DEFUNCTIONING LOOP ILEOSTOMY IN RECTAL CANCER SURGERY: THE EXPERIENCE OF A REFERRAL CENTER

Authors

  • Telma Fonseca Serviço Cirurgia Geral, Centro Hospitalar Universitário São João, Porto, Portugal http://orcid.org/0000-0001-9190-0327
  • Elisabete Campos Serviço Cirurgia Geral, Centro Hospitalar Universitário São João; Faculdade Medicina Universidade do Porto, Porto, Portugal
  • Maria Manuel Castro Enfermeira Estomaterapeuta, Centro Hospitalar Universitário São João, Porto, Porugal
  • Susana Costa Enfermeira Estomaterapeuta, Centro Hospitalar Universitário São João, Porto, Porugal
  • Ana Azevedo Serviço Cirurgia Geral, Centro Hospitalar Universitário São João; Serviço Cirurgia Geral, Hospital da Luz – Arrábida, Portugal
  • Elisabete Barbosa Serviço Cirurgia Geral, Centro Hospitalar Universitário São João; Faculdade Medicina Universidade do Porto, Porto, Portugal

DOI:

https://doi.org/10.34635/rpc.918

Keywords:

rectal cancer, anterior rectal resection, defunctioning loop ileostomy, transit reconstruction

Abstract

Introduction: In rectal surgery, protective ileostomy is frequent to minimize the impact of anastomotic dehiscence. Despite the temporary intent, a significant proportion of stomas become permanent. The objective of this study is to determine which factors are associated with a lower probability of closure of a protective ileostomy after rectal resection surgery.

Methods:  An observational, retrospective, single-center study was carried out. We reviewed the clinical data of patients with a primary diagnosis of rectal cancer and who underwent elective resection surgery with protective ileostomy between 2008 and 2019. Risk factors for not closing the temporary stoma were assessed.

Results: 201 patients were included, of which 168 (83.58%) were reconstructed, with a mean waiting time for reconstruction of 7.92 months. 33 patients were not reconstructed, 10 (4.97%) died before 12 months after surgery, 1 patient (0.5%) refused transit reconstruction and 3 patients (1.49%) are awaiting endoscopic study for scheduling the reconstruction. When excluding these patients, only nineteen patients (9.45%) were called with permanent stomas (ileostomies n = 16, reversion to definitive terminal colostomy n = 3).

Conclusion: The independent risk factors for non-closure of the protective ileostomy were tumours located closer to the anal margin (<= 7 cm), presence of synchronous metastases and presence of local recurrence. Other factors that contributed to the non-closure of the ileostomy were the performance of adjuvant chemotherapy and the presence of complications in the colorectal anastomosis. Patients with these risk factors should be advertised for the possibility of non-closure of the ileostomy.

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Author Biographies

Elisabete Campos, Serviço Cirurgia Geral, Centro Hospitalar Universitário São João; Faculdade Medicina Universidade do Porto, Porto, Portugal

 

 

Ana Azevedo, Serviço Cirurgia Geral, Centro Hospitalar Universitário São João; Serviço Cirurgia Geral, Hospital da Luz – Arrábida, Portugal

 

Elisabete Barbosa, Serviço Cirurgia Geral, Centro Hospitalar Universitário São João; Faculdade Medicina Universidade do Porto, Porto, Portugal

 

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Published

2022-12-09

Issue

No. 53 (2022): December 2022

Section

Original Papers

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