CC BY-NC-ND 4.0 · Journal of Coloproctology 2021; 41(02): 131-137
DOI: 10.1055/s-0041-1730040
Original Article

Role of Covering Ileostomy in Causation of Anastomotic Strictures in Low Anterior Resections for Rectum Carcinoma

O papel da ileostomia de proteção como causa das estenoses anastomóticas nas ressecções anteriores de reto
1  Department of General Surgery, Govt Medical College Hospital, Rajouri, J&K, India
,
Rauf A. Wani
2  Department of Colorectal Surgery SKIMS, Srinagar, J&K, India
,
Asif Mehraj
2  Department of Colorectal Surgery SKIMS, Srinagar, J&K, India
,
Arshad Baba
3  Directorate of Health Services, J&K, India
,
Mushtaq Laway
3  Directorate of Health Services, J&K, India
,
Nisar A. Chowdri
2  Department of Colorectal Surgery SKIMS, Srinagar, J&K, India
,
Fazl Q. Parray
2  Department of Colorectal Surgery SKIMS, Srinagar, J&K, India
› Institutsangaben
Funding Information The present research project did not receive any grants from any funding agency in the public, commercial, or not-for-profit sectors.

Abstract

Background Colorectal resection anastomosis is the commonest cause of rectal strictures. Anastomotic site ischemia, incomplete doughnuts from stapled anastomosis and pelvic infection, are some of the risk factors that play a role in the development of postoperative rectal strictures. However, the role of diverting stoma in the development of rectal strictures has not been studied extensively.

Objectives To study the difference in the occurrence of anastomotic strictures (AS) in patients submitted to low anterior resection (LAR) with covering ileostomy (CI), and to LAR without CI for carcinoma rectum.

Methods This was a prospective, comparative case control study carried out at a tertiary care referral center. Low anterior resection with covering ileostomy was performed in patients with rectum carcinoma in the study group, while LAR without covering ileostomy was performed in the control group. The study group had 29 patients, while the control group had 33 patients with rectum carcinoma.

Results During the mean follow-up period of 9.1months, 8 (28%) patients in the study group and 2 (6%) patients in the control group developed AS (p =0.019). Out of these 8 patients with AS in the study group, 50% had Grade-I AS, 25% had Grade-II AS, while 25% of the patients had Grade-III (severe) AS. However, both patients who developed AS in the control group had a mild type (Grade I) of AS.

Conclusion Covering ileostomy increases the chances of AS formation after LAR for rectum carcinoma. Also, the SKIMS Clinical Grading of Rectal Strictures is a simple and handy tool available for every surgeon to grade, classify and monitor the postoperative rectal strictures.

Resumo

Introdução A anastomose de ressecção colorretal é a causa mais comum de estenoses retais. A isquemia do local da anastomose, donuts (anéis) incompletos de anastomose grampeada e infecção pélvica são alguns dos fatores de risco que desempenham um papel no desenvolvimento de estenoses retais pós-operatórias. No entanto, o papel do estoma de desvio no desenvolvimento de estenoses retais não foi estudado extensivamente.

Objetivos Estudar a diferença na ocorrência de estenoses anastomóticas (EA) em pacientes submetidos à ressecção anterior baixa (LAR) com ileostomia de proteção e a LAR sem ileostomia de proteção para carcinoma de reto.

Métodos Este foi um estudo prospectivo e comparativo de caso-controle realizado em um centro de referência de atenção terciária. A ressecção anterior baixa com ileostomia de proteção foi realizada em pacientes com carcinoma de reto no grupo de estudo, enquanto LAR sem ileostomia de proteção foi realizada no grupo controle. O grupo de estudo tinha 29 pacientes, enquanto o grupo controle tinha 33 pacientes com carcinoma de reto.

Resultados Durante o período de acompanhamento médio de 9, 1 meses, 8 (28%) pacientes no grupo de estudo e 2 (6%) pacientes no grupo controle desenvolveram EA (p = 0,019). Destes 8 pacientes com EA no grupo de estudo, 50% tinham EA de Grau I, 25% tinham EA de Grau II, enquanto 25% dos pacientes tinham EA de Grau III (grave). No entanto, ambos os pacientes que desenvolveram EA no grupo de controle tinham um tipo leve (Grau I) de EA.

Conclusão A ileostomia de proteção aumenta as chances de formação de AS após LAR para carcinoma de reto. Além disso, o SKIMS Clinical Grading of Rectal Strictures é uma ferramenta simples e útil disponível para cada cirurgião para graduar, classificar e monitorar as estenoses retais pós-operatórias.

Limitations of the Present Study

Since the present study is a small sized, nonrandomized study, we suggest that further large sized, multi-institutional randomized controlled trials (RCTs) be performed in order to confirm or refute our results.


Author Contributions

All authors have contributed equally to the present study.




Publikationsverlauf

Eingereicht: 13. Oktober 2020

Angenommen: 18. Januar 2021

Publikationsdatum:
30. Juni 2021 (online)

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