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：

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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.	劉坤, 趙任. 預防性造口在中低位直腸癌保肛手術的應用. 中國實用外科雜志, 2014, 34(9): 903-905.
6.	丘素語, 胡民輝, 過文泰, 等. 直腸癌保括約肌手術患者預防性回腸造口延遲回納的危險因素. 中國普外基礎與臨床雜志, 2019, 26(4): 418-422.
7.	潘宏達, 王林, 彭亦凡, 等. 直腸癌低位前切除保護性回腸口還納術后并發癥. 中華胃腸外科雜志, 2015, 18(7): 656-660.
8.	中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 81(5): 314-320.
9.	曾莉. 腹腔粘連研究進展. 南京中醫藥大學學報, 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.	黃榕康, 何丹丹, 趙潔, 等. 直腸癌保留括約肌術后預防性回腸造口回納術后并發癥的危險因素分析. 中國普外基礎與臨床雜志, 2016, 23(11): 1335-1338.
17.	葉穎江, 王杉, 和宇, 等. 結直腸癌手術部位感染相關并發癥影響因素分析. 中華普通外科雜志, 2006, 21(2): 122-124.
18.	Marks JB. Perioperative management of diabetes. Am Fam Physician, 2003, 67(1): 93-100.
19.	謝凌鐸, 周鑫, 謝海艇, 等. 腹腔鏡直腸癌全直腸系膜切除術預防性末端回腸造瘺后相關并發癥危險因素和造瘺還納時機分析. 中華胃腸外科雜志, 2015, 18(6): 563-567.
20.	蘭平, 練磊. 腸造口及其相關問題. 中華胃腸外科雜志, 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. 劉坤, 趙任. 預防性造口在中低位直腸癌保肛手術的應用. 中國實用外科雜志, 2014, 34(9): 903-905.
6. 丘素語, 胡民輝, 過文泰, 等. 直腸癌保括約肌手術患者預防性回腸造口延遲回納的危險因素. 中國普外基礎與臨床雜志, 2019, 26(4): 418-422.
7. 潘宏達, 王林, 彭亦凡, 等. 直腸癌低位前切除保護性回腸口還納術后并發癥. 中華胃腸外科雜志, 2015, 18(7): 656-660.
8. 中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 81(5): 314-320.
9. 曾莉. 腹腔粘連研究進展. 南京中醫藥大學學報, 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. 黃榕康, 何丹丹, 趙潔, 等. 直腸癌保留括約肌術后預防性回腸造口回納術后并發癥的危險因素分析. 中國普外基礎與臨床雜志, 2016, 23(11): 1335-1338.
17. 葉穎江, 王杉, 和宇, 等. 結直腸癌手術部位感染相關并發癥影響因素分析. 中華普通外科雜志, 2006, 21(2): 122-124.
18. Marks JB. Perioperative management of diabetes. Am Fam Physician, 2003, 67(1): 93-100.
19. 謝凌鐸, 周鑫, 謝海艇, 等. 腹腔鏡直腸癌全直腸系膜切除術預防性末端回腸造瘺后相關并發癥危險因素和造瘺還納時機分析. 中華胃腸外科雜志, 2015, 18(6): 563-567.
20. 蘭平, 練磊. 腸造口及其相關問題. 中華胃腸外科雜志, 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

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