Is a Defunctioning Stoma Necessary After Left Colectomy in High-risk Patients for Anastomotic Leak?. Issue 6 (21st December 2022)

• Record Type: Journal Article
• Authors: Bouland, Tressy; Sabbagh, Charles; Allart K, Kevin; Pellegrin, Alexandra; Regimbeau, Jean-Marc
• Is Part Of: Surgical laparoscopy endoscopy & percutaneous techniques. Volume 32:Issue 6(2022)
• Page Start: 677
• Page End: 682
• Publication Date: 2022-12-21
• Subjects: colon leak score -- anastomosis -- stoma -- colectomy -- leakage; Endoscopic surgery -- Periodicals; Laparoscopic surgery -- Periodicals; Endoscopy -- Periodicals; Laparoscopy -- Periodicals; 617.550597
• DOI: 10.1097/SLE.0000000000001109
• Languages: English
• ISSNs: 1530-4515

Abstract

Abstract : Introduction: Left colectomy is associated with a 7% risk of anastomotic leak. In 2011, a prediction score for AL [the colon leakage score (CLS)] was developed. The aim was to evaluate the impact of a defunctioning stoma on AL and its consequences after left colectomy in high-risk patients. Patients: From January 2012 to June 2019, high-risk patients who underwent a left colectomy with anastomosis were included in this retrospective, single-center study. Two groups of patients were defined: patients undergoing a left colectomy with an anastomosis without a defunctioning stoma (no-stoma group) and those with a defunctioning stoma (stoma group). The primary endpoint was the rate of anastomotic leakage. Results: Ninety-two patients were included in this study. The anastomotic leakage rate was 16.4% in the no-stoma group and 21.6% in the stoma group ( P =0.5). A conservative approach was applied to 11.2% in the no-stoma group and 50% in the stoma group ( P =0.1). The severe morbidity rate was 14.5% in the no-stoma group and 21.6% in the stoma group ( P =0.4). The rate of unplanned admissions was 7% in the no-stoma group and 27% in the stoma group ( P =0.01). Conclusion: A defunctioning stoma does not appear to reduce the rate of AL in high-risk patients, but its impact on the management of AL remains unclear.