Ileostomy reversal with handsewn techniques. Short-term outcomes in a teaching hospital
| Autor: | Mariano Cesare Giglio, Gaetano Luglio, Viviana Sollazzo, Giovanni Domenico De Palma, Emanuela Spadarella, Francesco Terracciano, Cristina Bucci, Roberto Peltrini, Michele Sacco, Luigi Bucci |
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| Přispěvatelé: | Luglio, Gaetano, Terracciano, Francesco, Giglio, MARIANO CESARE, Sacco, Michele, Peltrini, Roberto, Sollazzo, Viviana, Spadarella, Emanuela, Bucci, Cristina, DE PALMA, GIOVANNI DOMENICO, Bucci, Luigi |
| Rok vydání: | 2016 |
| Předmět: |
lleostomy reversal
Adult Male medicine.medical_specialty Leak Time Factors Time Factor Adolescent Handsewn technique medicine.medical_treatment 030230 surgery Anastomosis 03 medical and health sciences Ileostomy Young Adult 0302 clinical medicine Postoperative Complications Colonanal anastomosi Internal medicine medicine 80 and over Humans Young adult Hospitals Teaching Aged Aged 80 and over business.industry Mortality rate Incidence (epidemiology) Teaching Handsewn techniques Suture Techniques Gastroenterology Colonanal anastomosis Hepatology Middle Aged Hospitals Surgery Exact test Ileostomy morbidiy Treatment Outcome 030220 oncology & carcinogenesis Female Postoperative Complication business Human |
| Zdroj: | International journal of colorectal disease. 32(1) |
| ISSN: | 1432-1262 |
| Popis: | Fecal diversion is considered an effective procedure to protect bowel anastomosis at high risk for leak. Some concerns exist regarding the risk for a significant morbidity associated to ileostomy creation itself and moreover to its closure. Surgical expertise and closure techniques are considered potential factors influencing morbidity. Aim of the study is to present a single-institution experience with ileostomy closures, in a teaching hospital, whereas ileostomy reversal is mainly performed by young residents. A prospective database was investigated to extract data of patients who underwent loop ileostomy closure between January 2005 and December 2014. Ileostomy reversion was always realized in a handsewn fashion, performing either a direct closure (DC) or a resection plus end-to-end anastomosis (EEA). Postoperative morbidity was graded according to Clavien-Dindo classification. Outcomes after DC and EEA were compared by Fisher’s exact test and Wilcoxon rank-sum test. Two hundred ninety-eight patients were included. Ileostomy reversal was performed by EEA in 236 patients (79.19 %) and by DC in 62 patients (20.81 %). Surgery was performed with a peristomal access in 296 cases (99.33 %). Incidence of anastomotic leak was 0.67 % (2/298). Overall reoperation rate was 0.34 % (1/298). Short-term overall morbidity rate was 20.47 %; but major complications (≥ grade III) occurred in only one patient (0.34 %). Mortality was nil. No significant differences in postoperative morbidity were found between the DC and EEA group. Loop ileostomy reversal is a safe procedure, associated to a low major morbidity and excellent results, even if performed with a handsewn technique by supervised trainee surgeons. |
| Databáze: | OpenAIRE |
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