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The influence of specific technical maneuvers utilized in the creation of diverting loop-ileostomies on stoma-related morbidity

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Abstract

Purpose

The association between technical maneuvers in fashioning a diverting loop-ileostomy and stoma-related complications remains unclear. Thus, this study aimed to evaluate their relevance to stoma-related morbidity.

Methods

This retrospective multicenter study was designed to collect data from 37 institutions. We evaluated the perioperative outcomes of consecutive patients who underwent surgery to create a diverting loop-ileostomy in 2013.

Results

A total of 4137 patients with colorectal disease underwent colorectomy, 279 of whom received an ileostomy. The results of these 279 patients were analyzed. The most common complications were parastomal dermatitis (n = 132) followed by ileus (n = 36), mucocutaneous separation (n = 24), parastomal hernia (n = 16), stoma retraction (n = 15), and stoma prolapse (n = 9). The technical maneuvers used in the creation of ileostomies were heterogeneous and some had a great deal of relevance to the complications. A long distance from the ileocecal valve to the ileostomy was associated with a low risk of stoma retraction and a high risk of ileus. Additionally, the height of the distal limb of the ileostomy significantly affected the incidence of parastomal dermatitis and mucocutaneous separation.

Conclusions

Specific technical maneuvers that are utilized in the creation of diverting loop-ileostomies had a significant influence on the incidence of stoma-related morbidities. Our findings emphasize the possibility of minimizing stoma-related complications with appropriate surgical techniques.

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References

  1. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1:1479–82.

    Article  CAS  PubMed  Google Scholar 

  2. Mohammed S, Anaya DA, Awad SS, Albo D, Berger DH, Artinyan A. Sphincter preservation rates after radical resection for rectal cancer in the United States veteran population: opportunity for improvement in early disease. Ann Surg Oncol. 2015;22:216–23.

    Article  PubMed  Google Scholar 

  3. Akagi Y, Kinugasa T, Shirouzu K. Intersphincteric resection for very low rectal cancer: a systematic review. Surg Today. 2013;43:838–47.

    Article  PubMed  Google Scholar 

  4. Saito N, Ito M, Kobayashi A, Nishizawa Y, Kojima M, Nishizawa Y, et al. Long-term outcomes after intersphincteric resection for low-lying rectal cancer. Ann Surg Oncol. 2014;21:3608–15.

    Article  PubMed  Google Scholar 

  5. Krarup PM, Nordholm-Carstensen A, Jorgensen LN, Harling H. Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg. 2014;259:930–8.

    Article  PubMed  Google Scholar 

  6. Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253:890–9.

    Article  PubMed  Google Scholar 

  7. Mongin C, Maggiori L, Agostini J, Ferron M, Panis Y. Does anastomotic leakage impair functional results and quality of life after laparoscopic sphincter-saving total mesorectal excision for rectal cancer? A case-matched study. Int J Colorectal Dis. 2014;29:459–67.

    Article  PubMed  Google Scholar 

  8. Sahami S, Bartels SA, D’Hoore A, Fadok TY, Tanis PJ, Lindeboom R, et al. A multicentre. Evaluation of risk factors for anastomotic leakage after restorative proctocolectomy with ileal pouch-anal anastomosis for inflammatory bowel disease. J Crohns Colitis. 2015;pii:jjv170 (Epub ahead of print).

    Google Scholar 

  9. Sagap I, Remzi FH, Hammel JP, Fazio VW. Factors associated with failure in managing pelvic sepsis after ileal pouch-anal anastomosis (IPAA)—a multivariate analysis. Surgery. 2006;140:691–703.

    Article  PubMed  Google Scholar 

  10. Weston-Petrides GK, Lovegrove RE, Tilney HS, Heriot AG, Nicholls RJ, Mortensen NJ, et al. Comparison of outcomes after restorative proctocolectomy with or without defunctioning ileostomy. Arch Surg. 2008;143:406–12.

    Article  PubMed  Google Scholar 

  11. Matthiessen P, Hallböök O, Rutegård J, Simert G, Sjödahl R. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg. 2007;246:207–14.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Fujita F, Torashima Y, Kuroki T, Eguchi S. The risk factors and predictive factors for anastomotic leakage after resection for colorectal cancer: reappraisal of the literature. Surg Today. 2014;44:1595–602.

    Article  PubMed  Google Scholar 

  13. Hüser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg. 2008;248:52–60.

    Article  PubMed  Google Scholar 

  14. Hallböök O, Matthiessen P, Leinsköld T, Nyström PO, Sjödahl R. Safety of the temporary loop ileostomy. Colorectal Dis. 2002;4:361–4.

    Article  PubMed  Google Scholar 

  15. García-Botello SA, García-Armengol J, García-Granero E, Espí A, Juan C, López-Mozos F, et al. A prospective audit of the complications of loop ileostomy construction and takedown. Dig Surg. 2004;21:440–6.

    Article  PubMed  Google Scholar 

  16. Phatak UR, Kao LS, You YN, Rodriguez-Bigas MA, Skibber JM, Feig BW, et al. Impact of ileostomy-related complications on the multidisciplinary treatment of rectal cancer. Ann Surg Oncol. 2014;21:507–12.

    Article  PubMed  Google Scholar 

  17. Chow A, Tilney HS, Paraskeva P, Jeyarajah S, Zacharakis E, Purkayastha S. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis. 2009;24:711–23.

    Article  PubMed  Google Scholar 

  18. Tilney HS, Sains PS, Lovegrove RE, Reese GE, Heriot AG, Tekkis PP. Comparison of outcomes following ileostomy versus colostomy for defunctioning colorectal anastomoses. World J Surg. 2007;31:1142–51.

    Article  PubMed  Google Scholar 

  19. Rondelli F, Reboldi P, Rulli A, Barberini F, Guerrisi A, Izzo L, et al. Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis. 2009;24:479–88.

    Article  CAS  PubMed  Google Scholar 

  20. Marcello PW, Roberts PL, Schoetz DJ Jr, Coller JA, Murray JJ, Veidenheimer MC. Obstruction after ileal pouch-anal anastomosis: a preventable complication? Dis Colon Rectum. 1993;36:1105–11.

    Article  CAS  PubMed  Google Scholar 

  21. Kouba E, Sands M, Lentz A, Wallen E, Pruthi RS. Incidence and risk factors of stomal complications in patients undergoing cystectomy with ileal conduit urinary diversion for bladder cancer. J Urol. 2007;178: 950–954.

    Google Scholar 

  22. Scarpa M, Ruffolo C, Boetto R, Pozza A, Sadocchi L, Angriman I. Diverting loop ileostomy after restorative proctocolectomy: predictors of poor outcome and poor quality of life. Colorectal Dis. 2010;12:914–20.

    Article  CAS  PubMed  Google Scholar 

  23. Cottam J, Richards K, Hasted A, Blackman A. Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. Colorectal Dis. 2007;9:834–8.

    Article  CAS  PubMed  Google Scholar 

  24. Persson E, Berndtsson I, Carlsson E, Hallén AM, Lindholm E. Stoma-related complications and stoma size—a 2-year follow up. Colorectal Dis. 2010;12:971–6.

    Article  CAS  PubMed  Google Scholar 

  25. Ostomy Guidelines Task Force, Goldberg M, Aukett LK, Carmel J, Fellows J, Folkedahl B, et al. Management of the patient with a fecal ostomy: best practice guideline for clinicians. J Wound Ostomy Cont Nurs. 2010;37:596–8.

    Article  Google Scholar 

  26. Sung YH, Kwon I, Jo S, Park S. Factors affecting ostomy-related complications in Korea. J Wound Ostomy Cont Nurs. 2010;37:166–72.

    Article  Google Scholar 

  27. Nastro P, Knowles CH, McGrath A, Heyman B, Porrett TR, Lunniss PJ. Complications of intestinal stomas. Br J Surg. 2010;97:1885–9.

    Article  CAS  PubMed  Google Scholar 

  28. Kobayashi S, Ito M, Sugito M, Kobayashi A, Nishizawa Y, Saito N. Association between incisional surgical site infection and the type of skin closure after stoma closure. Surg Today. 2011;41:941–5.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank the following surgeons and institutions for their participation in this study: T. Ohnishi (NTT West Osaka Hospital, Osaka), H. Ota (Ikeda City Hospital, Ikeda), S. Morita (Toyonaka Municipal Hospital, Toyonaka), Y. Kai (Hanwasumiyoshi General Hospital, Osaka), Y. Baba (Sakurabashi Watanabe Hospital, Osaka), R. Nezu (Nishinomiya Municipal Central Hospital, Nishinomiya), H. Maruyama (Kawanishi City Hospital, Kawanishi), C. Matsuda (Osaka General Medical Center, Osaka), A. Ogawa (Tane General Hospital, Osaka), T. Tanigawa (Iseikai Hospital, Osaka), H. Akamatsu (Osaka Police Hospital, Osaka), Y. Fumimoto (Saiseikai Tondabayashi Hospital, Tondabayashi), H. Takemoto (Kinki Central Hospital, Itami), S. Yoshioka (Hyogo Prefectural Nishinomiya Hospital, Nishinomiya), R. Suzuki (Osaka Minato Central Hospital, Osaka), M. Fujii (Nissay Hospital, Osaka), K. Kitani (Nara Hospital Kinki University Faculty of Medicine, Ikoma), H. Tamagawa (Otemae Hospital, Osaka), N. Tanaka (Itami City Hospital, Itami), T. Shinkai (Saiseikai Senri Hospital, Suita), S. Mizutani (Ashiya Municipal Hospital, Ashiya), Y. Ide (Yao Municipal Hospital, Yao), M. Yasui (Kaizuka City Hospital, Kaizuka), H. Mizuno (JCHO Osaka Hospital, Osaka), M. Okuyama (Higashiosaka City General Hospital, Higashiosaka), K. Ikeda (Minoh City Hospital, Minoh), I. Ohashi (Hannan Chuo Hospital, Matsubara), H. Fujii (Rinku General Medical Center, Izumisano), K. Murata (Suita Municipal Hospital, Suita), H. Tominaga (National Hospital Organization Kure Medical Center, Kure), Y. Okada (Kawachi General Hospital, Higashiosaka). Special thanks to S. Tanaka (Osaka University Graduate School of Medicine) for stoma management and helpful discussion.

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Correspondence to Ichiro Takemasa.

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The authors declare no conflicts of interest in association with the present study.

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M. Miyo and I. Takemasa contributed equally to this work.

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Miyo, M., Takemasa, I., Ikeda, M. et al. The influence of specific technical maneuvers utilized in the creation of diverting loop-ileostomies on stoma-related morbidity. Surg Today 47, 940–950 (2017). https://doi.org/10.1007/s00595-017-1481-2

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  • DOI: https://doi.org/10.1007/s00595-017-1481-2

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