Early vs. Standard Loop Ileostomy Closure: An Unmatched Case-Control Study / Cierre Temprano vs Estándar de Ileostomía en Asa. Estudio de Casos y Controles no Emparejado

SUMMARY: Early closure of a loop ileostomy (ECI) is a relatively new practice, for which there is insufficient evidence regarding its effectiveness in relation to closure at conventional times. The aim of this study was to report postoperative complications (POC) and hospital mortality in patients with loop ileostomy (LI) who underwent ECI, compared with patients with LI who underwent late closure. Un- matched case-control study. Patients with LI who underwent surgery at Clínica RedSalud Mayor Temuco (2010-2022) were included. Cases were defined as patients with LI who underwent early closure and controls as subjects who underwent closure at the usual times. No matching was performed, but a 1:1 relationship between cases and controls was considered. Outcome variables were postoperative complications and hospital mortality. Other variables of interest were surgical time and hospital stay. Descriptive statistics were applied with calculation of proportions and measures of central tendency. Subsequently, t-test and Pearson Chi2 for comparison of averages and proportions was applied, and odds ratios and their respective 95 % CI were calculated. In this study 39 patients with AI were operated on (18 cases and 21 controls). Age and BMI average of the studied subjects was 71.3±7.1 years and 27.3±19.8 kg/m2 respectively. Mean LI closure time, surgical time, and hospitalization were: 10.0±0.7 months; 62.5±10.6min; 3.8±0.1 days respectively. POC were only surgical site infections. Three in cases (16.7 %) and 3 in controls (14.3 %). No anastomotic dehiscence or hospital mortality was observed in either cases or controls. There were no differences in comorbidities or surgical site infection between cases and controls (OR of 0.6 and 1.2 respectively) In this experience, the results of performing the CTI were similar to the late closing in relation to the variables studied.

El cierre temprano de una ileostomía en asa (IA), es una práctica relativamente nueva, sobre la que no hay suficiente evidencia respecto de su efectividad en relación con el cierre en tiempos convencionales. El objetivo de este estudio fue verificar diferencias en la tasa de complicaciones postoperatorias (CPO) y de mortalidad hospitalaria en pacientes con IA sometidos a cierre temprano comparados con pacientes con IA sometidos a cierre tardío. Estudio de casos y controles sin emparejamiento. Se incluyeron pacientes con IA que fueron sometidos a cirugía en la Clínica RedSalud Mayor Temuco (2010-2022). Los casos se definieron como pacientes con IA sometidos a cierre temprano y los controles como sujetos con IA sometidos a cierre en tiempos habituales. No se realizó emparejamiento. Se consideró una relación 1:1 entre casos y controles. Las variables de resultado fueron CPO y mortalidad hospitalaria. Otras variables de interés fueron: tiempo quirúrgico y hospitalización. Se aplicó estadísticas descriptivas (cálculo de proporciones y medidas de tendencia central). Posteriormente, se aplicó prueba t-test y Chi2 para comparación de promedios y proporciones; y se calcularon odds ratios e intervalos de confianza del 95 %. Se operaron 39 pacientes con IA (18 casos y 21 controles). El promedio de edad e IMC fue 71,3±7,1 años y 27,3±19,8 kg/m2, respectivamente. El tiempo promedio de cierre de IA, tiempo quirúrgico y hospitalización fueron: 10,0±0,7 meses; 62,5±10,6 minutos; 3,8±0,1 días, respectivamente. Las CPO fueron infecciones del sitio quirúrgico (3 casos; 16,7 % y 3 controles; 14,3 %). No se observó dehiscencia anastomótica ni mortalidad hospitalaria en casos ni controles. No hubo diferencias en comorbilidades ni en infecciones del sitio quirúrgico entre casos y controles (OR de 0,6 y 1,2, respectivamente). No se evidenciaron diferencias entre realizar cierre temprano o tardío de IA, respecto de las variables CPO y de mortalidad hospitalaria.

Intestinal Stomas - Complications, Prevention and Management: Our Experience in Tertiary Hospital

INTRODUCTION: A stoma is defined as an opening into a hollow viscus either natural or surgically created which connects a portion of body cavity to the external environment[1]. Ileostomy or colostomy creation is a crucial part of numerous surgical procedures carried out for a variety of gastrointestinal problems. Despite the frequent occurrence of intestinal stomas, stoma-related problems are still frequent and are associated with high morbidity and expense. OBJECTIVE: The objective if this article is to understand these frequent issues, go into depth about how to prevent or avoid them, and provide management advice. METHOD: Prospective RESULTS: Peristomal skin complications and parastomal hernia were the most common complications. End colostomy had the highest incidence of morbidity, followed by loop colostomy and loop ileostomy. CONCLUSIONS: Ileostomy and colostomy forms are frequently done procedures, but sadly they are linked to high morbidity and stoma-related complication rates that range from 21 to 70%. It has been demonstrated that preoperative entero-stomal therapy consultation and stoma site labelling by either an entero-stomal therapist or skilled surgeon lessen postoperative problems. In addition, it is crucial to pay close attention to the technical aspects of stoma production. In order to definitively address concerns concerning the optimal trephine size, the use of prophylactic mesh, and other aspects of stoma creation, additional randomized trials are required. Clinical wound ostomy nurse specialists are extremely helpful following surgery, and the use of standardized protocols has further helped to reduce the frequency of common problems and readmissions for dehydration.

Therapeutic effect of a new hybrid technique which combined laparoscopic method and abdominal repair for parastomal hernia repair / 中华外科杂志

Objective@#To investigate the safety and effectiveness of a new hybrid technique which combined laparoscopic method and abdominal repair (Dual Lap) for parastomal herniarepair.@*Methods@#The clinical and follow-up data of 27 cases who accepted Dual Lap procedure performed at Department of Hernia and Abdominal Wall Surgery, Wuhan Central Hospital, Tongji Medical College of Huazhong University from January 2010 to January 2015 were analyzed retrospectively. The data included 22 male patients and 5 female patients with mean age of 54 years. Of the patients, there were 19 cases of the left hernia and 8 cases of the right hernia, without ostomy hernia repair history. There were 4 cases of the occult hernial defects during the operation. There were 8 patients with ilealneobladder, 2 patients with ileostomyafter total colectomy for familial adenomatous polyposis, 3 patients with ileostomy and 14 patients with colostomy for ulcerative colitis.@*Results@#All cases underwent hybrid technique successfully. The mean operation time was (108±16) minutes(ranging from 90 to 150 minutes) and the diameter of the hernial ring was (6.4±1.8)cm (ranging from 3 to 13 cm). There were no intestinal, kidney and ureteral obstructions in operations. Five cases need to use the analgesic adjuvant at 48-hour after operation. The time of postoperative defecations was (9.3±2.4) days (ranging from 7 to 16 days) and there were no intestinal leakage, local hematoma, wound infection and fat liquefaction after operations. All patients were followed up for (16.3±4.2) months (ranging from 12 to 48 months). There was no ileus, obvious seroma, hernia recurrence, chronic pain and mesh infection.@*Conclusion@#The Dual Lap procedureis safe and effective for parastomal hernia repair with less complication.

Role of zipper in the management of abdominal sepsis.

BACKGROUND: Continuous peritoneal lavage, staged laparotomies and radical peritoneal debridement have been used to reduce mortality from severe abdominal sepsis. Recently, open abdomen technique using a 'zipper' with or without mesh for abdominal lavage has shown promising results. AIMS: To evaluate open abdominal technique using a zipper in patients with advanced diffuse peritonitis with impending or established multiple organ failure. METHODS: Modified open abdomen technique using zipper with or without mesh was used for abdominal closure in eight patients with severe generalized peritonitis (APACHE-II score range 27-30). RESULTS: Zipper was inserted at first laparotomy in three patients, at second exploration in four and at the time of third laparotomy in one case. Two patients required strips of mesh in addition to zipper. Six of eight patients survived and were discharged after an average period of 27 days. Two deaths were due to multisystem organ failure. In four patients additional surgical procedures like closure of perforation, temporary ileostomy and resection anastomosis of small bowel was carried out through the zipper. Zipper-mesh were removed an average of 10.5 days after insertion. Three patients developed incisional hernia at 6 months follow-up. CONCLUSION: This technique merits further controlled trials to ascertain its indications and benefits.