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Defunctioning loop ileostomy for rectal anastomoses: predictors of stoma outlet obstruction

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Creation of defunctioning loop ileostomy is a standard procedure in laparoscopic lower rectal surgery. Stoma-related obstruction sometimes occurs, but its cause has not been fully analyzed. This study aims to assess stoma obstructive complications and clarify the risk factors of stoma-related obstructions.

Methods

Two hundred and thirty consecutive patients who underwent laparoscopic rectal cancer surgery with defunctioning loop ileostomy between April 2007 and December 2017 were recruited, numbering 230. We statistically examined the frequency and risk factor of stoma outlet obstruction.

Results

Postoperative stoma-related complications developed in 41 patients (17.8%) overall, and there was no 30-day mortality. Stoma outlet obstructions occurred in 16 patients (7.0%) during postoperative course. Thick subcutaneous fat at the stoma-marking site (vertical distance ≥ 20 mm) and body mass index (≥ 22.2) were significantly associated with the risk of stoma outlet obstruction in univariate analysis. Thick subcutaneous fat was a significant predictive factor of stoma outlet obstruction according to multivariate analysis (odds ratio 3.80).

Conclusions

This report investigates significant predictors of stoma outlet obstruction in laparoscopic rectal cancer surgery for the first time. In laparoscopic procedure, stoma outlet obstruction should be particularly considered in obese patients who have especially thick subcutaneous fat of the abdominal wall.

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Acknowledgements

All authors appreciate the staff who are concerned with the surgery and the treatments.

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Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8510, Japan

    Koichi Tamura, Kenji Matsuda, Shozo Yokoyama, Hiromitsu Iwamoto, Yuki Mizumoto, Daisuke Murakami, Yuki Nakamura & Hiroki Yamaue

Authors
  1. Koichi Tamura
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  2. Kenji Matsuda
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  3. Shozo Yokoyama
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  4. Hiromitsu Iwamoto
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  5. Yuki Mizumoto
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  6. Daisuke Murakami
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  7. Yuki Nakamura
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  8. Hiroki Yamaue
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Contributions

Study conception and design: T, M, Y.

Acquisition of data: T, I, M, M, N.

Analysis and interpretation of data: M, Y.

Drafting of manuscript: M, Y.

Critical revision: M, Y.

Supervision: Y.

Corresponding author

Correspondence to Hiroki Yamaue.

Ethics declarations

Ethical statement

For this retrospective study, the authors receive ethics committee approval of Wakayama Medical University following Ethical Guidelines for Medical and Health Research Involving Human Subjects.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Tamura, K., Matsuda, K., Yokoyama, S. et al. Defunctioning loop ileostomy for rectal anastomoses: predictors of stoma outlet obstruction. Int J Colorectal Dis 34, 1141–1145 (2019). https://doi.org/10.1007/s00384-019-03308-z

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  • DOI: https://doi.org/10.1007/s00384-019-03308-z

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