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Bulut A, Attaallah W. Completely Diverted Tube Ileostomy Versus Conventional Loop Ileostomy. Cureus 2022; 14:e30997. [DOI: 10.7759/cureus.30997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
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Climent M, Biondo S. Ileostomy closure: is timing of the essence? Tech Coloproctol 2022; 26:847-849. [PMID: 35941259 DOI: 10.1007/s10151-022-02673-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- M Climent
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, and IDIBELL (Bellvitge Biomedical Investigation Institute), C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - S Biondo
- Colorectal Unit, Department of General and Digestive Surgery, Bellvitge University Hospital, University of Barcelona, and IDIBELL (Bellvitge Biomedical Investigation Institute), C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
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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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Chen W, Zhang Y, Qin H, Fan Z, Hu H, Chen M, Jiang C, Qian Q, Ding Z. A pilot study on prophylactic tube enterostomy for the prevention of anastomotic leakage in patients with high-risk intestinal anastomosis. Langenbecks Arch Surg 2021; 407:267-275. [PMID: 34549336 DOI: 10.1007/s00423-021-02326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Anastomotic leakages (ALs) are one of the most serious complications following gastrointestinal anastomosis. Currently, very few operative measures are available for the prevention of ALs. This pilot study aimed to evaluate the safety and efficacy of tube enterostomy (T-E) for the prevention of ALs in patients with high-risk intestinal anastomosis. METHODS In this retrospective study, demographic data and postoperative outcomes were compared among patients who received T-E and two historical cohorts: one group that underwent primary anastomosis without T-E (non-T-E group) and another that underwent conventional stoma construction without anastomosis (stoma group). The operative procedures were selected according to a scoring system that quantitatively evaluated risk of Als (Zhongnan score). RESULTS From March 2017 to March 2020, a total of 45 consecutive patients were enrolled in the T-E group. Among these patients, 53.3% (24/45) were diagnosed with Crohn's disease (CD), and 66.7% (30/45) of them underwent emergency surgery. After propensity score matching, the demographic data were comparable among the three groups. One case of AL (2.2%) occurred in the T-E group, while four cases of ALs (8.9%, 4/45) were found in the non-T-E group (p = 0.13). Tube feeding was provided to 33.3% (15/45) of the T-E patients. Major tube-related complications included one tube dislocation (2.2%) and 3 (6.7%) minor leakages after tube withdrawal (treated conservatively). One death occurred in the stoma group. In the subgroup analysis of CD patients, lower rates of ALs and abdominal abscesses were observed in the T-E group than in the non-T-E and stoma subgroups, but the differences were not significant. CONCLUSIONS T-E seems to be a safe and feasible operative method for the protection of high-risk intestinal anastomosis, can be reversed and can provide enteral feeding with acceptable tube-related complications. Further studies are needed to validate the role of T-E.
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Affiliation(s)
- Wenhao Chen
- Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.,Inflammatory Bowel Diseases Center of Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Yichao Zhang
- Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Haibo Qin
- Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Zhou Fan
- Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China
| | - Hang Hu
- Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.,Inflammatory Bowel Diseases Center of Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Min Chen
- Gastroenterology Department, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Congqing Jiang
- Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.,Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Qun Qian
- Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China.,Inflammatory Bowel Diseases Center of Zhongnan Hospital, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Zhao Ding
- Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, People's Republic of China. .,Inflammatory Bowel Diseases Center of Zhongnan Hospital, Wuhan University, Wuhan, China. .,Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China. .,Division of Colon and Rectal Surgery, Colorectal Surgery Department, Zhongnan Hospital of Wuhan University, Wuhan, China.
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5
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Is routine splenic flexure mobilization always necessary in laparotomic or laparoscopic anterior rectal resection? A systematic review and comprehensive meta-analysis. Updates Surg 2021; 73:1643-1661. [PMID: 34302604 DOI: 10.1007/s13304-021-01135-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
Splenic flexure mobilization (SFM) is one of the most difficult steps in laparoscopic colorectal surgery and its role is harshly debated. Some surgeons considered it routinely necessary to obtain a safe anastomosis and to respect oncologic criteria; for others SFM is frequently unnecessary, not ensuring the aspects mentioned above and increasing the risk of morbidity (splenic, bowel and vessels injury, lengthened procedure). We performed a systematic review and a comprehensive meta-analysis, without any language restriction, about the peri-operative and post-operative outcomes (anastomotic leakage, intra-operative complication, conversion rate, operative time, post-operative bleeding, intra-abdominal collection, prolonged ileus, wound infection, anastomotic stricture, overall complications, hospital stay, re-operation, post-operative mortality, R0 margin resection, local recurrence) in patients undergoing elective anterior rectal resection (ARR) with or without SFM, both in laparotomic (LT) and laparoscopic (LS) approach. Fourteen studies were meta-analyzed with a total amount of 42,221 patients. The comprehensive meta-analysis shows that the mobilization or the preservation (SFP) of the splenic flexure does not statistically influence the incidence of colorectal anastomotic leakage, conversion rate, post-operative bleeding, intra-abdominal collection, prolonged ileus, wound infection, anastomotic stricture, overall complications, hospital stay, re-operation, R0 margin resection, and local recurrence results. The operative time is significantly longer in every group of patients undergoing SFM. The incidence of intra-operative complication is statistically increased in overall patients and also in the LS subgroup of patients undergoing SFM, in which also higher incidence of wound infection and re-operation is shown. The meta-analysis shows that SFM may be considered not necessary to ensure better peri-operative and post-operative outcomes in both LT and LS ARR.
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Attaallah W, Bulut A, Uprak TK, Yegen C. A new technique of completely diverted tube ileostomy for the protection of colorectal anastomosis: a pilot study. Colorectal Dis 2020; 22:452-458. [PMID: 31652398 DOI: 10.1111/codi.14890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022]
Abstract
AIM This study was designed to evaluate a new technique for a completely diverting tube ileostomy achieved through temporary occlusion of the distal ileum using a flexible rubber strip. METHODS This prospective interventional study was conducted in one centre. Patients who underwent colorectal resections with a primary anastomosis and who were deemed as requiring a defunctioning stoma were included in the study. After completion of resection and anastomosis, the tube ileostomy was fashioned by inserting a reinforced (spiral) endotracheal tube with an inner diameter of 7.5 mm into the ileum. To provide complete faecal diversion, temporary occlusion of the distal ileum was performed using a flexible rubber strip. The primary outcome of this study was the incidence of complete diversion achieved using this method. RESULTS Fifty consecutive patients underwent a diverted tube ileostomy using the technique described above. Defaecation before removal of the strip did not occur in any of the patients inferring that complete diversion was observed in all patients (100%). The tube was removed at postoperative week 3. After tube removal, the resulting enterocutaneous fistulas closed spontaneously in a median of 6 (2-30) days. CONCLUSION The diverting tube ileostomy technique using an easily removable rubber strip to defunction the colorectal anastomosis is a safe and effective method that precludes the need to fashion a stoma.
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Affiliation(s)
- W Attaallah
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - A Bulut
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - T K Uprak
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - C Yegen
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
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Rondelli F, Franco L, Balzarotti Canger RC, Ceccarelli G, Becattini C, Bugiantella W. Purse-string closure versus conventional primary closure of wound following stoma reversal: Meta-analysis of randomized controlled trials. Int J Surg 2018; 52:208-213. [PMID: 29474885 DOI: 10.1016/j.ijsu.2018.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 02/03/2018] [Accepted: 02/06/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE Surgical site infection (SSI) is one of the most frequent complications after stoma closure and the optimal skin closure technique is still not clear. The goal of this review was to compare outcomes with purse-string closure technique (PSC) versus conventional closure technique (CCT) for skin closure after stoma reversal. METHODS We performed a systematic review and meta-analysis of available randomized controlled trials (RCTs) to compare SSI rate within 30 days, operative time, hospital stay, incisional hernia and intestinal obstruction rates between PSC and CCT. RESULTS The pooled analysis of 5 studies showed a statically significant lower rate of SSI in favor of PSC compared to CCT (OR -0.24; 95% CI -0.32, - 0.15; p < 0.00001). No statistically significant differences were observed in the operative time (OR -0.05; 95% CI -3.95, 3.84; p = 0.98) and in the length of hospital stay (OR -0.20; 95% CI -0.76, 0.36; p = 0.48), between the two techniques. Additionally, two out of the five studies provided data on incisional hernia and intestinal obstruction and the pooled analysis revealed no statistically significant differences between PSC and CCT techniques: incisional hernia (OR 0.81, 95% CI 0.27-2.47; p = 0.71) and intestinal obstruction (OR 1.07, 95% CI 0.41-2.84; p = 0.88). CONCLUSIONS The analysis of 5 RCTs showed that SSI rate is statistically significant lower when PSC is performed, compared to CCT. Whereas, no significant differences were found between the two techniques with regards to operative time, length of hospital stay, incisional hernia and intestinal obstruction rates.
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Affiliation(s)
- Fabio Rondelli
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria2, Foligno, Italy; Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy.
| | - Laura Franco
- Internal Vascular and Emergency Medicine, University of Perugia, Perugia, Italy.
| | | | - Graziano Ceccarelli
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria2, Foligno, Italy.
| | - Cecilia Becattini
- Internal Vascular and Emergency Medicine, University of Perugia, Perugia, Italy.
| | - Walter Bugiantella
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria2, Foligno, Italy.
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Bugiantella W, Rondelli F, Mariani L, Polistena A, Sanguinetti A, Avenia N, Mariani E. Cost-effectiveness analysis of the temporary percutaneous ileostomy for faecal diversion after colorectal resection in elderly. Aging Clin Exp Res 2017; 29:47-53. [PMID: 27832466 DOI: 10.1007/s40520-016-0658-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/12/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Conventional loop ileostomy (CLI) is a suitable procedure for transitory faecal diversion after colorectal anastomosis, but it causes relevant morbidities (dehydration, discomfort, peristomal infections) and requires a second operation to be closed. We already described an alternative technique of temporary percutaneous ileostomy (TPI), which can be removed without surgery. AIMS We analyse the outcomes and the costs of the TPI in protecting low colorectal anastomosis in elderly, compared to the CLI. METHODS Data of patients underwent elective anterior rectal resection for rectal cancer with extra-peritoneal colorectal anastomosis protected by ileostomy from January 2011 to December 2015 were reviewed. Sixty-one out of 132 patients were older than 70; 35 underwent faecal diversion by TPI and 26 by CLI. RESULTS The two groups resulted homogenous about age, sex, operative time, short-term post-operative complications. None of the patients reported anastomotic leakage. The hospital stay and the cost for the first surgical procedure did not show statistically significant differences between TPI and CLI. When comparing the overall hospital stay and costs the differences are statistically significant: the TPI showed a shorter hospital stay (12.4 vs 19.3 days, -35.7%) and a lower cost of hospitalization (7954.0 vs 14,372.1€, -44.7%), compared to CLI. DISCUSSION The limited duration of the faecal diversion and the uselessness of a second surgical procedure to remove the TPI are the most important advantages of TPI, especially in elderly. CONCLUSION The TPI not only improved the post-operative outcome of the patients, but also allowed a remarkable saving for the National Health System.
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9
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Zong Z, Zhou T, Jiang Z, Li Y, Yang B, Hou Z, Han F, Chen S. Temporary Tube Stoma versus Conventional Loop Stoma for the Protection of a Low Anastomosis in Colorectal Surgery: A Systematic Review and Meta-analysis. Am Surg 2016. [DOI: 10.1177/000313481608200319] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The aim of this systematic review is to evaluate and compare the efficacy and safety of temporary tube stoma and conventional loop stoma for the protection of a low anastomosis in colorectal cancer. A systematic literature search was performed using PubMed, EMBASE, Science Citation Index, and Cochrane Central Register of Controlled Trails. Primary outcome measures were anastomotic leakage rate, the reoperation rate for anastomotic leakage, and stoma-related complications. Secondary outcome measures were operation time, length of hospital stay, time to stoma closure, and permanent stoma rate. Four studies were carried out and 642 patients (332 with temporary tube stoma and 310 with conventional loop stoma) met the inclusion criteria. The incidences of anastomotic leakage and reoperation rate were statistically similar in tube stoma and loop stoma groups. In comparison with conventional loop stoma, temporary tube stoma was associated with a significantly less stoma-related complications (odds ratio = 0.20; 95% confidence interval [CI]: 0.08–0.50), and shorter operation and hospital stay time (weighted mean difference = -47.28 minutes, 95% CI: -74.68 to -19.88; and weighted mean difference = -5.22 days, 95% CI: -10.32 to -0.13, respectively). Time to stoma closure was significantly shorter in the temporary tube stoma groups (weighted mean difference = -114.58 days, 95% CI: -148.38 to -80.77). Patients receiving temporary tube stoma had lower rates of stoma-related complications, shorter operation and hospital stay time, and stoma closure time. Tube can be easily removed without second surgery in most cases. Therefore, temporary tube stoma is a feasible and effective alternative to conventional loop stoma for the protection of a low colorectal anastomosis.
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Affiliation(s)
- Zhen Zong
- Department of Gastroenterological Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Taicheng Zhou
- Department of Gastroenterological Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
- Department of General Surgery, Affiliated Guangzhou First People's Hospital, Guangzhou Medical University, Guangdong, China
| | - Zhipeng Jiang
- Department of Gastroenterological Surgery and Hernia Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong, China; and
| | - Yingru Li
- Department of Gastroenterological Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
- Department of Gastroenterological Surgery and Hernia Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong, China; and
| | - Bin Yang
- Department of Gastroenterological Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Zehui Hou
- Department of Gastroenterological Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Fanghai Han
- Department of Gastroenterological Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangdong, China
| | - Shuang Chen
- Department of Gastroenterological Surgery and Hernia Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong, China; and
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A Modified Spontaneously Closed Defunctioning Tube Ileostomy After Anterior Resection of the Rectum for Rectal Cancer with a Low Colorectal Anastomosis. Indian J Surg 2015; 78:125-9. [PMID: 27303122 DOI: 10.1007/s12262-015-1332-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 08/20/2015] [Indexed: 01/18/2023] Open
Abstract
The aim of this study is to introduce a new technique of modified spontaneously closed defunctioning tube ileostomy after anterior resection of the rectum for rectal cancer with a low colorectal anastomosis. Patients with rectal cancer who underwent anterior resection of rectum with a low colorectal anastomosis and chose a modified defunctioning tube ileostomy between March 2012 and August 2013 were retrospectively reviewed. Data on the success of the operation procedures, post-operative hospital stay, and post-operative tube ileostomy-related complications were analyzed. One hundred fifty-two patients (87 males and 65 females; 57.1 ± 17.4 years) undergoing the modified defunctioning tube ileostomy after anterior resection for rectal cancer were included. The post-operative hospital stay was 11.9 ± 3.2 days. The tube was removed on days 22.6 ± 4.1 after operation and the ileostomy wound closed spontaneously within 13.1 ± 1.9 days. Twenty-five patients felt tube-associated pain or discomfort, which was relieved after a period of adaptation and appropriate tube adjustment. Nine patients suffered from tube blockage and were treated successfully with saline irrigation. Two patients had intestinal obstruction, which was resolved with conservative treatment. Three patients developed leakage of the distal anastomosis: two were successfully treated with conservative measures and the other completely recovered after reoperation. The modified spontaneously closed defunctioning tube ileostomy appears efficacious and safe. This technique may be used to protect the distal anastomosis and simultaneously decrease the ileostomy complications, and minimize the morbidity and mortality associated with stoma takedown.
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Zhou X, Chen W, Xu J. Reply to Bugiantella et al. Colorectal Dis 2015; 17:87-9. [PMID: 25311080 DOI: 10.1111/codi.12801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/02/2014] [Indexed: 02/08/2023]
Affiliation(s)
- X Zhou
- Department of Colorectal Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang, 310003, China
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Zhou X, Lin C, Chen W, Lin J, Xu J. Completely diverted tube ileostomy compared with loop ileostomy for protection of low colorectal anastomosis: a pilot study. Colorectal Dis 2014; 16:O327-31. [PMID: 24592884 DOI: 10.1111/codi.12604] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 01/12/2014] [Indexed: 12/14/2022]
Abstract
AIM The study was designed to evaluate a new completely diverted tube ileostomy (CDTI) with a reversible single-row stapled occlusion of the distal limb to defunction a low colorectal anastomosis, and to compare it with a loop ileostomy (LI). METHOD From September 2010 to August 2012, 95 patients with rectal cancer who underwent elective low anterior resections were recruited into the study. They received either a CDTI or a LI. Demographics, clinical features and operative data were recorded. RESULTS Fifty-four patients (56%) had a CDTI and 41 (44%) a LI. There were no significant differences in patient demographics and clinical characteristics. Anastomotic dehiscence occurred in three (5.6%) patients in the CDTI group and two (4.9%) in the LI group (not significant) and no patient developed faecal peritonitis. In the CDTI group, the distal ileum spontaneously recanalized from the stapler occlusion with an average anastomosis exclusion time of 27.9 (14-70) days. The CDTI tube was removed on day 33 (20-75) and the subsequent stoma closure time was 12.3 (6-30) days. CONCLUSION The CDTI procedure is a safe and effective technique for defunctioning an elective low colorectal anastomosis and avoids a formal stoma.
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Affiliation(s)
- X Zhou
- Department of Colorectal Surgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Bugiantella W, Rondelli F, Mariani L, Boni M, Ermili F, Avenia N, Mariani E. Temporary percutaneous ileostomy for faecal diversion after intestinal resection for acute abdomen in elderly: how to avoid the conventional loop ileostomy. Int J Surg 2014; 12 Suppl 2:S144-S147. [PMID: 25157995 DOI: 10.1016/j.ijsu.2014.08.361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/05/2014] [Accepted: 06/15/2014] [Indexed: 01/15/2023]
Abstract
Conventional loop ileostomy (CLI) is a suitable procedure for transitory faecal diversion after colocolic or colorectal anastomosis, but it causes relevant morbidities (dehydration, discomfort, peristomal infections) and requires a second operation to be closed. We already described an alternative technique of temporary percutaneous ileostomy (TPI), which can be removed without surgery, as faecal diversion in low colorectal anastomosis. Now we report our experience with the TPI in protecting colocolic and colorectal anastomosis in urgency in elderly. From January 2012 to June 2014, 45 patients underwent urgent surgical procedures for acute abdomen with colonic and/or rectal resections and colocolic or colorectal anastomosis with faecal diversion by TPI. Nineteen out of 45 patients were older than 70. Four low colorectal anastomoses, 10 intra-peritoneal colorectal anastomosis and 4 colocolic anastomosis were performed. Neither intra-operative complications nor post-operative deaths were observed. None of the 19 patients treated had evidence of clinical or radiological leakage of the anastomosis. Post-operative complications occurred in 7 patients and nobody required re-intervention. No intestinal obstruction was reported in the early (30 days) post-operative period. The TPI seems to be a valid alternative to standard ileostomy, ensuring an optimal faecal diversion both in elective surgery and in urgency. The TPI also ensures less patient discomfort and it can be easily removed without surgery, unlike the CLI. The limited duration of the faecal diversion and the uselessness of a second surgical procedure to remove the TPI are the most important advantages of this new technique, especially in elderly.
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Affiliation(s)
- W Bugiantella
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Perugia, Italy; University of Perugia, PhD School in Biotechnologies, Italy.
| | - F Rondelli
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Perugia, Italy; University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100 Perugia, Italy.
| | - L Mariani
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Perugia, Italy.
| | - M Boni
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Perugia, Italy.
| | - F Ermili
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Perugia, Italy.
| | - N Avenia
- General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100 Terni, Italy.
| | - E Mariani
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034 Foligno, Perugia, Italy.
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Traditional lateral ileostomy versus percutaneous ileostomy by exclusion probe for the protection of extraperitoneal colo-rectal anastomosis: The ALPPI (Anastomotic Leak Prevention by Probe Ileostomy) trial. A randomized controlled trial. Eur J Surg Oncol 2014; 40:476-83. [DOI: 10.1016/j.ejso.2013.12.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 12/28/2013] [Indexed: 02/06/2023] Open
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15
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Letter to the editor--reply. Eur J Surg Oncol 2013; 39:667. [PMID: 23579171 DOI: 10.1016/j.ejso.2013.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/15/2013] [Indexed: 11/23/2022] Open
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Rondelli F, Balzarotti R, Bugiantella W, Mariani L, Pugliese R, Mariani E. Temporary percutaneous ileostomy versus conventional loop ileostomy in mechanical extraperitoneal colorectal anastomosis: a retrospective study. Eur J Surg Oncol 2012; 38:1065-70. [PMID: 22951359 DOI: 10.1016/j.ejso.2012.07.110] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/27/2012] [Accepted: 07/19/2012] [Indexed: 12/27/2022] Open
Abstract
AIM Loop ileostomy is a suitable procedure for transitory faecal diversion after low colorectal anastomosis, but it causes relevant morbidities (discomfort, peristomal infections, dehydration) and requires a second operation to be closed. We already described an alternative technique of temporary percutaneous ileostomy (TPI) that can be removed without surgery. METHOD The data of 143 consecutive patients, undergoing elective laparoscopic anterior resection of the rectum for adenocarcinoma and low mechanical colorectal anastomosis, 68 with conventional loop ileostomy (CLI) and 75 with TPI, were analyzed. RESULTS Neither intra-operative complications nor deaths occurred during the follow-up period. Clinical anastomotic leakage occurred in 4 patients with CLI and in 1 with TPI (p = 0.191). The median time required for the emission of gases and faeces through the stoma was respectively 1 and 2.5 days in the CLI group, and 1 and 2 days in the TPI group (p = 0.259 and p = 0.126). The median post-operative stay was 8 days in the CLI group and 11 days in the TPI group (p < 0.001). PTIs were removed on the median of 9 days after surgery without major complications, whereas the CLIs were re-canalized in 79.4% of patients on an average of 106 days, with 2 major complications. CONCLUSION The temporary percutaneous ileostomy seems to be a valid alternative to conventional ileostomy, ensuring optimal faecal diversion and less patient discomfort. It can be easily removed without surgery, allowing patients a better outcome.
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Affiliation(s)
- F Rondelli
- University of Perugia, School of Medicine, Department of Surgery, Via G. Dottori, 06132 Perugia, Italy.
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