Abstract
PurposePreventing outlet obstruction associated with a diverting stoma is important. Previously, we constructed a diverting loop ileostomy with the proximal limb of the small intestine on the caudal side, namely the oral inferior (OI) method. However, to address the issue of twisting and stenosis of the small intestine, we recently constructed a diverting loop ileostomy with the proximal limb on the cranial side, namely the oral superior (OS) method. We compared the incidence of outlet obstruction between the two methods.MethodsThe subjects of this retrospective study were 133 patients who underwent colorectal resection or total colectomy, with D2 or more lymph node dissection and diverting loop ileostomy construction, between April, 2001 and December, 2018, at our hospital. The OI method was performed in 54 patients and the OS method was performed in 79 patients.ResultsIn the OS group, a history of laparotomy, neoadjuvant therapy, clinical stage III, and the use of anti-adhesion materials were more common, whereas blood loss and the incidence of outlet obstruction were significantly lower. Multivariate analysis identified only OS placement as a significant factor for reducing the incidence of outlet obstruction.ConclusionWhen constructing a diverting loop ileostomy, placing the proximal limb on the cranial side is important.
Highlights
Recent remarkable advances in preoperative chemoradiation therapy and surgical techniques for lower rectal cancer and the widespread use of this treatment combination have led to an increase in the number of cases of diverting stoma construction to reduce the risk of postoperative leakage [1, 2]
Several reports indicate that rotating the proximal limb of the small intestine to the caudal side is better when constructing loop ileostomy; it is unclear if rotation of the small intestine can prevent OO [18, 19, 21,22,23]
There were no significant differences in stomarelated complications, except for bowel obstruction/ileus and OO, or in the degree of intra-abdominal adhesions confirmed during stoma closure, between the groups (Table 3)
Summary
Recent remarkable advances in preoperative chemoradiation therapy and surgical techniques for lower rectal cancer and the widespread use of this treatment combination have led to an increase in the number of cases of diverting stoma construction to reduce the risk of postoperative leakage [1, 2]. Several reports indicate that rotating the proximal limb of the small intestine to the caudal side is better when constructing loop ileostomy; it is unclear if rotation of the small intestine can prevent OO [18, 19, 21,22,23]. We construct it so that the oral side is the cranial side (oral superior; OS) because of recent findings of twist and stenosis of the small intestinal limb. We conducted this retrospective study to examine the incidence of OO after the OI method versus the OS method
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