Comparison of protective ileostomy and transverse colostomy through specimen extraction auxiliary incision following laparoscopic low anterior resection for rectal cancer / 中华胃肠外科杂志

Objective@#To introduce a new technique of protective ostomy using the specimen extraction auxiliary incision following laparoscopic low anterior resection for rectal cancer, and to compare the pros and cons of loop ileostomy (LI) and loop transverse colostomy (LTC).@*Methods@#A retrospective cohort study was performed. The data of patients who underwent laparoscopic low anterior resection for rectal cancer and ostomy using the auxiliary incision in Peking Union Medical College Hospital from January 2010 to December 2017 were retrospectively analyzed. Inclusion criteria: (1) patient underwent neoadjuvant chemoradiotherapy before operation; (2) patient was classified as tumor stage II or III; (3) patient was followed up and underwent stoma closure at our center; (4) ostomy was performed through specimen extraction incision. Patients with multiple gastrointestinal carcinomas or inflammatory bowel disease were excluded. Two hundred and eight patients were included in the study and divided into the LI group (n=86) and LTC group (n=122). The operation parameters and postoperative complications were compared between the two groups.@*Results@#There were 135 males and 73 females (1.85∶1.00). Mean age of the 208 patients was (59.6±11.6) years (range 29-85 years). There were no significant differences between LI and LTC groups in baseline data (all P>0.05). All of the patients completed surgery successfully. The severe complication rate after ostomy was 2.9% (6/208). In the fecal diversion period, LI group showed significantly faster defecation [(1.6±1.0) days vs. (2.2±1.9) days, t=-2.918, P=0.004] and lower incidence of parastomal hernia [8.1% (7/86) vs. 19.7% (24/122), χ2=5.290, P=0.021], but higher incidence of peristomal dermatitis [18.6% (16/86) vs. 4.9% (6/122), χ2=9.990, P=0.002] as compared to LTC group. The incidence of renal insufficiency was lower in LTC group, though the difference was not significant [4.9% (6/122) vs. 10.5% (9/86), χ2=2.320, P=0.128]. The severe complication rate after stoma closure was 1.9% (4/208). In the stoma closure period, a significantly higher incidence of wound infection was noted in LTC group [18.0% (22/122) vs. 4.7% (4/86), χ2=8.258, P=0.004]. There were no significant differences between the two groups in the incidence of anastomotic leakage, stenosis, and incisional hernia (all P>0.05). All complications were improved after treatment.@*Conclusions@#Both LI and LTC through auxiliary incision following laparoscopic low anterior resection for rectal cancer are safe and feasible. LTC is an optional method for those patients with sensitive skin.

Effects of protective transverse colostomy on the incidence of postoperative anastomotic leakage and stricture after laparoscopic resection for rectal cancer / 中华消化外科杂志

Objective To investigate the value of protective transverse colostomy in decreasing postoperative anastomotic leakage and stricture after laparoscopic resection for rectal cancer.Methods The clinical data of 128 patients with rectal cancer who were admitted to the Jinhua Hospital of Zhejiang University from March 2008 to February 2012 were retrospectively analyzed.All the patients received laparoscopic anterior resection of rectal cancer after neoadjuvant chemoradiotherapy.Sixty-one patients received protective transverse colostomy (colostomy group) and 67 patients did not receive protective transverse colostomy (non-colostomy group).The incidences of postoperative anastomotic leakage and stricture,condition of the patients and the prognosis of the patients in the 2 groups were compared.Patients were followed up via out-patient examination,in-patient chemotherapy or phone call till May 2013.All data were analyzed using the t test,chi-square test or Fisher exact probability.Results The overall incidence of postoperative anastomotic leakage was 7.03％ (9/128).The incidences of postoperative anastomotic leakage in the colostomy group and non-colostomy group were 6.56％ (4/61) and 7.46％ (5/67),with no significant difference between the 2 groups (x2 =0.000,P ＞ 0.05).The systemic condition of 4 patients who were complicated with anastomotic leakage in the colostomy group was comparatively better,and all of them were cured by conservative treatment.The condition of 5 patients who were complicated with anastomotic leakage in the non-colostomy group was severe,and 4 of them received reoperation,with the reoperation rate of 4/5 ; the other patient received conservative treatment.There was significant difference in the reoperation rate between the 2 groups (P ＜0.05).The overall incidence of postoperative anastomotic stricture was 13.28％ (17/128).The incidences of postoperative anastomotic stricture in the colostomy group and the non-colostomy group were 19.67％ (12/61) and 7.46％ (5/67),with significant difference between the 2 groups (x2=4.133,P ＜ 0.05).The incidences of severe anastomotic stricture of the colostomy group and the non-colostomy group were 8.20 (5/61) and 0,respectively.Conclusion Protective transverse colostomy could not reduce the incidence of postoperative anastomotic leakage,but could mitigate the symptoms followed anastomotic leakage and reduce the reoperation rate.Protective transverse colostomy may improve the incidence of anastomotic stricture,therefore it should be applied cautiously.

Complicaciones de ileostomías y colostomías de protección en cirugía por cáncer de recto / Ileostomy and colostomy complications of protection in rectal cancer surgery

Introducción: en los últimos años, la tradicional colostomía lateral utilizada para proteger las anastomosis colorrectales bajas, ha sido reemplazada en muchos centros por una ileostomía en asa. Si bien se ha generado cierta controversia entre ambas técnicas, aún no ha quedado claramente demostrado qué técnica es la más recomendada. Objetivo: comparar el índice de complicaciones de ileostomías y colostomías de protección en cirugías por cáncer de recto. Material y Método: se analizaron retrospectivamente todos los pacientes operados de cáncer de recto, entre 2002 y 2012, a los que se les realizó una ostomía de protección. Se excluyó a los pacientes a los cuales por diversas razones nunca se les restableció el tránsito intestinal. Los parámetros analizados fueron: edad, sexo, complicaciones del ostoma, complicaciones del cierre del ostoma y mortalidad. Las complicaciones fueron clasificadas con la escala STROC. Se analizó un total de 106 pacientes (59 hombres y 47 mujeres). La edad promedio fue de 64 años (24 a 89). Se realizaron 80 ileostomías en asa (Grupo IA) y 26 colostomías laterales transversas (Grupo CLT). Se utilizó para el análisis estadístico el test de Fisher. Resultados: hubo 12 complicaciones relacionadas con la confección de las ostomías (11.3%). Esto incluye 11 complicaciones de ileostomías (13,7%) y una de las colostomías (3,8%) (p=0,15). No hubo mortalidad. Con relación al cierre del ostoma, hubo 18 complicaciones con una incidencia del 16,9%; de estas, 10 correspondieron al grupo IA (12,5%), y 8 al grupo CLT (30,8%) (p=0,03). Dentro de estas complicaciones del cierre de los ostomas, la más frecuente fue la infección de la herida quirúrgica, de la que se registraron 7 casos, 2 en el grupo IA y 5 en el grupo CLT (p=0,009)... (TRUNCADO)

Background: in recent years, the traditional lateral colostomy used to protect low colorectal anastomosis has been replaced in many centers by a loop ileostomy. While some controversy was generated between the two techniques it has not yet been clearly demonstrated which of them is the best choice. Objective: to compare the rate of complications of ileostomy and colostomy protection after rectal cancer surgery. Material and Methods: we retrospectively analyzed all patients undergoing rectal cancer surgery who needed a protective stoma between 2002 and 2012. We excluded patients to whom intestinal transit was never restored. The parameters analyzed were: age, sex, stoma complications, closure of stoma complications and mortality. Complications were classified according to STROC scale. We analyzed a total of 106 patients (59 men and 47 women), mean age was 64 years (24-89). This included 80 loop ileostomies (Group IA) and 26 lateral transverse colostomies (CLT Group). Fisher’s test was used for statistical analysis. Results: there were 12 complications related to the making of the ostomy (11,3%). This included 11 ileostomy complications (13,7%), and one after a colostomy (3,8%) (p=0,15). There was no mortality. Regarding the closure of the stoma, there were 18 complications with an incidence of 16,9%. Of these, 10 occurred in group IA (12,5%), and 8 in CLT group (30,8%) (p=0,03). Within stoma closure complications, infection of the surgical wound was the most common, with 7 cases, 2 in group IA and 5 in the CLT group (p = 0,009). The mortality rate was 2,8%, 2,5% corresponded to the ileostomy group and 3,8% corresponded to the colostomy group (p=0,57). Conclusions: the implementation of a stoma should be clearly justified since the procedure is not without complications... (TRUNCATED)

The impact of preventive transverse colostomy on anastomotic leakage of rectal low anterior resection / 中国普通外科杂志

0.05).Conclusions Preventive transverse colostomy can not effectively reduce the incidence of AL rate following LAR,and besides the patients have preventive transverse colostomy will require reperation to close the colostomy.