Ileostomy closure by colorectal surgeons results in less major morbidity: results from an institutional change in practice and awarenessReportar como inadecuado




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International Journal of Colorectal Disease

, Volume 31, Issue 3, pp 661–667

First Online: 05 January 2016Accepted: 14 December 2015

Abstract

PurposePrevious institutional analysis of ileostomy closure revealed substantial morbidity. This subsequent study aimed at determining if a change in clinical practice resulted in reduced complication rates.

MethodsBetween June 2004 and January 2014, all consecutive adult patients undergoing ileostomy closure were retrospectively identified. Postoperative outcome after change in clinical practice consisting of routine participation of a colorectal surgeon, stapled side-to-side anastomosis and increased clinical awareness cohort B was compared with our previously published historical control group cohort A. The primary outcome was major morbidity, defined as Clavien-Dindo grade three or higher. Independent risk factors of major morbidity were identified using multivariable analysis.

ResultsIn total, 165 patients underwent ileostomy closure in cohort A, and 144 patients in cohort B. At baseline, more primary diverting ileostomies were present in cohort A 94 vs. 82 %; p = 0.001 with a similar rate of loop and end-ileostomy between the two cohorts p = 0.331. A significant increase in colorectal surgeon participation 89 vs. 53 %; p < 0.001 and stapled side-to-side anastomosis was observed 63 vs. 16 %; p < 0.001. The major morbidity rate was 11 % in cohort A, which significantly reduced to 4 % in cohort B p = 0.03. Surgery being performed or supervised by a colorectal surgeon odds ratio OR 0.28, 95 % CI 0.11–0.67 and loop-ileostomy compared to end-ileostomy OR 0.18, 95 % CI 0.07–0.52 were independently associated with lower major morbidity.

ConclusionIleostomy closure appears to be more complex surgery then generally considered, especially end-ileostomy closure. Postoperative outcome could be significantly improved by a change in surgical practice.

KeywordsIleostomy reversal Ileostomy closure Ileostomy Complications Morbidity Electronic supplementary materialThe online version of this article doi:10.1007-s00384-015-2478-1 contains supplementary material, which is available to authorized users.

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Autor: G. D. Musters - J. J. Atema - H. L. van Westreenen - C. J. Buskens - W. A. Bemelman - P. J. Tanis

Fuente: https://link.springer.com/article/10.1007/s00384-015-2478-1



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