Closure before Adjuvant Chemotherapy after Rectal Cancer Surgery: An Observational Study from a Chinese Center

Background. The optimal timing of temporary ileostomy closure with respect to the time of adjuvant chemotherapy following sphincter-saving surgery for rectal cancer remains unclear. The aim of this study is to investigate the clinical and oncological outcomes of ileostomy closure before, during, and after adjuvant chemotherapy following curative rectal cancer resection. Methods. Patients diagnosed with rectal adenocarcinoma who underwent low anterior resection and temporary loop ileostomy during May 2015 and September 2019 were retrospectively evaluated. Patients undergoing ileostomy closure before adjuvant chemotherapy (Group I) were compared to patients undergoing closure during (Group II) and after (Group III) adjuvant chemotherapy. Results. A total of 225 patients were evaluated for eligibility, and 132 were finally selected and divided into 3 groups (24 in Group I, 53 in Group II, and 55 in Group III). No significant differences were observed in operative time, postoperative hospital stay, postoperative complications, total adjuvant chemotherapy cycles, and low anterior resection syndrome scores among the three groups. There was no significant difference in disease-free survival ( p = 0.834 ) and overall survival ( p = 0.462 ) between the three groups. Conclusion. Temporary ileostomy closure before adjuvant chemotherapy following curative rectal cancer resection can achieve a clinical and oncological safety level equal to stoma closure during or after chemotherapy in selected patients.

Surgical Outcomes of Temporary Ileostomy Patients attended at a Tertiary Care hospital in Dhaka City

Background: Management of temporary ileostomy cases is very important considering the outcomes. Objective: The purpose of the present study was to observe the surgical complications of temporary ileostomy patients. Methodology: This prospective cohort study was conducted in the Department of Surgery at Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh over a period of six months from July, 2011 to December, 2011. All patients who had undergone temporary ileostomy after admission were selected as the study population. Patients with temporary ileostomy at any age in both male and female were included in this study. The surgical complications like prolapse, retraction, stenosis, necrosis, skin excoriation, parastomal hernia, bleeding and wound infection were recorded. Result: A total number of 100 patients were selected for observation and management of complications of temporary ileostomy. Their ages ranging from 15 to 65 years with mean age 33.9±11.92 years. Complications were developed in majority cases of cases (52.0%). Several systemic complications were recorded like electrolytes imbalance (31%), hypoproteinaemia (14%), RTI (6%) and significant weight loss (4%). Skin excoriation was the more frequent local complication developed in 32 (32%) patients. However, 36 patients developed laparotomy wound related complication. Conclusion: In conclusion high frequency of complications are found among the temporary ileostomy patients. Journal of Current and Advance Medical Research, January 2021;8(1):65-69

Quality of Life and Bowel Function Following Early Closure of a Temporary Ileostomy in Patients with Rectal Cancer: A Report from a Single-Center Randomized Controlled Trial

The aim of this study was to assess quality of life and bowel function in patients undergoing early vs. standard ileostomy closure. We retrospectively assessed patients from our previous randomized controlled trial. Patients with a temporary ileostomy who underwent rectal cancer surgery and did not have anastomotic leakage or other. Early closure (EC; 30 days after creation) and standard closure (SC; 90 days after creation) of ileostomy were compared. Thirty-six months (17–97) after stoma closure, we contacted patients by phone and filled in two questionnaires—The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and low anterior resection syndrome (LARS) score. This index trial was not powered to assess the difference in bowel function between the two groups. All the patients in the SC group had anastomosis <6 cm from the anal verge compared to 42 of 43 (97.7%) in the EC group. There were no statistically significant differences between EC (26 patients) and SC (25 patients) groups in the EORTC QLQ-C30 and LARS questionnaires. Global quality of life was 37.2 (0–91.7; ±24.9) in the EC group vs. 34.3 (0–100; ±16.2) in the SC (p = 0.630). Low anterior resection syndrome was present in 46% of patients in the EC and 56% in the SC group (p = 0.858). Major LARS was found more often in younger patients. However, no statistical significance was found (p = 0.364). The same was found with quality of life (p = 0.219). Age, gender, ileostomy closure timing, neoadjuvant treatment, complications had no effect of worse bowel function or quality of life. There was no difference in quality of life or bowel function in the late postoperative period after the early vs. late closure of ileostomy based on two questionnaires and small sample size. None of our assessed risk factors had a negative effect on bowel function o quality of life.

Prospective, randomised, multicentre, open-label trial, designed to evaluate the best timing of closure of the temporary ileostomy (early versus late) in patients who underwent rectal cancer resection and with indication for adjuvant chemotherapy: the STOMAD (STOMa closure before or after ADjuvant therapy) randomised controlled trial

IntroductionTemporary ileostomy is a valuable aid in reducing the severity of complications related to rectal cancer surgery. However, it is still unclear what is the best timing of its closure in relation to the feasibility of an adjuvant treatment, especially considering patient-reported outcomes and health system costs. The aim of the study is to compare the results of an early versus late closure strategy in patients with indication to adjuvant chemotherapy after resection for rectal cancer.Methods and analysisThis is a prospective multicentre randomised trial, sponsored by Rete Oncologica Piemonte e Valle d’Aosta (Oncology Network of Piedmont and Aosta Valley-Italy). Patients undergone to rectal cancer surgery with temporary ileostomy, aged >18 years, without evidence of anastomotic leak and with indication to adjuvant chemotherapy will be enrolled in 28 Network centres. An early closure strategy (between 30 and 40 days from rectal surgery) will be compared with a late one (after the end of adjuvant therapy). Primary endpoint will be the compliance to adjuvant chemotherapy with and without ileostomy. Complications associated with stoma closure as well as quality of life, costs and oncological outcomes will be assessed as secondary endpoints.Ethics and disseminationThe trial will engage the Network professional teams in a common effort to improve the treatment of rectal cancer by ensuring the best results in relation to the most correct use of resources. It will take into consideration both the patients’ point of view (patient-reported outcome) and the health system perspective (costs analysis). The study has been approved by the Ethical Review Board of Città della Salute e della Scienza Hospital in Turin (Italy). The results of the study will be disseminated by the Network website, medical conferences and peer-reviewed scientific journals.Trial registration numberNCT04372992.