Temporary Ileostomy Research Articles

Routine Contrast Imaging of Low Pelvic Anastomosis Prior to Closure of Defunctioning Ileostomy: is it Necessary?

PurposeThe purpose of the study was to determine the utility of routine contrast enema prior to ileostomy closure and its impact on patient management in patients with a low pelvic anastomosis. Material and MethodsTwo hundred eleven patients had a temporary loop ileostomy constructed to protect a low colorectal or coloanal anastomosis following low anterior resection for cancer (57%) or other disease (12%) or to protect an ileal pouch–anal anastomosis following restorative proctocolectomy (31%). All patients were evaluated by physical examination, proctoscopy, and water-soluble contrast enema prior to ileostomy closure. Imaging results were correlated with the clinical situation to determine the effects on patient management. ResultsThe mean time from ileostomy creation to closure was 15.6 weeks. Overall, 203 patients (96%) had an uncomplicated course. Eight patients (4%) developed an anastomotic leak, seven of which were diagnosed clinically and confirmed radiographically before planned ileostomy closure. Resolution of the leak was confirmed by follow-up contrast enema. One patient, whose pouchogram revealed a normal anastomosis, clinically developed a leak after ileostomy closure. It is important to note that routine contrast enema examination did not reveal an anastomotic leak or stricture that was not already suspected clinically. ConclusionsAll patients who developed an anastomotic leak in this study were diagnosed clinically, and the diagnosis was confirmed by selective use of radiographic tests. Routine contrast enema evaluation of low pelvic anastomoses before loop ileostomy closure did not provide any additional information that changed patient management. The utility of this routine practice should be questioned.

The Duhamel/Martin operation in the treatment of Hirschsprung's disease.

Thirty-four patients with Hirschsprung's disease, 17 of whom were operated on by the original Duhamel procedure and 17 by the Martin modification are reported on. Thirty-two have had a satisfactory result. Fourteen patients developed early complications. One patient died. Twenty-two have been followed for more than five years. The Martin modification obviates the main disadvantage of the Duhamel operation. A proximal temporary diversionary colostomy or ileostomy greatly reduces the incidence of complications following the pull-through procedures.

This Month in Gastroenterology

This Month in Gastroenterology

Results of laparoscopic anterior resection for rectal adenocarcinoma: retrospective analysis of 157 cases

BackgroundLaparoscopic excision of rectal tumors has gained favor in the last decade and several issues have reported encouraging results: still, the use of laparoscopy remains open to debate. The aim of the current study is to assess the reliability of laparoscopic anterior resection (LAR) for rectal cancer analyzing short-term outcomes and long-term survival. MethodsThe charts of 157 patients were reviewed retrospectively after anterior resection for rectal adenocarcinoma performed by minimal access. Patients undergoing emergency surgery were excluded. LAR was excluded in presence of preoperative features at computed tomography (CT) scan suggesting bulky tumors unresectable by laparoscopy or in case of anesthesiologic contraindications. Conversion rate and functional and oncologic outcomes were analyzed. Data on long-term results and survival were evaluated. ResultsLAR was performed in 157 patients, and conversion to laparotomy was required in 12 cases. Mean operation time for nonconverted patients was 229 minutes (overall 238 minutes). Total mesorectal excision (TME) was performed in tumors of the mid and low rectum and a temporary ileostomy was performed in 56 patients. The mean length of hospital stay (LOS) was 10.5 days. Morbidity of anterior resection included 17 anastomotic leaks after laparoscopic surgery (LS; 5 in the converted patients). Conversion increased significantly the risk of leak (P < .005). Two leaks caused death. The mean number of nodes collected was 12. The incidence of local relapse was 4%, and the rate of anastomotic recurrence was nil. Survival probability with LS was .73 at 5 years. Patients in stage III took advantage of adjuvant treatment and had a better survival than patients in stage II (P = not significant [NS]). ConclusionsThe outcomes of this study suggest that LAR for rectal cancer is a reliable procedure. Oncologic requirements were respected; parameters such as length of specimen, distal margin, and number of nodes retrieved were quite acceptable. Incidences of local recurrence and long-term survival were comparable with those of other series.

Quality of Life after Low Anterior Resection and Temporary Loop Ileostomy

Low anterior resection has become the operation of choice for mid rectal or low rectal cancer. A defunctioning stoma is routinely created at some centers to decrease the risk of leakage requiring surgical intervention. This study was designed to evaluate the quality of life in patients undergoing low anterior resection with a temporary ileostomy. A prospective longitudinal study was conducted in 22 patients with rectal cancer who underwent low anterior resection with a loop ileostomy. Quality of life was assessed by using the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-CR38 questionnaires. Twenty-five patients who underwent high anterior resection for rectosigmoid cancer were studied concurrently to evaluate the impact of major colorectal resection without a stoma. Patients' scores on the quality of life questionnaires generally improved after high anterior resection; however, for patients who underwent low anterior resection, the scores for physical and role functioning before ileostomy closure were worse than the preoperative values. The scores on the quality of life questionnaires generally improved after ileostomy closure. Ileostomy closure required a short hospital stay and was rarely associated with complications. Patients who underwent low anterior resection with ileostomy had significant reductions in physical and role functioning, which apparently improved after ileostomy closure. Similar declines in these quality of life variables were not found in patients who underwent high anterior resection. A temporary ileostomy should be created in selected patients with the highest risk of anastomotic leakage. Increased resources for not only surgical care but also for stoma therapy are necessary for patients who undergo low anterior resection with a temporary ileostomy.

Gracilis transposition for repair of recurrent anovaginal and rectovaginal fistulas in Crohn’s disease

Local surgical procedures in the presence of Crohn's disease have a markedly reduced success rate, especially in the treatment of recurrent anovaginal and distant rectovaginal fistulas. In these patients, local surgery (e.g., flap closure) has unsatisfactory results if the anal canal is destroyed by ulceration and indurations or in patients with extensive defects of the perineum. Over a period of 6 years (2000 to 2006), 12 patients with recurrent rectovaginal fistulas were treated with graciloplasty. The age of the female patients ranged from 24 to 47 years, the mean age being 38 years. The presence of Crohn's disease in all patients had a mean duration of 12 years. Corticosteroids, mesalazin, or azathioprin were administered preoperatively. All patients were diverted by a temporary ileostomy before graciloplasty. RESULTS Rectovaginal fistula was closed in 11 of 12 patients after graciloplasty with a mean follow-up of 3.4 years. One rerecurrence of a rectovaginal fistula was documented. One of 12 ileostomies was not closed due to persistence of the fistula tract. One patient had a pouch-anal and, additionally, a pouch-vaginal fistula. In this patient, the first transposition of the gracilis muscle was unsuccessful. After a few months, she underwent renewed graciloplasty. There was no recurrence of a fistula within the follow-up period. Reconstruction of the perineum constituted an additional positive effect of the graciloplasty. In one patient, the preexisting fecal incontinence persisted, even after secondary implantation of a pacemaker. Due to diarrhea and persistent fecal incontinence, the patient opted for a renewed ileostomy. In our series, gracilis transposition in the treatment of recurrent anovaginal and rectovaginal fistulas in patients with Crohn's disease has excellent short-term results. In addition, graciloplasty can reconstruct the perineal defect.

Dietary Protein Absorption of the Small Intestine in Human Neonates

The intestine plays a key role in the absorption of dietary proteins, which determines growth of human neonates. Bowel resection in the neonatal period brings loss of absorptive and protective surface and may consequently lead to malabsorption of dietary nutrients. However, there are no data on net dietary protein absorption of the small intestine in the period after intestinal surgery in human neonates. We therefore evaluated dietary feeding tolerance and quantified net dietary protein absorption capacity of the small intestine in human neonates in whom a temporary jejunostomy or ileostomy was created. Seventeen patients were included in the study. We collected small intestinal outflow fluid at the level of the enterostomy weekly for 24-48 hours during weeks 3 through 6 postoperatively. Protein levels in the intestinal outflow fluid were determined by bicinchoninic acid (BCA) assay. In 14 patients, an enteral intake of >100 mL/kg/d was reached at a median of 17 days (range, 8-32 days) postoperatively. Three patients did not reach this level within the study period. Overall, the net dietary protein absorption capacity was 70%-90% of the total enteral protein intake. This study demonstrates that the dietary protein absorption capacity of the small intestine is intact in most human neonates after intestinal surgery in a very critical period of their lives. Furthermore, our results do not support the use of hydrolyzed or elemental formula in newborns with an enterostomy to improve amino acid uptake.

Closure of the temporary ileostomy after anterior resection

Colorectal DiseaseVolume 9, Issue 8 p. 759-759 Closure of the temporary ileostomy after anterior resection J. T. Lordan, J. T. Lordan Department of Colorectal Surgery, Frimley Park Hospital, Portsmouth Road, Frimley, Surrey GU16 7UJ, UK. E-mail: dr_lordan@yahoo.co.ukSearch for more papers by this authorR. Heywood, R. Heywood Department of Colorectal Surgery, Frimley Park Hospital, Portsmouth Road, Frimley, Surrey GU16 7UJ, UK. E-mail: dr_lordan@yahoo.co.ukSearch for more papers by this authorS. Shirol, S. Shirol Department of Colorectal Surgery, Frimley Park Hospital, Portsmouth Road, Frimley, Surrey GU16 7UJ, UK. E-mail: dr_lordan@yahoo.co.ukSearch for more papers by this authorD. P. Edwards, D. P. Edwards Department of Colorectal Surgery, Frimley Park Hospital, Portsmouth Road, Frimley, Surrey GU16 7UJ, UK. E-mail: dr_lordan@yahoo.co.ukSearch for more papers by this author J. T. Lordan, J. T. Lordan Department of Colorectal Surgery, Frimley Park Hospital, Portsmouth Road, Frimley, Surrey GU16 7UJ, UK. E-mail: dr_lordan@yahoo.co.ukSearch for more papers by this authorR. Heywood, R. Heywood Department of Colorectal Surgery, Frimley Park Hospital, Portsmouth Road, Frimley, Surrey GU16 7UJ, UK. E-mail: dr_lordan@yahoo.co.ukSearch for more papers by this authorS. Shirol, S. Shirol Department of Colorectal Surgery, Frimley Park Hospital, Portsmouth Road, Frimley, Surrey GU16 7UJ, UK. E-mail: dr_lordan@yahoo.co.ukSearch for more papers by this authorD. P. Edwards, D. P. Edwards Department of Colorectal Surgery, Frimley Park Hospital, Portsmouth Road, Frimley, Surrey GU16 7UJ, UK. E-mail: dr_lordan@yahoo.co.ukSearch for more papers by this author First published: 11 September 2007 https://doi.org/10.1111/j.1463-1318.2007.01324.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume9, Issue8October 2007Pages 759-759 RelatedInformation

Enterocutaneous Fistula after Closure of Temporary Ileostomy, Incidence, Management and Outcome

Enterocutaneous Fistula after Closure of Temporary Ileostomy, Incidence, Management and Outcome

Is Laparotomy Warranted at the Closure of Temporary Ileostomy? A Review of 571 Patients with Bowel Obstruction Following Restorative Proctocolectomy with Ileal Pouch

Table: Enterocutaneous Fistula at Old Ileostomy SitePurpose: Small bowel obstruction (SBO) is a usual complication following major abdominal surgery, which frequently requires surgical intervention. Temporary ilestomy is commonly employed for fecal diversion, which requires a second surgery, albeit small, for closure. At the time of ileostomy takedown, instead of a local excision, would a full laparotomy beneficial in reducing the risk of recurrent bowel obstruction? Methods: Patients with SBO were identified from the institutional ileal pouch anal anastomosis (IPAA) database of 3176 cases during a 23-year period. Clinical details reviewed and analyzed included timing of ileostomy closure and incisions used. Results: 794 episodes of SBO from 571 patients were identified following IPAA. Surgical intervention was required in 229 episodes (29%). Seventy six patients were excluded because no ileostomy was utilized (49), or ileostomy not closed (3) or closed at another institution. For the remaining 495 patients, average ileostomy duration was 120 days. The study group numbered 140 patients who had 1st episode of SBO before ileostomy closure. Depending on the incision type at the ileostomy takedown, the study group was divided into three subgroups: A) peristomal incision at the regular time of ileostomy takedown (> 7 wks), 102 patients; B) laparotomy at the regular time of takedown, 15 patients; C) laparotomy before the regular time of takedown, 23 patients. SBO recurrence was lower in patients who underwent a laparotomy (23.7%) than those who had peristomal incision (30.4%). There were 130 patients (26.2%) who developed their 1st SBO within 60 days following ileostomy closure. Of these, 101 (77.7%) had only one episode of SBO. 80 of the 101 (80%) patients were managed medically without recurrence. Conclusion: The ileostomy take down presents a valuable opportunity for patients who already display signs of obstruction. Laparotomy with full exploration at this point can safely reduce the risk of future bowel obstruction. The majority of bowel obstruction cases occurring immediately following take down can be successfully managed medically without recurrence.Table: Small Bowel Obstruction Recurrence after Ileostomy Takedown

Cats' tongues and an unusual case of severe bilateral meningo-encephalitis

A 44 year old woman with a temporary ileostomy following surgery for a diverticular abscess presented with a 4 day history of earache and a 1 day history of severe headache and vomiting. She had been found in bed unable to speak or move the right side of her body. On admission her temperature was recorded as 39 °C and GCS as 10/15 (V1, E3, M6). Blood pressure was 96/32 mmHg with a pulse rate of 70 beats per minute. She had neck stiffness with right-sided hyper-reflexic paralysis. Blood investigations showed a neutrophilia of 17.5 x 109/L (normal 2.0-7.5) with normal platelets, clotting and U&Es. C-reactive protein was markedly elevated at 380 mg/L (normal 0-5). CT scan showed gross cerebral oedema with evidence of severe bilateral meningo-encephalitis and raised intra-cranial pressure. She required aggressive fluid resuscitation in A&E. As a result of a fall in her GCS to 7/15 the patient was admitted to ITU for intubation. She was treated as severe community acquired meningo-encephalitis with high dose intravenous cefotaxime and intravenous acyclovir. A single 10 mg dose of intravenous hydrocortisone was administered on the night of admission. After 24 hours, blood cultures grew Pasteurella multocida sensitive to penicillin (MIC 0.064 mg/L). The patient had 48 hours of intravenous cefotaxime 2 g 4 hourly followed by 16 days of intravenous benzylpenicillin 2.4 g 4 hourly. She was discharged from ITU after 13 days at which time the right-sided paralysis was resolving, but she was still aphasic. She was discharged home after 23 days having made a full neurological recovery.

Toxic pseudomembranous colitis in a patient with ulcerative colitis

Toxic colitis is a severe disease that may be caused by several inflammatory and/or infectious diseases. Ulcerative colitis is one of the most frequent causes of toxic colitis in the United States. Toxic megacolon complicating Clostridium difficile colitis is a rare occurrence with significant morbidity and mortality. Case Report: A 52-year-old male presented with rectal bleeding and tenesmus. He had been treated for amebiasis with metronidazole, and had improved. Two weeks later, symptoms recurred, and he was referred to our hospital. A sigmoidoscopy and biopsies demonstrated mucosal ulcerative colitis. He underwent treatment with systemic prednisone, mesalamine, and hydrocortisone enemas with adequate response. He was asymptomatic for 2 months, but later presented with a tender abdomen and rectal bleeding. Plain abdominal and thorax films showed colonic distention and free intraperitoneal air. Emergency laparotomy was performed, and an inflamed and distended colon, with free inflammatory liquid in the peritoneum, was found. A total abdominal colectomy with temporary ileostomy and Hartmann's pouch was performed. The histopathology analysis demonstrated a Clostridium difficile pseudomembranous colitis. Conclusion: The presence of toxic megacolon due to Clostridium difficile in patients with ulcerative colitis is a rare complication that may be suspected in patients with initial relapse who are on antibiotics.

Twenty‐five consecutive isolated intestinal transplants in adult patients: a five‐yr clinical experience

Between December 2000 and December 2005, 25 isolated intestinal transplants from cadaveric donors have been performed for short gut syndrome (short bowel syndrome, 52%), chronic intestinal pseudo-obstruction (24%), Gardner syndrome (16%), radiation enteritis (4%) and massive intestinal angiomatosis (4%). Indications for transplantation were: loss of venous access, recurrent sepsis due to central line infection, major electrolyte and fluid imbalance. Liver dysfunction was present in 13 cases. All patients were adult; median age was 36.3 yr and mean weight at transplantation 61.6 kg. All recipients were on life-threatening parenteral nutrition for a mean time of 23.7 months. Mean donor/recipient body weight ratio was 1.08. Rejection monitoring was accomplished by graft ileoendoscopies and intestinal biopsies through the temporary ileostomy. Our immunosuppressive regimen was based on induction therapy with three different protocols: daclizumab for induction, tacrolimus and steroids as maintenance therapy; alemtuzumab for induction and low-dose tacrolimus as maintenance; thymoglobulin for induction and maintenance based on low-dose tacrolimus. Closure of the abdomen at the end of transplantation represented a technical problem with several options performed: graft reduction, only skin closure, prothesic meshes, abdominal closure in two steps, cutaneous flaps and abdominal wall transplant in one case. The mean hospital stay was 37 days. The mean follow-up 27 months. Twenty patients are alive (80%) with two- and five-yr patient survival rate of 80% and 66%; mortality rate was 20% due to sepsis in all cases. Our two- and five-yr graft survival rate is 76% and 64%, graftectomy rate was 16%. Sixteen grafts are working properly, with no need of parenteral nutrition. We diagnosed 35 mild acute cellular rejection (ACRs), seven moderate ACRs and three severe ACRs (two needed graftectomy). We experienced two episodes of chronic rejection biopsy-proven. Rapamicine was added in case of renal failure or biopsy-proven intestinal rejection. Graft-vs.-host disease was not seen in our series while post-transplant lymphoproliferative disease in two cases. After discharge, the most common indication for medical support was dehydration. The abdominal wall transplant did not experience any rejection. Induction therapy has reduced the amount of postoperative immunosuppressive agents, especially in the first period, lowering the risk of renal failure and sepsis and the mucosal surveillance protocol for early detection of rejection dramatically reduced the number of severe ACR.

Fulminant Postcesarean Clostridium difficile Pseudomembranous Colitis

Pseudomembranous colitis due to Clostridium difficile infection is rarely reported in the obstetric literature. This disease process is associated with prior antibiotic exposure. A term primigravida was delivered by primary cesarean for failed vacuum extraction. She received Intravenous cefazolin after cord clamping, which was continued for 36 hours for a presumptive diagnosis of endometritis. On day 3, oral amoxicillin and clavulanate was started for suspected cellulitis of the incision. She was readmitted 1 day after her discharge with severe diffuse abdominal pain and distention. Proctoscopy showed pseudomembranous colitis. Colectomy with temporary ileostomy was performed for worsening symptoms and imminent perforation. The diagnosis of pseudomembranous colitis should be considered in postpartum women who have low-grade fever, abdominal and gastrointestinal symptoms, and recent antibiotic exposure.

Following anterior resection for rectal cancer, defunctioning ileostomy closure may be significantly delayed by adjuvant chemotherapy: a retrospective study

A temporary loop ileostomy is often created to minimize the impact of peritoneal sepsis from an anastomotic dehiscence following colo-anal or low colorectal anastomosis. These stomas are not without complications. Clinicians tend to advise patients that their loop ileostomy will be reversed within 6-12 weeks of formation. However, factors such as adjuvant chemotherapy may affect the timing of closure. The aim of this study was to review the time between formation and closure of loop ileostomies following total mesorectal excision in patients with rectal cancer. A retrospective study of 50 patients with loop ileostomies to defunction total mesorectal excisions for rectal cancer, between April 2002 and July 2005. Of the 50 patients with defunctioning loop ileostomies, 24 received adjuvant chemo-radiotherapy, and 26 did not. There was a 28% morbidity. The overall median time from formation to closure was 142 days (35-575). Median time from formation to closure in those with adjuvant therapy was 197 days (35-575) and in those with no adjuvant therapy was 133 days (75-395). This was a significant delay (P = 0.049). Sixteen stomas were not closed to date. Time between formation and closure of loop ileostomy following anterior resection of rectum is significantly delayed by adjuvant chemotherapy. Because of their high morbidity, defunctioning ileostomies should be closed as early as medically possible, especially if adjuvant chemotherapy is planned.

Clinical and quality-of-life outcomes after fertility-sparing laparoscopic surgery with bowel resection for severe endometriosis

Study objective To describe the effect of fertility-sparing laparoscopic excision of endometriosis and bowel resection on clinical and quality-of-life outcomes. Design Prospective observational cohort study (Canadian Task Force classification II-2). Setting Australian tertiary referral center for the surgical treatment of endometriosis. Patients Seven consecutive patients with known endometriosis involving the bowel. Intervention Laparoscopic resection of all endometriosis, including laparoscopic bowel resection with end-to-end anastomosis with or without temporary ileostomy. Measurements and main results Preoperative and 12-month postoperative data were collected by use of visual analogue scores for dysmenorrhea, nonmenstrual pelvic pain, dyspareunia, and dyschezia. Validated research tools (SF12, EuroQOL, and Sexual Activity Questionnaire) also assessed quality of life. Reduction in median pain scores at baseline was demonstrated and at 12 months after operation for dysmenorrhea 71 (interquartile range 43–85) versus 5 (0–10); p = .028, nonmenstrual pelvic pain 74 (48–85) versus 11 (0–18); p = .046, dyspareunia 66 (0–98) versus 5 (0–8); p = .080, and dyschezia 48 (20–64) versus 20 (0–40); p = .173. All measures of quality of life were improved at 12 months after surgery, although not reaching statistical significance because of the small sample size. All three women wishing to conceive after operation have been successful, resulting in three live births at term. There were few complications associated with this surgery. Conclusion Fertility-sparing laparoscopic excision of endometriosis with bowel resection results in improvements in all aspects of pain and quality of life. Results appear to parallel published data for conservative resection of endometriosis not involving bowel. For women with severe endometriosis involving bowel, this surgical treatment provides a viable alternative to pelvic clearance and successfully maintains fertility.

Coloanal Sleeve Anastomosis (Soave Procedure): The Ultimate Treatment Option for Complex Rectourinary Fistulas

Acquired rectourinary fistulas represent a therapeutic challenge. Multiple previous unsuccessful procedures increase the difficulty of successful repair, leaving many patients with no option other than permanent urinary and/or fecal diversion. We report our experience with coloanal sleeve anastomosis (Soave procedure) as a salvage procedure for complex rectourinary fistulas. Between 1994 and 2005, eight males (median age, 60 (range, 33-72) years) had Soave procedure in our institution. Four fistulas were the result of radical prostatectomy and four followed anterior resection for rectal cancer after radiochemotherapy. The location of the fistulas was bladder (n = 5) and urethra (n = 3). Five patients had previous attempts at surgical repair (median, 2 (range, 1-3) operations). The Soave procedure was chosen as first-line treatment because of fistula size (20 mm and 30 mm) in two patients and because of concomitant severe radiation proctitis in one patient. Morbidity was 38 percent. All patients had a temporary ileostomy, which was successfully reversed in seven patients. One patient required ileal pouch-anal anastomosis on postoperative Day 1 because of necrosis of the descended colon. Two patients had recurrent fistulas at two and three months respectively. One patient had moderate problems with this recurrent fistula and had his stoma closed, but the other patient required a permanent ileostomy. Soave procedure is an effective treatment for complex rectourinary fistula in the setting of high-dose pelvic radiation or after failed previous repair attempts.

Construction and Closure of Temporary Loop Ileostomy

appropriate. We also used this approach in individuals on longterm chemotherapy.The procedure was accepted with mixed emotions. No major bleeding or infectious problems were encountered while placing the puncture from within the pharynx. But we did not have high longterm acceptance by either the patient or the staff. Of note, saliva or salivary leakage were of particular concern. The authors have demonstrated a nice, minimally invasive concept for these patients and their problems. We do wonder if their usage of the left side of the neck may lend itself to less patient dissatisfaction and fewer complications.

Endoscopic treatment of deep infiltrating endometriosis (DIE) involving the bladder and rectosigmoid colon

To study the feasibility, complications and symptom relief of laparoscopic treatment in patients with deep infiltrating endometriosis. From January 2004 to March 2005, 24 patients with deep infiltrating endometriosis were treated with laparoscopic techniques. Preoperative symptoms, staging, involvement of the disease, and surgical procedures were recorded. Operating time and perioperative complications were also registered, as well as follow-up of the patients. The surgical treatment was individualized with removal of deep infiltrating endometriosis in all 24 patients, additional bladder resection in five patients and colorectal resection in eight patients. In two cases laparoconversion was performed, and one patient had a temporary loop ileostomy. We observed no major peri- or postoperative complications. Median operating time was 3.4 h (range 1.4-8.0 h). All patients with bladder involvement were relieved of their urinary dysfunction, while all except three patients were successfully treated for their pain problems, and also these three patients had symptom relief. Patients with deep infiltrating endometriosis represent a challenge to surgical procedures. Our results show that radical laparoscopic surgery including colorectal and bladder resection is feasible, safe, and effective in almost all patients.

Morbidity of Temporary Loop Ileostomy in Patients With Colorectal Cancer

This study was designed to quantify the temporary loop ileostomy-related morbidity in patients with colorectal cancer and contrast the morbidity rates after ileostomy closure before, during, and after the start of adjuvant therapy. Between 1997 and 2004, 120 patients with colorectal carcinoma underwent colorectal resection and creation of a temporary loop ileostomy to protect the low anastomosis. Stoma-related complications and perioperative morbidity after ileostomy closure were assessed retrospectively by reviewing the medical records. Sixteen of the 120 patients (13.3 percent) suffered stoma-related complications, requiring early ileostomy closure in three. After ileostomy closure, anastomotic leakage of the ileoileostomy occurred in 3 of the 120 patients (2.5 percent), 2 of them died postoperatively (1.7 percent). The rate of minor complications (16.7 percent in all patients) was much higher in patients undergoing adjuvant chemotherapy or radiochemotherapy (25.5 percent) than in patients receiving no additional therapy (9.2 percent). In the former patients, there was a trend toward fewer complications when ileostomy closure was performed before (12.5 percent), rather than during (42.9 percent) or after (21.2 percent), the start of adjuvant therapy. The morbidity following closure of a temporary loop ileostomy in colorectal cancer patients is much higher in patients receiving adjuvant chemotherapy or radiochemotherapy. The morbidity, however, might possibly be lowered to the level of patients receiving no additional therapy if ileostomy closure is performed before the start of adjuvant therapy.