Defunctioning stoma- a prognosticator for leaks in low rectal restorative cancer resection: A retrospective analysis of stoma database. (September 2017)

• Record Type: Journal Article
• Authors: Abudeeb, Haytham; Hammad, Ahmed; Ugwu, Ajogwu; Darabnia, Jamshid; Malcomson, Lee; Maung, Min; Khan, Khurram; Mclaughlin, Clare; Mukherjee, Arijit
• Is Part Of: Annals of medicine and surgery. Volume 21(2017)
• Page Start: 114
• Page End: 117
• Publication Date: 2017-09
• Subjects: Low rectal cancer -- Loop ileostomy -- Anastomotic leak -- Reversal; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2017.07.044
• Languages: English
• ISSNs: 2049-0801

Abstract

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. Highlights: Case series to assess reduction of anastomotic leak with loop ileostomy in anterior resection. Loop Ileostomy mitigates the risk of anastomotic leak and reduces consequence. Short and long-term complications are minimal with no extra risk.