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Steen CJ, Wei MYK, Vadakkenchery Varghese E, Asghari-Jafarabadi M, Sansom W, Balakrishnan V, An V, Chandra R. Quality of life amongst patients with diverting umbilical stomas in rectal surgery: a single centre prospective randomized controlled pilot study. ANZ J Surg 2024; 94:187-192. [PMID: 37749845 DOI: 10.1111/ans.18709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/08/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The umbilical stoma (umbistoma) has been proposed as a viable alternative site for a temporary defunctioning stoma. Suggested advantages of the umbistoma include decreased number of surgical incisions required, improved cosmesis and ease of reversal surgery. This study aimed to assess the patient experience of umbilical loop ileostomies in rectal surgery, with the primary outcome being patient reported quality of life (QoL). METHODS A total of 20 patients undergoing laparoscopic rectal cancer surgery were randomly allocated to have a defunctioning ileostomy at a conventional site (right iliac fossa) or at the umbilicus. Patient-reported QoL was assessed at 6 weeks using the Stoma-QoL questionnaire. Secondary outcomes were number of stomas reversed, length of time awaiting stoma reversal surgery, duration of operative time for stoma reversal, length of hospital stay following stoma reversal and rate of parastomal or post reversal incisional hernias. RESULTS Patients who had an umbilical stoma scored significantly lower on the Stoma-QoL questionnaire compared to the conventional group, particularly on questions regarding feelings of tiredness, body insecurity and anxiety. No significant differences were observed between the two groups in relation to secondary outcomes. CONCLUSION There may be potential disadvantages to the umbilical stoma with negative impacts on body image and subsequent increased social anxiety. Patient selection and adequate counselling will be important when considering an umbilical stoma. Further larger scale prospective studies are required to further validate the feasibility and longer-term safety of umbilical stomas in both clinical outcomes as well as patient QoL.
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Affiliation(s)
- Christopher J Steen
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Cabrini Research, Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Matthew Y K Wei
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | | | - Mohammad Asghari-Jafarabadi
- Cabrini Research, Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Wendy Sansom
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Vikram Balakrishnan
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Vinna An
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Raaj Chandra
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Liu C, Zhang J, Li L, Zhang L, Shang L, Ma Y. Comparison of specimen extraction site and another site for protective loop ileostomy in laparoscopic low anterior rectal resection: a retrospective comparative study. Langenbecks Arch Surg 2023; 408:151. [PMID: 37055576 PMCID: PMC10102083 DOI: 10.1007/s00423-023-02886-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/04/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Protective loop ileostomy is commonly performed in laparoscopic low anterior rectal resection to prevent the serious complications of anastomotic fistula. It is usually created at the right lower quadrant of the abdomen and another wound is required for stoma. The study aimed to evaluate the outcomes of ileostomy at the specimen extraction site (SES) and another site (AS) beside the auxiliary incision. METHODS A retrospective analysis was conducted on 101 eligible patients with pathologically diagnosed adenocarcinoma of the rectum from January 2020 to December 2021 in the study center. According to whether the ileostomy was at the specimen extraction site, patients were divided into SES group (40 patients) and AS group (61 patients). Clinicopathological characteristics, the intraoperative details, and postoperative outcomes of the two groups were measured. RESULTS Univariate analysis showed that the operative time was significantly shorter and the blood loss was significantly less in the SES group than in the AS group during laparoscopic low anterior rectal resection, the time to first flatus was significantly shorter, and the pain was significantly less in the SES group than in the AS group during ileostomy closure. The postoperative complications were similar in both groups. Multivariable analysis showed that ileostomy at the specimen extraction site was a significant factor influencing the operative time and blood loss of rectal resection, and influencing the pain and the time to first flatus during ileostomy closure. CONCLUSION Compared to ileostomy at AS, protective loop ileostomy at SES was time-saving and less bleeding during laparoscopic low anterior rectal resection, and more quick to first flatus and less pain during stoma closure, and did not lead to more postoperative complications. The median incision of the lower abdomen and the left lower abdominal incision were both good sites for ileostomy.
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Affiliation(s)
- Chao Liu
- Department of Laser Cosmetic Clinic, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Jizhun Zhang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Leping Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Li Zhang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Liang Shang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Yan Ma
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
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Coletta D, De Padua C, Iannone I, Puzzovio A, Greco PA, Patriti A, La Torre F. Defunctioning Ileostomy to Prevent the Anastomotic Leakage in Colorectal Surgery. The State of the Art of the Different Available Types. Front Surg 2022; 9:866191. [PMID: 35495739 PMCID: PMC9043457 DOI: 10.3389/fsurg.2022.866191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/08/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Diego Coletta
- Department of Surgical Sciences, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
- *Correspondence: Diego Coletta ; orcid.org/0000-0002-9116-0733
| | - Cristina De Padua
- Department of General Surgery, Emergency Department, Emergency and Trauma Surgery Unit, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Immacolata Iannone
- Department of General Surgery, Emergency Department, Emergency and Trauma Surgery Unit, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonella Puzzovio
- Department of General Surgery, Emergency Department, Emergency and Trauma Surgery Unit, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Alberto Patriti
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Filippo La Torre
- Department of Surgical Sciences, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
- Department of General Surgery, Emergency Department, Emergency and Trauma Surgery Unit, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
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Vigna C, Arndt K, Dressler J, Loehner D, Messaris E. Single Center Experience with Umbilical Stomas Following Colorectal Surgery. J Laparoendosc Adv Surg Tech A 2022; 32:432-437. [PMID: 35119309 DOI: 10.1089/lap.2021.0809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The umbilicus is commonly used as an access site to perform minimally invasive colorectal surgery. Umbilical stomas are becoming an attractive option as an alternative site for temporary stomas since they reduce the need for additional abdominal incisions. Methods: We retrospectively evaluated patients who underwent umbilical stoma creation after colorectal resection for diagnosis of rectal cancer, diverticulitis, or ulcerative colitis between January 2020 and July 2021. Surgical technique, clinical and perioperative outcomes, complications, and cosmetic end results were described. Results: A total of 11 patients underwent umbilical stoma creation. There were no major surgical complications. Peristomal skin irritation was secondary to difficulties with the management of the pouching system. One patient presented with ostomy prolapse. Three patients experienced incisional hernia after stoma reversal. There were no wound infections. Conclusion: Umbilical stomas appear to be a safe alternative to conventional stomas and provide superior cosmetic outcomes.
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Affiliation(s)
- Carolina Vigna
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kevin Arndt
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jeremy Dressler
- Division of Colorectal Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Donna Loehner
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Ku DH, Kim HS, Shin JY. Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery. Ann Coloproctol 2020; 36:304-310. [PMID: 32054255 PMCID: PMC7714381 DOI: 10.3393/ac.2019.10.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose Limited data exist on the use of low midline and transverse incisions for specimen extraction or stoma sites in laparoscopic rectal cancer surgery (LRCS). We compared the short-term and medium-term outcomes of these incisions and assessed whether wound complications in specimen extraction sites (SES) are increased by specimen extraction through the stoma site (SESS) in LRCS. Methods From March 2010 to December 2017, 189 patients who underwent LRCS and specimen extraction through low abdominal incisions were divided into 2 groups: midline (n = 102) and transverse (n = 87), and perioperative outcomes were compared. Results The midline group showed a higher frequency of temporary stoma formation (P = 0.001) and splenic flexure mobilization (P < 0.001) than the transverse group. The overall incisional hernia and wound infection rates in the SES were 21.6% and 25.5%, respectively, in the midline group and 26.4% and 17.2%, respectively, in the transverse group (P = 0.494 and P = 0.232, respectively). In patients who underwent SESS, the incisional hernia and wound infection rates of SES after stoma closure were 39.1% and 43.5%, respectively, in the midline group, and 35.5% and 22.6%, respectively, in the transverse group (P = 0.840 and P = 0.035, respectively). Conclusion In terms of incisional hernia and wound infection at the SES, a low midline incision may be used as a low transverse incision in patients without temporary stoma in LRCS. However, considering the high wound complication rates after stoma closure in patients with SESS in this study, SESS should be performed with caution in LRCS.
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Affiliation(s)
- Do Hoe Ku
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyeon Seung Kim
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Yong Shin
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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