Defunctioning stoma- a prognosticator for leaks in low rectal restorative cancer resection: a retrospective analysis of stoma database

Abudeeb, H., Hammad, A., Ugwu, A., Darabnia, J., Malcomson, L., Maung, M., Khan, K. , Mclaughlin, C. and Mukherjee, A. (2017) Defunctioning stoma- a prognosticator for leaks in low rectal restorative cancer resection: a retrospective analysis of stoma database. Annals of Medicine and Surgery, 21, pp. 114-117. (doi: 10.1016/j.amsu.2017.07.044) (PMID:28861269) (PMCID:PMC5567768)

Abstract

Aims: Low anterior resection (LAR) has higher risk of anastomotic leak with its attendant morbidity -mortality. De-functioning loop ileostomy (DLI), claimed to mitigate the consequences of anastomotic leak, has been questioned in recent years. This study aims to evaluate the impact of ileostomy on LAR. Methods: A retrospective analysis of stoma database. 136 patients with stoma (March 2011-July 2015) were assessed. Data was analysed in respect to LAR anastomotic leak rate, impact on morbidity-mortality, short and long-term stoma complications, rate of ileostomy reversal and reasons for non-reversal. Results: 45 patients had loop ileostomy for LAR. Male (28) to female (17) ratio was 1.65:1 with median age of 69 (IQR: 56–75.5). Only 3 anastomotic leaks (3/45, 6.5%) occurred, all treated conservatively with no mortality. 29 had reversal, average reversal time is 10 months (3–24) and 5 awaiting. Reasons for non-reversal included patients’ choice (7), death from cardiac cause (1), chemotherapy (1), unfit for surgery (1) and failed reversal (1). Acute complications included high output & reversible AKI (1), bleeding (3) and minor complications (6) as skin excoriation, separation and appliance issues. Parastomal hernia was repaired during reversal (12/15). Conclusions: De-functioning ileostomy for LAR is a safe procedure with low morbidity. Most stomas are reversible. Series highlights a late reversal contrary to the nationally recommended guidelines. Most interestingly, the study demonstrated de-functioning mitigated clinical consequences of anastomotic leak to an extent that reoperation was avoidable, in keeping with recent meta-analysis indicating a significantly low anastomotic leakage rates and reoperation. Larger study is invaluable to substantiate findings.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Khan, Mr Khurram

Creator Roles

Khan, K.: Data curation

• Authors: Abudeeb, H., Hammad, A., Ugwu, A., Darabnia, J., Malcomson, L., Maung, M., Khan, K., Mclaughlin, C., and Mukherjee, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Annals of Medicine and Surgery
• Publisher: Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
• ISSN: 2049-0801
• ISSN (Online): 2049-0801
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in Annals of Medicine and Surgery 21:114-117
• Publisher Policy: Reproduced under a Creative Commons license