Stoma reversal after surgery for complicated acute diverticulitis: A multicentre retrospective study.

Autor: Roig JV; Servicios de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España; Hospital Nisa 9 de Octubre, Valencia, España. Electronic address: roigvila@telefonica.net., Salvador A; Servicios de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España., Frasson M; Servicios de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, España; Servicios de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia, Valencia, España., García-Mayor L; Servicios de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, España., Espinosa J; Servicios de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Alicante, Alicante, España., Roselló V; Servicios de Cirugía General y del Aparato Digestivo, Hospital Lluís Alcanyís de Xàtiva, Xàtiva, Valencia, España., Hernandis J; Servicios de Cirugía General y del Aparato Digestivo, Hospital General de Elda, Elda, Alicante, España., Ruiz-Carmona MD; Servicios de Cirugía General y del Aparato Digestivo, Hospital de Sagunto, Sagunto, Valencia, España., Uribe N; Servicios de Cirugía General y del Aparato Digestivo, Hospital Universitario Arnau de Vilanova, Valencia, España., García-Calvo R; Servicios de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón de la Plana, España., Bernal JC; Servicios de Cirugía General y del Aparato Digestivo, Hospital General de Requena, Requena, Valencia, España., García-Armengol J; Hospital Nisa 9 de Octubre, Valencia, España., García-Granero E; Servicios de Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, Valencia, España; Servicios de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Valencia, Valencia, España.
Jazyk: English; Spanish; Castilian
Zdroj: Cirugia espanola [Cir Esp (Engl Ed)] 2018 May; Vol. 96 (5), pp. 283-291. Date of Electronic Publication: 2018 Mar 09.
DOI: 10.1016/j.ciresp.2018.02.001
Abstrakt: INTRODUCTION THE AIM: was to analyse the stoma reversal rate after surgery for complicated acute diverticulitis (CAD), and more specifically the end-stoma-reversal, as well as the delay, feasibility, complications and risk factors for stoma maintenance.
Methods: A multicentre retrospective study of patients who had undergone urgent surgery for CAD with stoma formation in ten hospitals during a period of 6 years. The frequency of reversal over time and the factors affecting the decision for reversal were analysed.
Results: Out of 385 patients operated for CAD, 312 underwent stoma creation: 292 end colostomies and 20 diverting stomas. During follow-up, stoma reversal surgery was performed in 161 patients (51.6%) after a median of 9 months. The main causes for not performing stoma reversal were comorbidities and the death of the patient. Advanced age was an adverse factor in the multivariate analysis, and the actuarial rate of reversal was higher in men and in patients with no previous Hartmann's operation. Stoma reversal surgery was completed in all but one patient, and a loop ileostomy was associated in four. Morbidity and mortality rates were 35.7% and 1.9%, respectively. A total of 8.4% of patients underwent re-operation, and 6% experienced an anastomotic leak. Twelve patients remained with a stoma after the attempted reconstruction surgery.
Conclusions: Surgery for CAD is frequently associated with an end stoma, which will ultimately not be reversed in almost 50% of patients. Moreover, reversal surgery is frequently delayed and is associated with significant morbidity and mortality.
(Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)
Databáze: MEDLINE
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