Factors of surgical difficulty and complications associated with closure of temporary ileostomy in patients with rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HAN Yongqiang , GAO Guangrong , LI Da , SHAN Yongqi ,  ZHANG Cheng

Department of General Surgery, Northern Theater Command General Hospital, Shenyang 110016, P. R. China;

Corresponding author：

ZHANG Cheng, Email: cz1971@126.com

Keywords：

rectal cancer; temporary ileostomy; operation time; incision infection

DOI：

10.7507/1007-9424.201902032

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate factors for surgical difficulty and complications following closure of temporary ileostomy for rectal cancer. Methods The clinical data of 103 patients with low rectal cancer treated with closure of temporary ileostomy from January 2014 to July 2017 in the Northern Theater Command General Hospital were retrospectively analyzed. The associated factors of surgical difficulty and postoperative complications were identified by the univariate and multivariate logistic regression analyses. Results In this study, there were 11 (10.7%) patients with surgical difficulty (operation time >100 min) in the 103 patients. The multivariate logistic regression analysis showed that the history of previous abdominal surgery ［OR=5.272, 95% CI (1.325, 20.977), P=0.018］ and minimally invasive surgery ［OR=0.166, 95% CI (0.037, 0.758), P=0.020］ were the independent influencing factors of the difficulty of surgery. The complications following closure of temporary ileostomy included 16 (15.5%) patients with the incision infection, 5 (4.9%) patients with the intestinal obstruction, and 3 patients with the pulmonary infection (2.9%). The multivariate logistic regression analysis showed that the diabetes ［OR=4.855, 95% CI (1.133, 20.804), P=0.033］, operation time >100 min ［OR=11.914, 95% CI (2.247, 63.171), P=0.004］, and peristomal dermatitis ［OR=18.814, 95% CI (3.978, 88.988), P<0.001］ were the independent influencing factors for the incision infection. Conclusions History of previous abdominal surgery is main cause for difficulty of surgery and minimally invasive surgery can reduce difficulty of surgery. Diabetes mellitus, longer operation time, and peristomal dermatitis are main causes of postoperative incision infection.

Citation： HAN Yongqiang, GAO Guangrong, LI Da, SHAN Yongqi, ZHANG Cheng. Factors of surgical difficulty and complications associated with closure of temporary ileostomy in patients with rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(7): 803-807. doi: 10.7507/1007-9424.201902032 Copy

1.	Hawkes N. Campaigners win fight to retain UK statistics on cancer deaths, lifestyle, and suicides. BMJ, 2014, 348: g1504.
2.	Gastinger I, Marusch F, Steinert R, et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg, 2005, 92(9): 1137-1142.
3.	Chen J, Wang DR, Yu HF, et al. Defunctioning stoma in low anterior resection for rectal cancer: a meta-analysis of five recent studies. Hepatogastroenterology, 2012, 59(118): 1828-1831.
4.	Hüser N, Michalski CW, Erkan M, et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg, 2008, 248(1): 52-60.
5.	刘坤, 赵任. 预防性造口在中低位直肠癌保肛手术的应用. 中国实用外科杂志, 2014, 34(9): 903-905.
6.	丘素语, 胡民辉, 过文泰, 等. 直肠癌保括约肌手术患者预防性回肠造口延迟回纳的危险因素. 中国普外基础与临床杂志, 2019, 26(4): 418-422.
7.	潘宏达, 王林, 彭亦凡, 等. 直肠癌低位前切除保护性回肠口还纳术后并发症. 中华胃肠外科杂志, 2015, 18(7): 656-660.
8.	中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2001, 81(5): 314-320.
9.	曾莉. 腹腔粘连研究进展. 南京中医药大学学报, 2004, 20(2): 126-128.
10.	Molinas CR, Mynbaev O, Pauwels A, et al. Peritoneal mesothelial hypoxia during pneumoperitoneum is a cofactor in adhesion formation in a laparoscopic mouse model. Fertil Steril, 2001, 76(3): 560-567.
11.	Szomstein S, Lo Menzo E, Simpfendorfer C, et al. Laparoscopic lysis of adhesions. World J Surg, 2006, 30(4): 535-540.
12.	Krenkel C, Grunert I. The Endo-Distractor for preimplant mandibular regeneration. Rev Stomatol Chir Maxillofac, 2009, 110(1): 17-26.
13.	González-García A, Diniz-Freitas M, Somoza-Martín M, et al. Piezoelectric and conventional osteotomy in alveolar distraction osteogenesis in a series of 17 patients. Int J Oral Maxillofac Implants, 2008, 23(5): 891-896.
14.	Chow A, Tilney HS, Paraskeva P, et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis, 2009, 24(6): 711-723.
15.	Phatak UR, Kao LS, You YN, et al. Impact of ileostomy-related complications on the multidisciplinary treatment of rectal cancer. Ann Surg Oncol, 2014, 21(2): 507-512.
16.	黄榕康, 何丹丹, 赵洁, 等. 直肠癌保留括约肌术后预防性回肠造口回纳术后并发症的危险因素分析. 中国普外基础与临床杂志, 2016, 23(11): 1335-1338.
17.	叶颖江, 王杉, 和宇, 等. 结直肠癌手术部位感染相关并发症影响因素分析. 中华普通外科杂志, 2006, 21(2): 122-124.
18.	Marks JB. Perioperative management of diabetes. Am Fam Physician, 2003, 67(1): 93-100.
19.	谢凌铎, 周鑫, 谢海艇, 等. 腹腔镜直肠癌全直肠系膜切除术预防性末端回肠造瘘后相关并发症危险因素和造瘘还纳时机分析. 中华胃肠外科杂志, 2015, 18(6): 563-567.
20.	兰平, 练磊. 肠造口及其相关问题. 中华胃肠外科杂志, 2012, 15(4): 317-319.
21.	Rathnayake MM, Kumarage SK, Wijesuriya SR, et al. Complications of loop ileostomy and ileostomy closure and their implications for extended enterostomal therapy: a prospective clinical study. Int J Nurs Stud, 2008, 45(8): 1118-1121.
22.	Milanchi S, Nasseri Y, Kidner T, et al. Wound infection after ileostomy closure can be eliminated by circumferential subcuticular wound approximation. Dis Colon Rectum, 2009, 52(3): 469-474.
23.	Patel, Frost, Bearn, et al. Canoe closureof loop ileostomy gives improved cosmesis compared with conventional closure. Colorectal Dis, 1999, 1(3): 155-157.
24.	Dusch N, Goranova D, Herrle F, et al. Randomized controlled trial: comparison of two surgical techniques for closing the wound following ileostomy closure: purse string versus direct suture. Colorectal Dis, 2013, 15(8): 1033-1040.
25.	Lahat G, Tulchinsky H, Goldman G, et al. Wound infection after ileostomy closure: a prospective randomized study comparing primary vs. delayed primary closure techniques. Tech Coloproctol, 2005, 9(3): 206-208.
26.	Sharma A, Deeb AP, Rickles AS, et al. Closure of defunctioning loop ileostomy is associated with considerable morbidity. Colorectal Dis, 2013, 15(4): 458-462.

1. Hawkes N. Campaigners win fight to retain UK statistics on cancer deaths, lifestyle, and suicides. BMJ, 2014, 348: g1504.
2. Gastinger I, Marusch F, Steinert R, et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg, 2005, 92(9): 1137-1142.
3. Chen J, Wang DR, Yu HF, et al. Defunctioning stoma in low anterior resection for rectal cancer: a meta-analysis of five recent studies. Hepatogastroenterology, 2012, 59(118): 1828-1831.
4. Hüser N, Michalski CW, Erkan M, et al. Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg, 2008, 248(1): 52-60.
5. 刘坤, 赵任. 预防性造口在中低位直肠癌保肛手术的应用. 中国实用外科杂志, 2014, 34(9): 903-905.
6. 丘素语, 胡民辉, 过文泰, 等. 直肠癌保括约肌手术患者预防性回肠造口延迟回纳的危险因素. 中国普外基础与临床杂志, 2019, 26(4): 418-422.
7. 潘宏达, 王林, 彭亦凡, 等. 直肠癌低位前切除保护性回肠口还纳术后并发症. 中华胃肠外科杂志, 2015, 18(7): 656-660.
8. 中华人民共和国卫生部. 医院感染诊断标准(试行). 中华医学杂志, 2001, 81(5): 314-320.
9. 曾莉. 腹腔粘连研究进展. 南京中医药大学学报, 2004, 20(2): 126-128.
10. Molinas CR, Mynbaev O, Pauwels A, et al. Peritoneal mesothelial hypoxia during pneumoperitoneum is a cofactor in adhesion formation in a laparoscopic mouse model. Fertil Steril, 2001, 76(3): 560-567.
11. Szomstein S, Lo Menzo E, Simpfendorfer C, et al. Laparoscopic lysis of adhesions. World J Surg, 2006, 30(4): 535-540.
12. Krenkel C, Grunert I. The Endo-Distractor for preimplant mandibular regeneration. Rev Stomatol Chir Maxillofac, 2009, 110(1): 17-26.
13. González-García A, Diniz-Freitas M, Somoza-Martín M, et al. Piezoelectric and conventional osteotomy in alveolar distraction osteogenesis in a series of 17 patients. Int J Oral Maxillofac Implants, 2008, 23(5): 891-896.
14. Chow A, Tilney HS, Paraskeva P, et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis, 2009, 24(6): 711-723.
15. Phatak UR, Kao LS, You YN, et al. Impact of ileostomy-related complications on the multidisciplinary treatment of rectal cancer. Ann Surg Oncol, 2014, 21(2): 507-512.
16. 黄榕康, 何丹丹, 赵洁, 等. 直肠癌保留括约肌术后预防性回肠造口回纳术后并发症的危险因素分析. 中国普外基础与临床杂志, 2016, 23(11): 1335-1338.
17. 叶颖江, 王杉, 和宇, 等. 结直肠癌手术部位感染相关并发症影响因素分析. 中华普通外科杂志, 2006, 21(2): 122-124.
18. Marks JB. Perioperative management of diabetes. Am Fam Physician, 2003, 67(1): 93-100.
19. 谢凌铎, 周鑫, 谢海艇, 等. 腹腔镜直肠癌全直肠系膜切除术预防性末端回肠造瘘后相关并发症危险因素和造瘘还纳时机分析. 中华胃肠外科杂志, 2015, 18(6): 563-567.
20. 兰平, 练磊. 肠造口及其相关问题. 中华胃肠外科杂志, 2012, 15(4): 317-319.
21. Rathnayake MM, Kumarage SK, Wijesuriya SR, et al. Complications of loop ileostomy and ileostomy closure and their implications for extended enterostomal therapy: a prospective clinical study. Int J Nurs Stud, 2008, 45(8): 1118-1121.
22. Milanchi S, Nasseri Y, Kidner T, et al. Wound infection after ileostomy closure can be eliminated by circumferential subcuticular wound approximation. Dis Colon Rectum, 2009, 52(3): 469-474.
23. Patel, Frost, Bearn, et al. Canoe closureof loop ileostomy gives improved cosmesis compared with conventional closure. Colorectal Dis, 1999, 1(3): 155-157.
24. Dusch N, Goranova D, Herrle F, et al. Randomized controlled trial: comparison of two surgical techniques for closing the wound following ileostomy closure: purse string versus direct suture. Colorectal Dis, 2013, 15(8): 1033-1040.
25. Lahat G, Tulchinsky H, Goldman G, et al. Wound infection after ileostomy closure: a prospective randomized study comparing primary vs. delayed primary closure techniques. Tech Coloproctol, 2005, 9(3): 206-208.
26. Sharma A, Deeb AP, Rickles AS, et al. Closure of defunctioning loop ileostomy is associated with considerable morbidity. Colorectal Dis, 2013, 15(4): 458-462.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Factors of surgical difficulty and complications associated with closure of temporary ileostomy in patients with rectal cancer

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content