Colostomy vs Tube Cecostomy for Protection of a Low Anastomosis in Rectal Cancer
| Autor: | E. Bodner, Rupert Prommegger, Heinz Wykypiel, Joerg Tschmelitsch |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Male
Reoperation medicine.medical_specialty Colorectal cancer medicine.medical_treatment Peritonitis Rectum Anastomosis Ileostomy Surgical anastomosis Postoperative Complications Colostomy medicine Carcinoma Humans Aged Rectal Neoplasms business.industry Anastomosis Surgical Middle Aged medicine.disease Surgery Cecostomy medicine.anatomical_structure Female business |
| Zdroj: | Archives of Surgery. 134:1385 |
| ISSN: | 0004-0010 |
| Popis: | Background Symptomatic anastomotic leakage is the most important surgical complication following rectal resection with intestinal anastomosis. Therefore, the routine use of a protective stoma is suggested by several authors. In our department 2 different techniques are performed to protect the anastomosis. Patients receive either a loop colostomy/ileostomy (C/I) or a tube cecostomy (TC). Hypothesis No significant difference is noted between C/I and TC for protection of a low anastomosis regarding clinical anastomotic leakage rate, reoperation rate for anastomotic leaks/fistulas, postoperative mortality, and permanent colostomy rate. By avoiding a second operation (for colostomy closure), median hospital stay should be significantly reduced. Design A retrospective review during 1985 to 1997. Setting Tertiary care center Patients One hundred fifty-eight patients who had undergone anterior resections for rectal cancer were studied. Protective C/Is were used in 19 patients; a TC was fashioned in 30 patients. Main Outcome Measures Clinical anastomotic leakage rate, reoperation rate for anastomotic leaks/fistulas, postoperative mortality, permanent colostomy rate, and median hospital stay. Results The rate of anastomotic leaks (C/I, 16%; TC, 17%), fecal peritonitis (C/I, 0%; TC, 10%), reoperation for anastomotic leaks/fistulas (C/I, 0%; TC, 13%), permanent colostomies (C/I, 0%; TC, 7%), and postoperative mortality (C/I, 5%; TC, 0%) did not differ significantly in both groups. Median hospital stay was significantly reduced in patients with TC (C/I, 28 days; TC, 15 days). Conclusion In our patients with low resections for rectal cancer, a C/I for protection of the anastomosis did not improve outcome significantly as compared with a TC. With a properly fashioned TC and adequate postoperative management a second operation (for colostomy closure) can be avoided and the overall hospital stay is significantly reduced. |
| Databáze: | OpenAIRE |
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