No abstract available.
Ileostomy*

BACKGROUND: The objective of this study was to evaluate the postoperative outcomes of early ileostomy closure compared to delayed closure in adult patients that have undergone bowel surgery. Specific outcomes measured included wound infection, ileus, postoperative obstruction, anastomotic failure, total number of complications and mortality. METHODS: Online search was made through Medline, Cochrane, EBSCHost, and ClinicalKey databases up to June 2018 for randomized controlled trials comparing early (<4 weeks) and delayed (≥ 4 weeks) closure of ileostomy. Review Manager 5.3 was utilized for data analysis. The odds ratio was determined for each of the outcomes. RESULTS: Eight RCT's met the inclusion criteria, yielding 1126 patients (506 in early closure and 620 in delayed closure group). Statistical analysis showed no advantage of delayed closure over early closure of ileostomy in terms of post-operative complications (OR 1.13, 95% CI, 0.84-1.54, p=0.45), rate of anastomotic leakage (OR 0.96;95% CI, 0.55-1.66, p=0.54) and over-all mortality (OR 2.00;95% CI, 0.18-22.29, p=0.57). Early closure patients were found to be less likely to have post-operative ileus or obstruction when compared to delayed closure (OR 0.36;95% CI, 0.14-0.90, p=0.03). However, early closure was more likely to cause postoperative wound infection compared to delayed closure (OR 2.32;95% CI, 1.48-3.63, p=0.0002). CONCLUSION Early closure of ileostomy is beneficial in terms of development of less post-operative ileus. Delayed closure of ileostomy is advantageous in terms of less wound infections.
Ileostomy

No abstract available.
Colitis, Ulcerative* ; Humans ; Ileostomy* ; Ulcer*

The double stapling technique has become an established reconstruction method for patients undergoing low anterior resection. We have used a modification of the conventional technique in which the lower rectal segment is closed with a linear stapler (TA-55) and the anastomosis is performed by using the circular EEA(CEEA) instrument across the linear staple line of the double stapling technique. The aim of this study was to evaluate the prophylactic effect of a loop ileostomy preventing anastomotic leakage. Stapled colorectal anastomosis and stapled coloanal anastomosis in 60 patients forms the basis for the report. The sixty patients were treated by using the double stapling technique either with or without a loop ileostomy. This review presents the advantages and disadvantages of a loop ileostomy for coloanal anastomosis. Postoperative anastomotic leakage in the double stapling technique group occurred in 5 (10.6%)cases of the total 31 cases while in the double stapling technique with loop ileostomy group, it allowed 1(3.4%) of the total 29 cases. This study suggests that the double stapling technique with a loop ileostomy is more effective than the double stapling technique without a loop ileostomy in preventing anastomotic leakage. The addition of a loop ileostomy to protect the low anastomosis might also be expected to influence anastomotic healing.
Anastomotic Leak ; Humans ; Ileostomy ; Rectal Neoplasms*

PURPOSE: A diverting stoma is known to reduce the consequences of distal anastomotic failure following colorectal surgery. The aim of this study was to evaluate the efficacy of a diverting stoma after an ultra-low anterior resection (uLAR) for rectal cancer. METHODS: Between 2000 and 2007, 836 patients who underwent an uLAR were divided into two groups, depending on the fecal diversion: 246 received fecal diversion, and 590 had no diversion. Patient- and disease-related variables were compared between the two groups. RESULTS: Thirty-two of the 836 patients (3.8%) had immediate anastomosis-related complications and required reoperation. Anastomosis leakage comprised 72% of the complications (23/32). The overall immediate complication rate was significantly lower in patients with a diverting stoma (0.8%, 2/246) compared to those without a diverting stoma (5.1%, 30/590; P = 0.005). The fecal diversion group had lower tumor location, lower anastomosis level, and more preoperative chemo-radiation therapy (P < 0.001). In total, 12% of patients in the diverting stoma group had complications either in making or reversing the stoma (30/246). CONCLUSION: The diverting stoma decreased the rate of immediate anastomosis-related complications. However, the rate of complications associated with the diverting stoma was non-negligible, so strict criteria should be applied when deciding whether to use a diverting stoma.
Colorectal Surgery ; Humans ; Ileostomy ; Rectal Neoplasms ; Reoperation

Permanant ileostomy is necessary in the case of a total proctocolectomy for a cancerous change in the distal rectum due to ulcerative colitis or familial adenomatous polyposis coli, but the fecal content after a conventional ileostomy is usually liquid or semiliquid. Sometimes, this resultes in dehydration and some nutrient loss. Nahm-gun Oh has designed an antiperistaltic ileostomy for formed stool evacuation. About a 25 cm length of the most distal ileum is cut, this segment is reversed, and then the antiperistaltic ileostomy is performed. The authors have performed antiperistaltic ileostomies in 6 cases of familial adenomatous polyposis or ulcerative colitis with a cancerous change in the low rectum. During the past 5 years and 7 months at the Department of Surgery, Pusan National University Hospital, we found that the profuse ileostomy discharge of the conventional ileostomy was decreased in the antiperistaltic ileostomy group, and that the antiperistaltic ileostomy discharge had a liquid component which was markedly decreased compared to that of the conventional ileostomy discharge. In addition, the antiperistaltic ileostomy discharge appeared to be much more solid and less voluminous. In conclusion, the antiperistaltic ileostomy should be considered for creating the effect of a reservoir by producing intestinal stasis proximal to the segment. The antiperistaltic ileostomy is effective in reducing the daily amount of ileostomy discharge and is convenient for stoma care due to the diminished water content in the discharge.
Adenomatous Polyposis Coli ; Busan ; Colitis, Ulcerative ; Dehydration ; Ileostomy* ; Ileum ; Rectum

PURPOSE: The study aimed to investigate the complications accompanying stoma take-down and to elucidate the significant factors associated with complications. METHODS: We recruited 341 patients who underwent stoma take-down in our hospital between January 2000 and December 2005. Data on various complications during this procedure, i.e., wound infection, prolonged ileus, and anastomotic leakage, were collected with respect to patient- and operation-associated parameters. RESULTS: Complications of stoma take-down developed in 72 (21.1%) patients: 53 (20.3%) patients in a loop ileosotmy, 10 (21.3%) patients in a loop colostomy, and 9 (27.3%) patients in a Hartmann colostomy, The overall complication rate was significantly associated with the urgency of the primary operation (elective vs. emergent, 17.8% vs. 29%, P=0.017), and with the operation time (< or =80 min vs. > 80 min, 16.5% vs. 29.3%, P=0.005). Among the complications, ileus developed in 46 (13.5%) patients, wound infection in 17 (5.0%) patients, and anastomotic leakage in 5 (1.5%) patients. Wound infection was related to the type of stoma between a loop ileostomy and a Hartmann colostomy (3.5% vs. 12.1%; P=0.014), but no other factors were associated with other complications. CONCLUSIONS: There were significant differences in overall complications in relation to urgency of the primary operation and the operation time, but there was no statistical difference in complications between a loop ileostomy and a loop colostomy take- down groups. The significance of these factors appears to be reduced with accurate surgical technique and patient care.
Anastomotic Leak ; Colostomy ; Humans ; Ileostomy ; Ileus ; Patient Care ; Wound Infection

Short-bowel syndrome is functionally defined as a state of malabsorption following loss of small bowel, which comprises the sequelae of nutrient, fluid, and weight loss. The proximal segment of the bowel of a patient with intestinal atresia is usually grossly distended and atonic. In contrast, distal segment is smaller. For this reason, anastomosis of the proximal and the distal segment is technically difficult and may cause no propulsion even when they are anastomosed. We experienced that continuous drip ileostomy feeding with the secretions from the proximal stoma stimulated the distal bowel to accommodate and resolved many sequelae following loss of small bowel in a patient with short-bowel syndrome due to IIIa ileal atresia.
Humans ; Ileostomy* ; Infant, Newborn* ; Intestinal Atresia ; Weight Loss

Permanent ileostomy is usually recommended in the cases of total proctolectomy for cancerous change on the distal rectum from ulcerative colitis or familial adenomatous polyposis, but fecal content through conventional ileostomy is usually liquid or semiliquid. Sometimes, it accompanies dehydration and some nutrient loss as complication. So, the author has devised namely, "antiperistaltic ileostomy" for formed stool evacuation. About 25cm length of the most dismal ileum was cut and this distal segment was reversed with intact mesentery and then antiperistaltic ileostomy was performed. The author has performed antiperistaltic ilestomy in 5 cases of familial adenomatous polyposis, or ulcerative colitis with a cancerous change in the low rectum for the past 5 years at the Department of Surgery in Pusan National University Hospital. The results obtained were as follows. 1) In theantiperistaltic ileostomy, the 24-hour ileostomy discharge was averagely 748 cc, in contrast to 1124 cc from conventional one. 2) In terms of weight, the 24-hour evacuated material from the conventional ileostomy weighed 810 gm on the average, but only 540 gm from the antiperistaltic ileostomy. 3) The 24-hour filtered liquid through a coffee filter of the 24-hour ileostomy discharge weighed averagely 514 gm in the conventional group, which was 63.5% of the prefiltered discharge, and weighed averagely 160 gm in the antiperistaltic group, which was 29.6% of the 24-hour discharge. In conclusion, the antiperistaltic ileostomy is claimed to create the effect of a reservoir by producing intestinal stasis in the segment, forming bacterial proliferation. The antiperistaltic ileostomy as a terminal segment is effective in reducing the daily amount of stool and facilitates stoma care owing to diminished liquid component in the ileostomy discharge.
Adenomatous Polyposis Coli ; Busan ; Coffee ; Colitis, Ulcerative ; Dehydration ; Ileostomy* ; Ileum ; Mesentery ; Rectum

Reversal of Hartmann's procedure is a major surgical procedure associated with significant morbidity and mortality. Because of the difficulty of the procedure, laparoscopic reversal of Hartmann's procedure is not well established. We describe our experience with this laparoscopic procedure to assess its difficulty and safety. Five patients (4 men and 1 woman) underwent laparoscopic reversal of Hartmann's procedure (LRHP). The initial surgeries were performed to manage obstructive colorectal cancer for 4 patients, and rectovesical fistula for one patient. The procedure was laparoscopically completed for 4 patients. Conversion to open laparotomy was required for one patient, secondary to massive adhesion in lower abdomen. Transient ileostomies were made in 2 cases. Operative time ranged from 240 to 545 minutes. There was no operative mortality. LRHP can be performed safely by an experienced surgeon. However, it is still technically challenging and time consuming.
Abdomen ; Colorectal Neoplasms ; Colostomy ; Fistula ; Humans ; Ileostomy ; Laparoscopy ; Laparotomy ; Male ; Operative Time