Loop Colostomy Research Articles

054. Loop Ileostomy Versus Loop Colostomy to Prevent Complications of Anterior Resection for Rectal Cancer: A Systematic Review and Meta-Analysis

Background: Anastomotic leaking constitutes a significant complication of colorectal cancer surgery, extending hospitalizations and adversely affecting patient prognosis. The preventative defunctioning stoma was created to diminish reoperation morbidity and death in high-risk anastomoses. Nonetheless, it is still uncertain if the often-employed loop colostomy (LC) or loop ileostomy (LI) can mitigate the risks associated with colorectal surgery. This study aims to evaluate the morbidities associated with LC and LI following anterior rectal cancer resection. Methods: We searched PubMed, Embase, WileyOnline Library, and the Cochrane Library to identify studies and trials published from 2019 to early 2024. The results of this investigation included stoma formation, stoma restriction, stoma stricture, and necrosis. We employed Revman 5.4.2 to do the meta-analysis. Results: Five studies were considered, comprising 1,011 patients, with 482 undergoing loop ileostomy and 529 undergoing loop colostomy. Our findings indicate that loop ileostomy was correlated with a reduction in the incidence of stoma formation, with a relative risk (RR) of 1.31 (95% CI [1.14; 1.49], p < 0.0001), and a decrease in stoma stricture, with an RR of 0.45 (95% CI [0.28; 0.72], p = 0.0009). Our results reveal that loop ileostomy was associated with an increased incidence of stoma retraction (RR 0.50, 95% CI [0.18; 1.37], p = 0.17) and necrosis (RR 0.84, 95% CI [0.47; 1.49], p = 0.54). Conclusion: This study demonstrated that loop ileostomy was related to reducing the incidence of stoma formation and stoma restriction. Additional investigations are required to validate these findings.

The Assessment of the Incidence of Parastomal Hernia in End Colostomy Patients Using Lateral Pararectal Approach versus Transrectal Approach; A Retrospective Comparative Study

Abstract Background A colostomy is a surgical procedure by which a stoma is constructed through exteriorization of the large intestine. A colostomy can be a loop colostomy or an end colostomy. Para-stomal hernia (PSH) is the most frequent late complication in patients with a stoma, but its true incidence is still difficult to determine. Since various surgical approaches for stoma placement in cancer colon represents major conflict and may be associated with complications, comparing the lateral pararectal with the transrectal stoma position with regard to parastomal herniation, stoma-related morbidity and quality of life was highlighted as a main point of interest. Objective To compare lateral pararectal and transrectal stoma placement regarding the incidence rate of parastomal hernia and other stoma complications. Methods This retrospective comparative study was conducted at tertiary care hospital at Ain Shams University hospitals from March 2023 till August 2023 and performed on total 50 patients who cases that had undergone end colostomy in Ain Shams University hospitals from January 2020 to January 2022 through either transrectal or pararectal approach regarding incidence of parastomal hernia. Results There was no significant difference between the studied groups regarding baseline demographic (age, sex and BMI) (p values = 0.245, 0.821, 0.578) respectively. Regarding risk factors of hernias, our study results revealed that chronic constipation was the most common risk factor (80%), followed by smoking (66%) and respiratory co-morbidities (28%). Colorectal cancer was the most common cause of surgical indication with no statistically significant differences among the study groups as regards the surgical indications (Colorectal cancer resection, Diverticular resection, IBD and Ischemic colitis) (p values = 0.715, 0.645, 0.913, 0.413) respectively. The presence of a parastomal hernia was confirmed in 21 patients (42%), 14 males and 7 females. In all these patients, clinical examination showed a parastomal mass in the upright position and while making a voluntary increase in abdominal pressure. The mass remained in 10 patients after returning to the prone position. The position of the colostomy, determined by means of clinical examination, was transrectal in 21 patients (42%), pararectal in 24 (48%). Colostomy position was doubtful in 5 (10%) cases; using CT it was possible to establish that the colostomy was in a transrectal position in four of these patients and pararectal in one. The position of the colostomy, therefore, was pararectal in 25 (50%) of the 50 patients studied and transrectal in 25 (50%). There were no statistically significant differences among the study groups as regards the postoperative complications (stoma prolapse, retraction, SSI, stoma stenosis and operative revision). Conclusion Creating colostomies away from the lateral edge of the rectus abdominis muscle i.e., at a “para-rectus” position is associated with a lower risk of having para-stomal hernia and is as effective as, if not better, creating those stomas at the “trans-rectus” site.

Anorectal avulsion-an unusual anorectal trauma

Anorectal avulsion is a rare trauma. In this type of lesion, the anus and the sphincter complex are pulled up by a tremendous compression of the pelvic floor. Frequently, this trauma is associated with other injured organs, like pelvic bones or urethra. We report a case of a young man who was admitted with a total anorectal avulsion associated with a pelvic fracture. A multidisciplinary treatment included external fixation of the broken pelvis, suprapubic cystostomy, sigmoid loop colostomy and reimplanting the anal complex in the original position with appropriate drainage. Anorectal injuries are uncommon and represent about less than 10% of rectal trauma, but anorectal avulsion is extremely rare. These cases often require a quick decision making and multidisciplinary approaches to reduce the possibilities of morbidity and mortality.

Impact of the Diverting Stoma on Renal Function.

Although loop ileostomy as a diverting stoma has been considered to affect renal dysfunction, few reports have compared loop colostomy with loop ileostomy regarding renal function. This is an important issue in the current setting of increased opportunities to perform surgery on patients with poor renal function. This study aims to reveal the effect of ileostomy on renal dysfunction compared to colostomy following sphincter-preserving rectal surgery. This study was a retrospective analysis. We compared preoperative and postoperative blood urea nitrogen, serum creatinine and estimated glomerular filtration rate values. The study was conducted at a single academic institution in Osaka, Japan. From October 2013 to November 2021, 135 consecutive patients underwent rectal surgery with diverting stoma are included. Differences in pre- and postoperative renal function values by stoma creation site in patients with preoperative chronic kidney disease. Risk factors for patients with newly kidney disease after stoma creation. In the preoperative chronic kidney disease (+) patients, the differences between the pre- and post-values in the blood urea nitrogen (p = 0.047) and the serum creatinine (P = 0.028) values were higher than in the preoperative chronic kidney disease (-) patients. In the preoperative chronic kidney disease (+) patients, ileostomy was significantly associated with an elevation of the serum creatinine value (p = 0.025) and a decrease in estimated glomerular filtration rate value (p = 0.041) from the pre-operative one compared with that of colostomy. In multivariate analysis, ileostomy (odds ratio; 7.443, p = 0.011) and hypertension (4.226, p = 0.008) were independent risk factors of newly kidney disease postoperatively. Limitations to our study includes its retrospective nature and bias due to the stoma site being determined by each surgeon. We should take care to choose diverting stoma especially in patients with a risk of kidney disfunction. See Video Abstract.

A case of small bowel evisceration through the rectum and anus

A 46-year-old man presented with a small bowel prolapsing through the anus after straining on the toilet, which was starting to become ischaemic. He admitted to inserting a plastic object in his rectum about half an hour before straining. The bowel was kept moist by placing an intravenous drip line with saline dripping onto a wet swab. In theatre, the bowel was found to be prolapsing through a hole in the upper rectum and out through the anus. It was reduced back into the abdominal cavity through the same perforation, which was 4 cm long, without needing to extend it. This was sutured with polydioxanone (PDS) 2-0 as there was no contamination with faeces or pus. Due to improvement in the appearance of a small bowel and an extremely bruised mesentery, a re-look was planned in 24 hours. At the re-look the small bowel appeared healthy, therefore no resection was performed. However, a loop colostomy was fashioned to protect the upper rectal perforation repair. This shows that resection is not always required in such cases.

Optimizing stoma closure: A laparoscopic technique yielding the least contamination.

In this study, we introduce a novel method for stoma closure, aiming to reduce wound infection rates. This method involves creating the common channel of both limbs of a loop stoma extracorporeally, which is particularly beneficial during laparoscopic stoma closure surgery by potentially avoiding contamination of the wound. We applied this technique in 23 patients undergoing laparoscopic stoma reversal surgery, comprising both loop colostomy and ileostomy cases. Notably, postoperative outcomes were promising: only two patients experienced postoperative ileus, and importantly, there were no instances of wound infection. These findings suggest that our laparoscopic stoma reversal surgery approach is not only safe and feasible but also offers a significant advantage in reducing wound infection rates.

Risk factors for stoma prolapse after laparoscopic loop colostomy.

Stoma prolapse (SP) is a common stoma-related complication, particularly in loop colostomies. This study aimed to investigate potential risk factors for SP development after laparoscopic loop colostomy. In total, data from 140 patients who underwent laparoscopic loop colostomy were analyzed between September 2016 and March 2022. Risk factors for SP were investigated retrospectively. The median follow-up duration after colostomy was 12.5months, and SP occurred in 33 (23.6%) patients. Multivariate analysis showed that being overweight (body mass index ≥ 25; odds ratio [OR], 8.69; 95% confidential interval [CI], 1.61-46.72; p = 0.012) and having a thin rectus abdominis penetration of the stoma (< 8.9mm; OR, 8.22; 95% CI, 2.50-27.05; p < 0.001) were independent risk factors for SP. Other patient characteristics and surgical factors associated with stoma construction were unrelated to SP development. Being overweight and the route penetrating the thinner rectus abdominis during stoma construction was associated with a significantly higher incidence of SP after laparoscopic loop colostomy. Selecting a construction site that penetrates the thicker rectus abdominis muscle may be crucial for preventing SP.

Хірургічне лікування природженої аноректальної вади розвитку з ректовезикальною норицею в хлопчиків

Congenital rectovesical fistula (RVF) is the most complex variant of anorectal malformations (ARM) in boys, characterized by a fistula connecting the rectum with the bladder. Purpose - to evaluate the results of surgical correction of RVF in children, using a differentiated approach to the diagnosis of this defect, depending on the anatomical options, the clinical course of associated defects, and, based on this, to develop the main tactical requirements for the treatment of this complex congenital ARM in children. Materials and methods. The study included 9 boys: 7 - RVF without pouch colon and 2 - RVF with congenital pouch colon, which accounted for 5.8% of all treated anorectal anomalies (n=154). Results. In patients with RVF without pouch colon: a double-stem disconnecting colostomy was performed in 3 (33.3%) and a double-stem loop colostomy in 4 (44.4%) boys. In children with RVF and pouch colon: a longitudinal, narrowing, stapler coloplasty of the large intestinal "pouch" was performed, with removal of the terminal stoma (n=1); formation of a double-stem disconnecting stoma without separation of the RVF, and at the II stage - elimination of the RVF, removal of the large intestinal «bag» and preservation of the ileostomy - as a permanent, lifelong stoma (n=1). In 7 (100%) patients with RVF without pouch colon at the II stage, abdomino-perineal posterosagittal anorectoplasty with separation of RVF was performed (n=5). At the III stage, 5 patients with RVF without a pouch colon underwent local access stoma closure. At the stages of primary correction of RVF 55.6% (n=5) of children had coloproctological complications. Conclusions. The use of a differentiated approach to diagnosis and methods of anorectoplasty, as well as the use of a complex of rehabilitation treatment in patients with RVF without a pouch colon made it possible to obtain good results in 50% and satisfactory results in 50% of children. Congenital pouch colon - a significant expansion of part or the entire colon already in the fetus, makes it possible to suspect and diagnose this defect in the prenatal period, and to carry out delivery and surgical correction in a specialized perinatal center. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research. No conflict of interests was declared by the author.

Purse-string skin closure versus linear skin closure in people undergoing stoma reversal.

Stoma reversal is associated with a relatively high risk of surgical site infection (SSI), occurring in up to 40% of cases. This may be explained by the presence of microorganisms around the stoma site, and possible contamination with the intestinal contents during the open-end manipulation of the bowel, making the stoma closure site a clean-contaminated wound. The conventional technique for stoma reversal is linear skin closure (LSC). The purse-string skin closure (PSSC) technique (circumferential skin approximation) creates a small opening in the centre of the wound, enabling free drainage of contaminants and serous fluid. This could decrease the risk of SSI compared with LSC. To assess the effects of purse-string skin closure compared with linear skin closure in people undergoing stoma reversal. We searched CENTRAL, MEDLINE, Embase, two other databases, and three trials registers on 21 December 2022. We also checked references, searched for citations, and contacted study authors to identify additional studies. We included all randomised controlled trials (RCTs) comparing PSSC and LSC techniques in people undergoing closure of stoma (loop ileostomy, end ileostomy, loop colostomy, or end colostomy) created for any indication. Two review authors independently selected eligible studies, extracted data, evaluated the methodological quality of the included studies, and conducted the analyses. The most clinically relevant outcomes were SSI, participant satisfaction, incisional hernia, and operative time. We calculated odds ratios (ORs) for dichotomous data and mean differences (MDs) for continuous data, each with its corresponding 95% confidence interval (CI). We used the GRADE approach to rate the certainty of the evidence. Nine RCTs involving 757 participants were eligible for inclusion. Eight studies recruited only adults (aged 18 years and older), and one study included people aged 12 years and older. The participants underwent elective reversal of either ileostomy (82%) or colostomy (18%). We considered all studies at high risk of performance and detection bias (lack of blinding) and four studies at unclear risk of selection bias related to random sequence generation. PSSC compared with LSC likely reduces the risk of SSI (OR 0.17, 95% CI 0.09 to 0.29; I2 = 0%; 9 studies, 757 participants; moderate-certainty evidence). The anticipated absolute risk of SSI is 52 per 1000 people who have PSSC and 243 per 1000 people who have LSC. The likelihood of being very satisfied or satisfied with stoma closure may be higher amongst people who have PSSC compared with people who have LSC (100% vs 89%; OR 20.11, 95% CI 1.09 to 369.88; 2 studies, 122 participants; low-certainty evidence). The results of the analysis suggest that PSSC compared with LSC may have little or no effect on the risk of incisional hernia (OR 0.51, 95% CI 0.07 to 3.70; I2 = 49%; 4 studies, 297 participants; very low-certainty evidence) and operative time (MD -2.67 minutes, 95% CI -8.56 to 3.22; I2 = 65%; 6 studies, 460 participants; very low-certainty evidence). PSSC compared with LSC likely reduces the risk of SSI in people undergoing reversal of stoma. People who have PSSC may be more satisfied with the result compared with people who have LSC. There may be little or no difference between the skin closure techniques in terms of incisional hernia and operative time, though the evidence for these two outcomes is very uncertain.

Novel Repair Technique for Oral and Anal Side Stoma Prolapse of a Loop Colostomy With the Stapled Modified Altemeier Method Using Indocyanine Green Fluorescence Imaging.

Stoma prolapse is a common complication in the late phase after stoma creation. With advances in chemotherapy, a double-orifice colostomy or ileostomy and chemotherapy are used to treat primary unresectable colorectal cancer. Preoperative therapy with a double-orifice colostomy or ileostomy is performed to aid primary colorectal cancer miniaturization. Therefore, the number of stoma prolapses will likely increase in the future. Previous reports on the repair of stoma prolapse focused on unilateral stoma prolapse of loop colostomy, and there are no reports about the bilateral stoma prolapse of loop colostomy or ileostomy. We report a novel repair technique for oral and anal side (bilateral) stoma prolapse of a loop colostomy with the stapled modified Altemeier method using indocyanine green (ICG) fluorescence imaging considering the distribution of marginal artery in preventing marginal artery injury which has considerable clinical significance. Our novel technique for the oral and anal side prolapse of a loop colostomy is considered effective and safe.

Experience with colostomy and colostomy reversal in children in Bauchi.

Colostomy is one of the common surgical procedures performed in pediatric surgical practice. The aim of this study was to retrospectively review our experience with colostomy and closure (reversal) in children. A retrospective review of the data of all children aged 15 years and below who had colostomy and colostomy closure in the past 5 years. Of the 67 children who had colostomy 42 (62.7%) boys and 25 (37.3%) girls, with an age range between 13 months and 8 years. Fifty-six (83.6%) of the children were <2 years. Anorectal malformation 53 (79.1%) was the common indication. Divided colostomy was performed in 62 (92.5%) patients and loop colostomy was performed in 5 (7.5%) patients. All the patients had intraperitoneal colostomy closure. A complication rate of 26.4% was seen. Duration of hospital stay ranged between 4 and 10 days. No mortality was recorded. Colostomy reversal is a safe procedure but morbidity may ensure and can easily manage.

Repair of stoma prolapse with the "peristomal cerclage" method using vessel tape.

Stoma prolapse is one of the most common late complications following stoma construction. Although prolapses can be managed conservatively, they often require surgical revision. This study aimed to describe a revision method called peristomal cerclage applied with local anesthesia to treat stoma prolapse. A 66-year-old male patient with advanced rectal cancer underwent sigmoid loop colostomy one year ago due to a distal occlusive tumor. A revision of the colostomy prolapse that developed postoperatively was planned. After the reduction of the 12 cm prolapse into the abdomen under local anesthesia, a repair was performed in the form of peristomal wrapping of a vessel tape; except for short-term abdominal distension, no complications developed in the patient. He is currently in the postoperative 26th month and terminal period, and his colostomy is working normally. The present report aimed to describe the peristomal cerclage method, a minimally invasive revision procedure applied to patients with stoma prolapse, and to deliver its long-term results. It is important to report the results obtained with the more widespread use of this method.

Stomal Prolapse Due to Sidedness of Transverse Loop Colostomy: A Retrospective Cohort Study.

Stomal prolapse (SP) is one of the most common complications of loop colostomy and can impair a patient's quality of life. Herein, we evaluated the risk factors for SP to prevent its occurrence after a transverse loop colostomy. This retrospective study included 84 patients who underwent loop transverse colostomy between January 2016 and December 2020. We evaluated the incidence of SP and examined the relationship between perioperative factors and SP using univariate and multivariate logistic regressions. SP occurred in 11 (13.0%) patients. Median time to SP was 99 postoperative days. In the univariate analysis, a right side abdominal wall stoma site, perioperative chemotherapy, and anti-VEGF antibody therapy were associated with a significantly higher incidence of SP. Multivariate analysis identified that construction of a temporary loop colostomy in the right transverse colon during rectal cancer surgery (odds ratio, 5.07; 95% confidence interval, 1.12-22.86) is an independent risk factor. In this study, multivariate analysis showed that the right side of the transverse colon was a risk factor for SP. Therefore, when constructing a transverse colon loop stoma, the stoma should be constructed in the left transverse colon to prevent SP.

Minimally invasive treatment of multiple primary tumors of the gastrointestinal tract. Clinical observation

For now days we don’t have any guidelines for the treatment of synchronous and metachronous tumors of the upper and lower gastrointestinal tract. In this case report, we are talking about optimal treatment strategy in a patient with early gastric cancer, a neuroendocrine tumor of the sigmoid colon, and a locally advanced rectal cancer. The patient underwent laparoscopic gastrectomy and endoscopic excision of the early neuroendocrine tumor of the sigmoid colon. View of the local advanced rectal cancer patient underwent combined preoperative “sandwich” treatment with 2 courses of chemotherapy before a long course of chemoradiotherapy and 2 courses of chemotherapy after. The treatment was well tolerated. Ten weeks later, the patient gets surgical procedure: laparoscopic low anterior resection with loop colostomy followed by adjuvant chemotherapy. At the end of chemotherapy colostomy closure was done. The minimally invasive surgical treatment is safe and feasible in patients with synchronous malignancies of upper and lower gastrointestinal tract. Fast track rehabilitation and minimal surgical trauma ensure timely delivery of chemotherapy.

Efficacy of laparoscopic surgery for loop colostomy: a propensity-score-matched analysis.

Colostomy is a common procedure for fecal diversion, but the optimal colostomy approach is unclear in terms of surgical outcomes and stoma-related complications. The purpose of this study was to examine the efficacy and feasibility of laparoscopic loop colostomy. This retrospective cohort study included patients who underwent loop colostomy at Shizuoka Cancer Center in Japanbetween April 2010 and March 2022. Patients were divided into two groups based on surgical approach: the laparoscopic (LAP) and open (OPEN) groups. Surgical outcomes and the incidences of stoma-related complications such as stomal prolapse (SP), parastomal hernia (PSH), and skin disorders (SD) were compared with and without propensity score matching. Of the 388 eligible patients, 180 (46%) were in the LAP group and 208 (54%) were in the OPEN group. The male-to-female ratio was 5.5:4.5 in the Lap group and was 5.3:4.7 in the OPEN group, respectively. The median age was 68 years (range, 31-88 years) in the LAP group and 65 years (range, 23-93 years) in the OPEN group, respectively. The LAP group, compared with the OPEN group, had a shorter operative time and lower incidences of surgical site infection (3.9% versus 16.3%, respectively; p < 0.01) and SD (11.7% versus 24.5%, respectively; p < 0.01). There was no significant difference between the LAP and OPEN groups in the incidence of SP (17.3% versus 17.3%, respectively) or PSH (8.9% versus 6.7%, respectively). After propensity score matching, the incidences of surgical site infection and SD were significantly lower in the LAP group than in the OPEN group, while there were no significant differences in the operative time or the incidences of SP and PSH. Our results suggest that laparoscopic surgery could be beneficial and feasible in loop colostomy.

Endoscopic management of acute sigmoid volvulus in high risk surgical elderly patients: a randomized controlled trial

BackgroundMost patients with sigmoid volvulus are of old age with multiple comorbidities. So, the risk of surgery for those elderly patients is usually associated with increased rates of morbidity and mortality. Early intervention is required for managing sigmoid volvulus to avoid its serious complications; therefore, early endoscopic untwist of sigmoid colon can be performed followed by endoscopic fixation of sigmoid colon under sedation in this category of the patients to avoid development of high risk surgical complications following surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy procedure to relieve obstruction.MethodsThis prospective randomized controlled clinical trial included all patients who developed acute sigmoid volvulus and were referred to the Zagazig University Hospital Emergency Department between December 2020 and August 2022. The study was prospectively approved by Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 9989/23-10-2022) and was retrospectively submitted in http://clinicaltrials.gov in November 2022 (http://clinicaltrials.gov ID: NCT05620446). Included eligible patients were simply randomized at a 1:1 ratio to “Endoscopic Group (EG)” or “Surgical Group (SG)” via drawing of sealed envelopes containing computer-generated random numbers prepared by a third party before start of intervention.ResultsSample size included 18 patients divided into 2 equal groups. (1) Endoscopic group included 9 patients who were subjected to endoscopic untwist of sigmoid colon followed by endoscopic fixation of sigmoid colon under sedation; (2) Surgical group included 9 patients who were subjected to surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy under general anesthesia. In comparison between both groups, there were statistically significant differences regarding length of hospital stay and procedure time. Unfortunately, there were no statistically significant differences regarding postoperative complications and co-morbidities. Eight patients in the endoscopy group demonstrated excellent quality of life, and one demonstrated good quality of life; unlike the surgical group, there were 3 patients with excellent quality of life, 5 patients with good quality of life, and 1 patient with poor quality of life. So there was statistically significant difference regarding quality of life between both groups. During the 9-month follow-up period, both groups demonstrated no cases of recurrence post-fixation.ConclusionEndoscopic management of acute sigmoid volvulus is effective and safe in elderly high risk surgical patients (either in managing the intestinal obstruction caused by volvulus or in definitive treatment of volvulus).

Comparison of Enhanced Recovery After Surgery (ERAS) Pathway Versus Standard Care in Patients Undergoing Elective Stoma Reversal Surgery- A Randomized Controlled Trial

BackgroundPractices such as prolonged preoperative fasting, bowel preparation, delayed ambulation and resumption of orals result in morbidity in 15-20% of stoma reversal cases which can be improved by Enhanced Recovery After Surgery (ERAS) pathways. AimTo evaluate the safety, feasibility and efficacy of ERAS pathway in patients undergoing elective loop ileostomy or colostomy reversal surgery MethodsThis was an open-labeled, superiority randomized controlled trial in which patients undergoing loop ileostomy or colostomy reversal were randomized to standard or ERAS care. Patients with ASA class ≥3, needing laparotomy for stoma reversal, cardiac, renal and neurological illnesses were excluded. Components of ERAS protocol included pre-operative carbohydrate loading, avoidance of mechanical bowel preparation, goal directed fluid therapy, avoidance of long-acting opioid anesthetics or analgesics, avoidance of drains, urinary catheter or nasogastric tube, early mobilization and early enteral feeding. The primary outcome was length of stay (LOS) while the secondary outcomes were postoperative recovery and morbidity parameters. ResultsForty patients each were randomized to standard care and ERAS. Demographic and laboratory parameters between the two groups were comparable. ERAS group patients had significantly reduced LOS (5.3±0.3 vs 7 ± 2.6; mean difference: 1.73 ± 0.98; p=0.0008). Functional recovery was earlier in the ERAS group compared to the standard care group, such as early resolution of ileus (median-2 days; p<0.001), time to first stool (median-3 days; p=0.0002), time to the resumption of liquid diet (median-3 days; p<0.001) and solid diet (median-4 days; p<0.001). Surgical site infections (SSI) were significantly lesser in ERAS group (12.5% vs 32.5%; p=0.03) while postoperative nausea/vomiting (p=0.08), pulmonary complications (p=0.17) and urinary tract infections (p=0.56) were comparable in both groups. ConclusionERAS pathways are feasible, safe and significantly reduces LOS in patients undergoing elective loop ileostomy or colostomy reversal surgery.

582 A case of small bowel prolapsing through the anus

Abstract Introduction A 46 year old man presented to the accident and emergency department in severe pain and with bowel prolapsing through the anus. This occurred when he was straining on the toilet. On closer examination it was noted that the bowel coming through the anus was small bowel, and starting to become ischaemic. On closer questioning he admitted to inserting a plastic object in his rectum about half an hour prior to straining. He was therefore taken straight to theatre for a laparotomy. Intra operative findings A midline laparotomy was performed. The small bowel was reduced back into the abdominal cavity and packed away in a warm swab. The rectum was examined and a 4cm hole was seen in the upper rectum. There was no contamination with faeces or pus, therefore it was sutured with PDS 2-0. By this time the small bowel was looking less dusky however the mesentery was extremely bruised. As there was improvement a decision was made to close and re-look in 24 hours. He was kept intubated overnight in ITU and was taken back to theatre the next day. At this point the small bowel appeared pink and healthy, therefore no resection was performed however a loop colostomy was fashioned to protect the upper rectal perforation repair. Discussion This is a rare condition with very few cases described in the literature. Management is highly dependent on clinical presentation. Imaging was not felt to be helpful in this case due to obviously comprised small bowel therefore he was operated on immediately.

Complications of preventive loop ileostomy versus colostomy: a meta-analysis, trial sequential analysis, and systematic review

BackgroundPreventive colostomy is required for colorectal surgery, and the incidence of complications associated with ileostomy and colostomy remains controversial. This study aimed to compare the incidence of postoperative complications between ileostomy and colostomy procedures.MethodsData analysis was conducted on 30 studies, and meta-analysis and trial sequential analysis (TSA) were performed on five studies. The basic indicators, such as stoma prolapse, leak, wound infection, ileus, and a series of other indicators, were compared.ResultsNo statistically significant differences were observed with complications other than stoma prolapse. Meta-analysis and TSA showed that the incidence of ileostomy prolapse was lower than that of colostomy prolapse, and the difference was statistically significant. Apart from the four complications listed above, the general data analysis showed differences in incidence between the two groups. The incidence of skin irritation, parastomal hernia, dehydration, pneumonia, and urinary tract infections was higher with ileostomy than with colostomy. In contrast, the incidence of parastomal fistula, stenosis, hemorrhage, and enterocutaneous fistula was higher with colostomy than with ileostomy.ConclusionsThere were differences in the incidence of ileostomy and colostomy complications in the selected studies, with a low incidence of ileostomy prolapse.PROSPERO registration numberCRD42022303133.

Acute stomal necrosis, conservative management. Case report and literature review

It is estimated that in the world in 2019 there were 1.3 million people living with an ostomy, and that each year in the US around 100,000 colostomies are made, most of which are performed due to trauma or cancer, offering a fairly good alternative In acute cases but they are not exempt from complications , one of the less frequent is ostomal necrosis which is generally managed surgically , we present the case of a patient who due to advanced cervical cancer had to undergo an urgent loop colostomy due to intestinal obstruction , which on the second day presented a purplish coloration and was managed conservatively and resolved spontaneously . We present this case as an alternative treatment for this ostomy complication for the knowledge of the scientific community.