Outcomes of asymptomatic anastomotic leaks found on routine postoperative water-soluble enema following anterior resection for cancer
| Autor: | J. E. Hartley, H. Ho Tin, J. Gunn, H. O’Grady, I. A. Hunter, P. Souroullas, Shane Killeen |
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| Rok vydání: | 2013 |
| Předmět: |
Male
Reoperation medicine.medical_specialty medicine.medical_treatment Anastomotic Leak Enema Anastomosis Stoma Ileostomy Patient satisfaction Postoperative Complications medicine Fecal incontinence Humans Prospective Studies Digestive System Surgical Procedures Aged Neoplasm Staging Aged 80 and over business.industry Rectal Neoplasms Middle Aged Occult digestive system diseases Surgery Radiography Treatment Outcome Patient Satisfaction Case-Control Studies Quality of Life Female Radiology medicine.symptom business Fecal Incontinence Abdominal surgery |
| Zdroj: | World journal of surgery. 37(11) |
| ISSN: | 1432-2323 |
| Popis: | The incidence and consequence of an anastomotic leak associated with low anterior resection for cancer mandates covering stoma in most cases. A water-soluble enema is often performed to assess anastomotic integrity prior to stoma reversal. The functional outcome following reversal in patients with occult radiologically detected leaks is poorly defined. The goal of the present study was to determine the functional outcome in patients with a radiologically detected anastomotic leak who subsequently underwent stoma reversal. This case control study used patients with and without radiologically detected occult anastomotic leak having undergone reversal of covering stomata. The study group was matched with controls for age, gender, procedure, tumor stage, and adjuvant/neoadjuvant therapy. Validated fecal incontinence quality of life (FIQL), Cleveland Clinic Fecal Incontinence Score (CCFIS), and the Memorial Sloan-Kettering Cancer Center (MSKCC) Bowel Function Index (BFI) were used. Patient satisfaction, medication use, and ancillary procedures prior to closure were also recorded. Thirteen patients with radiologically detected occult anastomotic leaks and 13 matched controls were identified from a prospectively maintained database. The FIQL, CCFIS, and MSKCC BFI scores were significantly reduced in those with occult leaks. The mean number of radiological and surgical interventions was significantly greater in the patients with occult leaks. Antidiarrheal and bulking agent use, as well as patient satisfaction, were the same for both groups. Only one patient in the occult leak group would not undergo stoma reversal again. Reversal of a defunctioning ileostomy in the presence of an occult radiological leak can be associated with poorer functional outcomes, but patient satisfaction is undiminished. |
| Databáze: | OpenAIRE |
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