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Abudeeb H, Hammad A, Ugwu A, et al. Defunctioning stoma- a prognosticator for leaks in low rectal restorative cancer resection: A retrospective analysis of stoma database. Ann Med Surg (Lond). 2017;21:114-117doi: 10.1016/j.amsu.2017.07.044.
Abudeeb, H., Hammad, A., Ugwu, A., Darabnia, J., Malcomson, L., Maung, M., Khan, K., Mclaughlin, C., & 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 (2012), 21114-117. https://doi.org/10.1016/j.amsu.2017.07.044
Abudeeb, Haytham, et al. "Defunctioning stoma- a prognosticator for leaks in low rectal restorative cancer resection: A retrospective analysis of stoma database." Annals of medicine and surgery (2012) vol. 21 (2017): 114-117. doi: https://doi.org/10.1016/j.amsu.2017.07.044
Abudeeb H, Hammad A, Ugwu A, Darabnia J, Malcomson L, Maung M, Khan K, Mclaughlin C, Mukherjee A. Defunctioning stoma- a prognosticator for leaks in low rectal restorative cancer resection: A retrospective analysis of stoma database. Ann Med Surg (Lond). 2017 Jul 19;21:114-117. doi: 10.1016/j.amsu.2017.07.044. eCollection 2017 Sep. PMID: 28861269; PMCID: PMC5567768.
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Ann Med Surg (Lond). 2017 Jul 19;21:114-117. doi: 10.1016/j.amsu.2017.07.044. eCollection 2017 Sep.

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

Annals of medicine and surgery (2012)

Haytham Abudeeb, Ahmed Hammad, Ajogwu Ugwu, Jamshid Darabnia, Lee Malcomson, Min Maung, Khurram Khan, Clare Mclaughlin, Arijit Mukherjee

Affiliations

  1. The Christie Hospital, Christie NHS Trust, United Kingdom.
  2. St. Thomas Hospital, Guy's & St. Thomas NHS Trust, United Kingdom.
  3. Monklands Hospital, South Lanarkshire NHS Trust, United Kingdom.
  4. Dr Grey Hospital, NHS Grampian, United Kingdom.
  5. Hairmyres Hospital, South Lanarkshire NHS Trust, United Kingdom.

PMID: 28861269 PMCID: PMC5567768 DOI: 10.1016/j.amsu.2017.07.044

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.

Keywords: Anastomotic leak; Loop ileostomy; Low rectal cancer; Reversal

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