Stoma Reversal Research Articles

Prophylactic effect of retromuscular mesh placement during loop ileostomy closure on incisional hernia incidence—a multicentre randomised patient- and observer-blind trial (P.E.L.I.O.N trial)

BackgroundIncisional hernia is a frequent complication following loop ileostomy reversal. Incisional hernias are associated with morbidity, loss of health-related quality of life and costs and warrant the investigation of prophylactic measures. Prophylactic mesh implantation at the time of surgical stoma reversal has shown to be a promising and safe method to prevent incisional hernias in this setting. However, the efficacy of this method has not yet been investigated in a large multicentre randomised-controlled trial (RCT) with adequate external validity. The P.E.L.I.O.N. trial will evaluate the efficacy of prophylactic mesh reinforcement after loop ileostomy closure in decreasing the rate of incisional hernia versus standard closure alone.MethodsP.E.L.I.O.N. is a multicentre, patient- and observer-blind RCT. Patients undergoing loop ileostomy closure will undergo intraoperative 1:1 randomisation into either abdominal wall closure with a continuous slowly absorbable suture in small-stitch technique without mesh reinforcement (control group) or abdominal wall closure with an additional reinforcement with a retromuscular non-absorbable, macro-pore (pore size ≥ 1000 μm or effective porosity >0%) light-weight monofilament or mixed structure mesh. A total of 304 patients (152 per group) will need to be randomised in the study. Based on inclusion and exclusion criteria, 1,014 patients are expected to be screened for eligibility in order to recruit the necessary number of patients. The primary endpoint will be the frequency of incision hernias within 24 months according to the European Hernia Society definition. Secondary endpoints will be the frequency of surgical site occurrences (including surgical site infections, wound seromas and hematomas, and enterocutaneous fistulas), postoperative pain, the number of revision surgeries and health-related quality of life. Safety will be assessed by measuring postoperative complications ≥ grade 3 according to the Dindo-Clavien classification.DiscussionDepending on the results of the P.E.L.I.O.N. trial, prophylactic mesh implantation could become the new standard for loop ileostomy reversal.Trial registrationDRKS00027921, U1111-1273-4657

P446 The INTESTINE study: INtended TEmporary STomas In crohN’s diseasE

Abstract Background Patients with ileocolic Crohn’s disease may require surgery resulting in temporary stoma formation. The impact on quality of life and morbidity related to stomas is well recognised and timely reversal should be targeted to alleviate this affect. This study aims to determine the proportion of stomas reversed, the timing and reasons for non-reversal in patients with Crohn’s disease. Methods This international retrospective trainee-led observational study included patients who underwent surgery for ileocolic Crohn’s disease between January 2017 and December 2020. Patients undergoing proctectomy or proctocolectomy were excluded. The primary outcome was the proportion of patients who still had a stoma at 18 months post-operatively. Secondary outcomes included: interval between formation and reversal of stoma, assessing complications and risk factors from non-reversal of the stoma. Evaluation of these outcomes were documented for short-term (6 months) and mid-term (18 months). Results Currently there are 38 collaborating centres collecting data across 18 countries. We present an intermediate analysis, with full results available in January 2023. Baseline and surgical characteristics are described in Tables 1 and 2. The intermediate analysis included 110 patients of which 37% had their stoma reversed at 6 month follow up (mean time to reversal 3.2 ± 1.4 months), and 56% reversed at 18 months (mean 5.9 ± 4.0 months). Reasons for non-reversal at 6 months included: ongoing Crohn’s disease (30%), patient unfit for surgery (14%), waiting lists (9%) and patient’s preference (8%). Stoma related complications at 6 months were reported in 16% of patients, consisting of: high output (6%), parastomal hernia (5%), stoma stenosis (3%) and peristomal cutaneous lesions (1%). 30-day postoperative outcomes and follow up at 6 and 18 months are reported in Tables 3 and 4. Conclusion This trainee-led international study will provide information on the proportion of stomas that are reversed and the reasons for non-reversal of stomas in Crohn’s disease. Preliminary results demonstrate that 18 months after stoma formation, 1 in 2 patients still had a stoma.

Protective loop ileostomy or colostomy? a risk evaluation of all common complications.

Protective ileostomy and colostomy are performed in patients undergoing low anterior resection with a high leakage risk. We aimed to compare surgical, medical, and daily care complications between these 2 ostomies in order to make individual choice. Patients who underwent low anterior resection for rectal tumors with protective stomas between January 2011 and September 2018 were enrolled. Stoma-related complications were prospectively recorded by wound, ostomy, and continence nurses. The cancer stage and treatment data were obtained from the Taiwan Cancer Database of our Big Data Center. Other demographic data were collected retrospectively from medical notes. The complications after stoma creation and after the stoma reversal were compared. There were 176 patients with protective colostomy and 234 with protective ileostomy. Protective ileostomy had higher proportions of high output from the stoma for 2 consecutive days than protective colostomy (11.1% vs. 0%, P<0.001). Protective colostomy resulted in more stoma retraction than protective ileostomy (21.6% vs. 9.4%, P=0.001). Female sex, open operation, ileostomy, and carrying stoma more than 4 months were also significantly associated with a higher risk of stoma-related complications during diversion. The incidence of complication after stoma reversal did not differ between colostomy group and ileostomy group (24.3% vs. 20.9%, P=0.542). We suggest avoiding colostomy in patients who are female and potential prolong diversion when stoma retraction is a concern. Otherwise, ileostomy should be avoided for patients with impaired renal function. Wise selection and flexibility are more important than using one type of stoma routinely.

Simultaneous Treatment of Complex Incisional Hernia and Stoma Reversal.

Purpose: The simultaneous repair of incisional hernias (IH) and the reconstruction of the intestinal transit may pose a challenge for many surgeons. Collaboration between units specialized in abdominal wall and colorectal surgery can favor simultaneous treatment. Methods: Descriptive study of patients undergoing simultaneous surgery of complex IH repair and intestinal transit reconstruction from the start of treatment in a joint team. All interventions were performed electively and with the collaboration of surgeons experts in abdominal wall and colorectal surgery. Results: 23 patients are included. 11 end colostomies, 1 loop colostomy, 6 end ileostomies and 5 loop ileostomies. Seven (30%) patients presented with a medial laparotomy incisional hernia, 3 (13%) with a parastomal incisional hernia, and 13 (56%) with a medial and parastomal incisional hernia. Closure of the hernial defect was achieved in 100% of cases, and reconstruction of the intestinal tract was achieved in 22 (95%). Component separation was required in 17 patients (74%), which were 11 (48%) posterior and 6 (26%) anterior. In-hospital morbidity was 9%, and only two patients presented Clavien-Dindo morbidity > III when requiring reoperation, one due to hemorrhage of the surgical bed and another due to dehiscence of the coloproctostomy. The mean follow-up was 11months, with 20 (87%) patients having no complications. Mesh had to be removed in one patient with anastomotic dehiscence, no mesh had to be removed due to surgical site infection.

The effectiveness of negative-pressure wound therapy for wound healing after stoma reversal: a randomized control study.

The purse-string closure (PSC) method is used for skin closure after stoma reversal to reduce surgical site infections (SSIs). However, PSC requires a longer healing period than primary closure. The application of negative-pressure wound therapy (NPWT) may reduce the healing period of many wound types. This study aimed to investigate whether the application of NPWT promotes wound healing after the PSC method for stoma reversal. This study was a randomized controlled study. Patients who had undergone stoma reversal surgery were randomized to receive NPWT or simple dressing after surgery. The primary outcome was a complete wound-healing period. We also investigated SSI, hospital stay, total cost, and the patient and observer scar assessment scale (POSAS) as secondary outcomes. A total of 36 patients were randomized into 2 groups. The median wound healing period was shorter in the NPWT group than in the control group (17.5 days [range, 11-24 days] vs. 21.5 days [range, 14-41 days], P = 0.006). SSI rate and hospital stay did not differ between the groups. However, the number of dressings was lower in the NPWT group than in the control group (5 [range, 3-7] vs. 17 [range, 10-30], P < 0.001). The total cost for dressing was comparable between the groups. The POSAS was not different between the groups. This study revealed that NPWT application after PSC for stoma reversal site is effective in reducing the wound healing period compared to simple dressing, without increasing SSI and total cost.

Outcome of Early Reversal of Intestinal Stoma: A Cross-Sectional Study

Outcome of Early Reversal of Intestinal Stoma: A Cross-Sectional Study

Purse-String Closure for Stoma Reversal in Pediatric Patients

Purse-String Closure for Stoma Reversal in Pediatric Patients

Low anterior resection syndrome (LARS): what stoma care nurses need to know

Nurses involved in the care of people having a low anterior resection for rectal cancer need to recognise the potential consequences of cancer treatment. Treatment for rectal cancers can lead to several different consequences, including bowel dysfunction. Bowel changes are collectively termed low anterior resection syndrome (LARS). The nurse can assist in the care of patients with LARS by recognising what LARS is and how it might affect patients. Providing information about LARS can enable patients the opportunity to set realistic expectations of bowel function after stoma reversal. Nursing advice can include basic information on bowel-management strategies, such as dietary manipulation and the use of loperamide. If these initial management strategies are ineffective, there are other interventions that will require onward referral, such as to a biofeedback nurse. Improving bowel symptoms can improve quality of life for patients after rectal cancer treatment.

Gastrointestinal procedures and anastomoses can be safely performed during complex abdominal wall reconstruction.

The literature regarding combined abdominal wall reconstruction and gastrointestinal surgery is limited and largely suggests staged procedures due to a reported increased incidence of surgical site infections (SSIs), hernia recurrence and anastomotic leak, but this exposes patients to the risks of two substantial procedures. This study evaluates the outcomes of single-stage GI surgery with complex abdominal wall reconstructions (CAWR) by a single surgeon. Analysis of 10years of a prospectively maintained single surgeon CAWR database compared those who had CAWR-alone with those having concomitant gastrointestinal surgery (CAWR-GI) such as stoma reversal or bowel resection but excluding cholecystectomy, gynaecological surgery and adhesiolysis alone. Groups were compared using the paired t test (continuous data) and Fisher's exact test (nominal data). Overall, 62 elective cases (42 CAWR-alone vs. 20 CAWR-GI) were analysed. Baseline demographics (age, BMI, co-morbidities, smoking status and hernia size) showed no differences; CAWR-GI mean operating time was significantly longer compared to the CAWR-alone group (5.4h vs. 4.1h) with an increased incidence of post-operative ileus in the intestinal group (40% vs. 11.9%, p < 0.05). Post-operative complications were common (chest infection (32.3%) and SSI (41.9%)), but similar between groups. There were no anastomotic leaks, and the hernia recurrence rate at almost 4years median follow-up was 10% in both groups. Performing simultaneous intestinal surgery during complex abdominal wall repair can be performed safely without increasing the risk of hernia recurrence, mesh infections or anastomotic leak. A careful choice of mesh implant is required.

Open versus laparoscopic Hartmann's procedure: a systematic review and meta-analysis.

Hartmann's procedure is traditionally performed in emergency situations where single-step procedures with immediate anastomosis may be unsafe. However, it can be associated with significant morbidity and low colostomy reversal rate. Whilst randomised controlled trials and a Cochrane review have reported strong evidence of laparoscopic over open colectomies, no such reviews have been performed for Hartmann's procedure. Hence, this paper aims to summarise the existing evidence to determine the efficacy of laparoscopic Hartmann's procedure over its open counterpart. Embase, Medline and Cochrane databases were searched from inception to 15 November 2020 for keywords relating to 'laparoscopy' and 'Hartmann' using strict inclusion and exclusion criteria. Odds ratio was estimated for dichotomous outcomes and weighted mean difference was estimated for continuous outcomes. From the 836 articles yielded from the search strategy, 12 articles were selected for meta-analysis. Pooled analysis revealed that laparoscopic Hartmann's procedure (LHP) allows for a shorter length of stay, and a lower risk of overall surgical site infections and superficial surgical site infections. There was no significant difference in other outcomes. Single-arm analysis of LHP also showed an unprecedented high colostomy reversal rate of over 80%. In clinically suitable patients, laparoscopic Hartmann's procedure has benefits over open Hartmann's procedure. Despite the selection bias of single-arm studies, LHP has reported a high stoma reversal rate of over 80%. Future well-controlled studies should be done to affirm the findings.

Primary versus secondary closure of stoma reversal skin wound: Randomized controlled trial.

To compare the efficacy of primary versus secondary closure of stoma reversal skin wound in terms of wound infection. The study was conducted at Surgical B Unit of Ayub Teaching Hospital, Abbottabad, Pakistan, from January 1 to December 31, 2020, and comprised adult patients of either gender undergoing stoma reversal. The patients were randomised into primary closure group A and secondary closure group B. Surgical procedure was similar in both the groups except the skin closure technique. In group A, skin was closed with interrupted polypropylene sutures, while in group B, wound was dressed with saline-soaked gauze daily using aseptic technique and was allowed to heal by secondary intention or delayed primary closure later on. Postoperatively, the wound was assessed for infection till 30th postoperative day or complete wound healing. Data was analysed using SPSS 16. Of the 50 patients, 35(70%) were males and 15(30%) were females. The overall mean age was 28±1.65years. There were 25(50%) patients in each of the two groups. There were 19(76%) males and 6(24%) females in group A with a mean age of 32±2.8years. There were 16(64%) males and 9(36%) females in group B with a mean age of 23±3.5years. Overall, 10(20%) patients had wound-site infections; 9(36%) in group A versus 1(4%) in group B (p=0.005). Frequency of wound infection with respect to gender, type of stoma and length of hospital stay was not significant (p>0.05). Secondary skin closure was found to be associated with significantly reduced wound infection rate after stoma reversal. https://clinicaltrials.gov/ct2/show/NCT04785404.

Risk factors for anastomotic leakage and postoperative outcomes after total and subtotal colectomy: A nationwide retrospective cohort study (RIALTCOT Study Collaborative Group)

AbstractAimAnastomotic leakage (AL) following ileorectal (IRA) or ileosigmoid (ISA) anastomosis is associated with a high morbidity. The identification of potential risk factors for AL could change operative planning and reduce further complications. This study assesses the rate, potential risk factors and management of AL after total colectomy (TC) and subtotal colectomy (STC).MethodsA nationwide, multicentre, retrospective cohort study involved 26 Spanish referral centres. It included TC and STC with IRA or ISA patients between January 2013 and December 2020. Clinical data, primary surgery and complications were collected. Univariate and multivariate analysis to identify risk factors for AL were performed. Management of Grade B–C AL and permanent stoma rate was assessed according to revisional surgeries.ResultsThe study included 1074 patients, 433 ISA group (40.3%) and 641 IRA group (59.7%). The overall incidence of AL was 14.3% with no differences between IRA and ISA (14.2% and 14.5% respectively), P = 0.871. Male sex, ASA score and lower total preoperative proteins were identified as independent risk factors for global and Grade B–C AL. Diverting ileostomy did not protect against AL (P = 0.084). Clavien–Dindo ≥IIIA complication was found in 251 patients (23.3%). Stoma reversal was not possible in 85 patients (8.1%), being more frequent after anastomosis excision and terminal ileostomy in AL Grade C.ConclusionTotal colectomy and STC with IRA or ISA are high‐risk procedures with an increased AL rate. Male sex, ASA score and lower preoperative protein level were associated with global AL and AL Grade B and C. A lower permanent stoma rate could be obtained when diverting ileostomy is performed in revision surgery.

It Has Become a Part of Me: Living With Low Anterior Resection Syndrome After Ostomy Reversal: A Phenomenological Study.

The purpose of this study was to explore challenges of individuals living with low anterior resection syndrome (LARS) 1 year or more after ostomy reversal and formulate a greater understanding of their needs. Qualitative study with a phenomenological approach. The sample comprised 2 women and 5 men. All participants had undergone low anterior resection in the Comprehensive Cancer Center of a Swiss university hospital. The mean age of participants was 66 years (range, 61-71 years). Interviews were conducted 12 to 42 months after ostomy reversal. Data were collected from one-on-one in-depth interviews using a standardized interview guide with open-ended questions. An interpretative phenomenological analysis was used to interpret data. Analysis revealed 3 central categories addressing the burden of living with LARS: "Internalizing new living conditions"; "Actively planning a new everyday life"; and "Knowing the body and controlling symptoms." "Unpredictability" emerged as the key challenge. Being informed in advance about the problems expected to arise, having the possibility to talk about problems, as well as receiving peer support and structured aftercare were identified as means to ease patients' challenges when living with LARS. Twelve to 42 months after stoma reversal, participants had internalized their new living conditions. Their level of acceptance of their situation was substantial. There are indications that a culture of open information before ostomy reversal contributed to being mentally prepared for the situation after surgery. Talking openly about their problems helped participants organize their everyday life.

Prolapse of intestinal stoma.

Stoma prolapse can usually be managed conservatively by stoma care nurses. However, surgical management is considered when complications make traditional care difficult and/or stoma prolapse affects normal bowel function and induces incarceration. If the stoma functions as a fecal diversion, the prolapse is resolved by stoma reversal. Loop stoma prolapse reportedly occurs when increased intraabdominal pressure induces stoma prolapse by pushing the stoma up between the abdominal wall and the intestine, particularly in cases of redundant or mobile colon. Therefore, stoma prolapse repair aims to prevent or eliminate the space between the abdominal wall and the intestine, as well as the redundant or mobile intestine. Accordingly, surgical repair methods for stoma prolapse are classified into 3 types: methods to fix the intestine, methods to shorten the intestine, and methods to eliminate the space between the stoma and the abdominal wall around the stoma orifice. Additionally, the following surgical techniques at the time of stoma creation are reported to be effective in preventing stoma prolapse: an avoidance of excessive fascia incision, fixation of the stoma to the abdominal wall, an appropriate selection of the intestinal site for the stoma orifice to minimize the redundant intestine, and the use of an extraperitoneal route for stoma creation.

Concurrent Chemo-radiotherapy in Anal Squamous Cell Carcinoma: A Retrospective Review of a Tertiary Centre Experience.

Anal cancer is a rare form of gastrointestinal malignancy, and treatment is often confined to specialist centres. It has a high cure rate with non-surgical approach resulting in organ preservation. The current accepted schedule is chemo-radiotherapy (CRT) with 5-fluorouracil and mitomycin with radiotherapy doses between 50.4 and 53.2 Gray in 28 fractions. This study included patients who had histological confirmation of squamous cell carcinoma and had completed the full CRT course for anal cancer between 2008 and 2018 in our centre. Data was collected retrospectively assessing demographics, staging, surgery, relapse, latest follow-up, date of death, CRT regimen and TNM stage. Outcome data and stoma reversal rate were analysed. Overall, 87 patients were included in the study. At diagnosis 94.3% of patients had T2-T4 disease, and 44.8% had involvement of positive loco-regional lymph nodes. Overall survival (OS) probability at 1, 3 and 5years were 98.8%, 87.4% and 83.7%, respectively. Results also revealed a statistically significant effect of time from diagnosis to the start of radiotherapy on OS (p = 0.039). Sixty-nine (79.3%) patients achieved complete remission at last follow-up. Twenty-one patients (24%) underwent surgery for a de-functioning stoma, and only five of these patients subsequently received stoma reversal surgery. Our data reflects the efficacy of CRT as the primary modality of treatment in the management of anal squamous cell carcinoma with effective organ preservation and disease control. Early stoma reversal may also enhance quality of life.

Impact of a diverting ileostomy in total mesorectal excision with primary anastomosis for rectal cancer

BackgroundThe role of diverting ileostomy in total mesorectal excision (TME) for rectal cancer with primary anastomosis is debated. The aim of this study is to gain insight in the clinical consequences of a diverting ileostomy, with respect to stoma rate at one year and stoma-related morbidity.MethodsPatients undergoing TME with primary anastomosis for rectal cancer between 2015 and 2017 in eleven participating hospitals were included. Retrospectively, two groups were compared: patients with or without diverting ileostomy construction during primary surgery. Primary endpoint was stoma rate at one year. Secondary endpoints were severity and rate of anastomotic leakage, overall morbidity rate within thirty days and stoma (reversal) related morbidity.ResultsIn 353 out of 595 patients (59.3%) a diverting ileostomy was constructed during primary surgery. Stoma rate at one year was 9.9% in the non-ileostomy group and 18.7% in the ileostomy group (p = 0.003). After correction for confounders, multivariate analysis showed that the construction of a diverting ileostomy during primary surgery was an independent risk factor for stoma at one year (OR 2.563 (95%CI 1.424–4.611), p = 0.002). Anastomotic leakage rate was 17.8% in the non-ileostomy group and 17.2% in the ileostomy group (p = 0.913). Overall 30-days morbidity rate was 37.6% in the non-ileostomy group and 56.1% in the ileostomy group (p < 0.001). Stoma reversal related morbidity rate was 17.9%.ConclusionsThe stoma rate at one year was higher in patients with ileostomy construction during primary surgery. The incidence and severity of anastomotic leakage were not reduced by construction of an ileostomy. The morbidity related to the presence and reversal of a diverting ileostomy was substantial.

Purse-String Closure vs Conventional Direct Closure of Wounds after Stoma Reversal: A Prospective Randomized Controlled Study

INTRODUCTION: Surgical site infection (SSI) is one of the most frequent complications after ileostomy closure. Our prospective randomized controlled trial aims to compare 2 operative techniques used to close the wound after ileostomy closure, the direct suture and purse-string suture. The main endpoint was the SSI rate. Secondary endpoint was cosmetic outcomes. METHODS: A total of 100 patients were enrolled and included in the statistical analysis; 50 patients were randomized into the purse-string suture group and 50 were randomized into the direct suture group. Follow-up was performed within 2 days after operation, at discharge, 1 month and 3 months after the operation. RESULTS: The purse-string suture group had a lower number of SSI compared with the direct suture group (2 vs 14, p = 0.007). The secondary outcome of cosmesis was similar in the 2 groups, with no statistically significant difference. CONCLUSION: In our experience, the purse-string suture has a lower risk of stoma site SSI. This type of closure should be considered as standard of care after ileostomy reversal.

P-093 GASTROINTESTINAL PROCEDURES AND ANASTOMOSES CAN BE SAFELY PERFORMED DURING COMPLEX ABDOMINAL WALL RECONSTRUCTION

Abstract Aim The literature regarding combined abdominal wall reconstruction and gastrointestinal surgery is limited and largely suggests staged procedures due to a reported increased incidence of surgical site infections (SSIs), hernia recurrence and anastomotic leak, but this exposes patients to the risks of two substantial procedures. This study aimed to evaluate outcomes of single-stage GI surgery with complex abdominal wall reconstructions (CAWR) by a single surgeon. Materials &amp; Methods Analysis of 10 years of a prospectively maintained single surgeon CAWR database compared those who had CAWR-alone with those having concomitant gastrointestinal surgery (CAWR-GI) such as stoma reversal or bowel resection but excluding cholecystectomy, gynaecological surgery and adhesiolysis alone. Groups were compared using the paired t-test (continuous data) and Fisher's exact test (nominal data). Results Overall, 62 elective cases (42 CAWR alone v 20 CAWR-GI) were analysed. Baseline demographics (age, BMI, co-morbidities, smoking status and hernia size) showed no differences; CAWR-GI mean operating time was significantly longer compared to the CAWR-alone group (5.4hrs vs 4.1hrs) with an increased incidence of post-operative ileus in the intestinal group (40% vs 11.9%, p&amp;lt;0.05). Post-operative complications were common (chest infection (32.3%) and SSI (41.9%)), but similar between groups. There were no anastomotic leaks and the hernia recurrence rate at almost 4 years follow up was 10% in both groups. Conclusion Performing simultaneous intestinal surgery during complex abdominal wall repair can be performed safely without increasing the risk of hernia recurrence, mesh infections or anastomotic leak.

Clinical assessment for non-reversal stoma and stoma re-creation after reversal surgery for patients with rectal cancer having undergoing sphincter-saving operation

BackgroundThis study aimed to identify the risk factors for permanent stoma (PS) in patients who underwent sphincter-saving operations for rectal cancer. MethodsWe retrospectively reviewed 597 consecutive patients with rectal cancer from January 2012 to December 2020 at Taipei Medical University Hospital. Univariate and multivariable analyses were used to analyze risk factors for PS. ResultsAfter a mean follow-up of 47.3 months (range 7–114 months), 59 patients (15.1%) were alive with a PS, including 46 patients who did not undergo reversal surgery and 13 patients who underwent stoma re-creation after reversal surgery. The mean period between primary surgery and stoma reversal was 6.0 months. Multivariate analysis revealed that the risk factors for PS were local recurrence [odd ratio (OR), 25.58; 95% confidence interval (CI), 4.428–147.761; p < 0.001], perirectal abscess [OR, 154.34; 95% CI, 15.806 - >999; p < 0.001], anastomosis site stenosis [OR, 187.081; 95% CI, 22.193 - >999; p < 0.001], perineural invasion [OR, 4.782; 95% CI, 1.22–18.736; p = 0.025], and operation time (min) [OR, 1.008; 95% CI, 1.002–1.014; p = 0.01]. ConclusionsLocal recurrence, perirectal abscess, anastomosis site stenosis, perineural invasion, and operation time were independent risk factors for PS. Therefore, before a patient undergoes surgery for rectal cancer, surgeons should consider the possibility of the need for a PS, and patients should be informed before the operation that closure of the temporary stoma may not always be possible.

Combined stoma reversal and liver resection for rectal metastatic cancer: A single center retrospective analysis.

Concomitant liver metastases are discovered at the time of diagnosis in 25% of patients with colorectal cancers. The appropriate time to restore digestive continuity after stoma creation during rectal surgery has not yet been established. The objective of this study is to assess the morbidity of stoma reversal during the secondary hepatectomy procedure. This was a single-center retrospective case-control study including patients who underwent ileostomy or colostomy reversal by a direct approach (REVERSAL group) compared to those who did not undergo stoma reversal (NON-REVERSAL group) during hepatic resection of rectal cancer metastasis between 2004 and 2016. Peri-operative data were collected. The primary outcome measure was the comprehensive complication index (CCI). The secondary outcomes were overall mortality, liver-related morbidity, duration of hospital stay and occurrence of gastrointestinal leaks. Statistical analysis was carried out using SPSS 23.0 software. Thirty liver resections were included; 14 in the REVERSAL group (female/male=11/19, age=60 years). No statistically significant difference was observed in the CCI scores (15 vs. 20.8; P=0.6). Complications occurred in 9 (64%) and 8 (50%) patients in the REVERSAL and NON-REVERSAL groups, respectively (P=0.48). No gastro-intestinal leaks or post-operative mortality occurred. Stoma reversal during hepatectomy for liver metastasis from a primary rectal cancer represents a safe alternative since post-operative outcome was not associated with additional morbidity in this series.