Diverting Ostomies and their Complications in Mechanical Colorectal Anastomosis for Rectum Cancer: Retrospective Study

INTRODUCTION: Anastomotic leakage after low anterior resection is the most serious complication and increases the morbidity and mortality rates and prolonges length of stay. In this study, the effectiveness and safety of diverting ostomies in colorectal anastomosis was compared retrospectively.
METHODS: The charts of all patients with diverting ostomies operated with extraperitoneal colorectal or coloanal anastomosis electively due to rectal adenocarcinoma between 2005-2010 were examined retrospectively.
RESULTS: A total of 101 patients were included in the study. Twentynine (28.7%) patients were given neoadjuvant chemoradiotherapy (NAKRT). Diverting ostomy was applied to 33 of the patients (32.7%) in the study group. Diverting ileostomy was performed to 33 (93.9%) of these patients, colostomy in the remaining two. Diverting ostomy was applied to 14 of 29 patients (48.2%) treated with NAKRT (p = 0.03). While the diverting ostomy was applied in 31 patients with BMI ≥25, it was used only in two patients with BMI <25 (p = 0.0001). Surgical site infection was the most frequent complication in 24 patients (23.8%). Stoma related complications were observed in 23 patients (69.6%). Additional treatments for dehydration were needed in 4 (12.2%) patients. Parastomal skin infections were observed in 14 of 31 patients (45%) with ileostomy
DISCUSSION AND CONCLUSION: In this series of patients, the diverting ostomy applications were found to be more frequent in patients with BMI ≥ 25 and treated with NAKRT. In this series of patients, the most common stoma complications were; skin irritations (42.4%), dehydration (12.1%), stoma bleeding (6.1%), mucocutaneous dehiscence (6.1%) and the need for stoma revision (3%). In terms of these complications care should be taken in patients undergoing diverting ostomy.

Rektum Kanserinde Mekanik Kolorektal Anastomozlarda Saptýrýcý Ostomiler ve Komplikasyonlarý: Retrospektif Çalýþma

GÝRÝÞ ve AMAÇ: Anastomoz kaçaðý aþaðý anterior rezeksiyon sonrasý en ciddi komplikasyondur ve morbidite -mortalite oranlarýný ve hastane kalýþ süresini uzatýr. Bu çalýþmada hastanemiz serisinde saptýrýcý ostomilerin kolorektal anastomozlarda etkinlik ve güvenliðinin retrospektif olarak karþýlaþtýrýlmasý amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: Hastanemizde 2005-2010 yýllarý arasýnda rektum adenokanseri tanýsýyla elektif olarak opere edilerek ekstraperitoneal kolorektal veya koloanal anastomoz yapýlýp saptýrýcý ostomi açýlmýþ tüm hastalarýn dosyalarý geriye dönük olarak incelendi.
BULGULAR: Çalýþmaya toplam 101 hasta alýnmýþtýr. Hastalarýn 29'una (%28.7) neoadjuvan kemoradyoterapi (NAKRT) uygulanmýþtý. Çalýþma grubundaki hastalarýn 33'üne (%32.7) saptýrýcý ostomi uygulanmýþtý. Bu hastalarýn 31'ine (%93,9) ileostomi, ikisine ise kolostomi uygulanmýþtý. NAKRT uygulanmýþ 29 hastanýn 14'üne (%48.2) saptýrýcý ostomi açýldýðý ve bunun da istatiksel olarak anlamlý olarak yüksek olduðu saptandý (p=0.03). BMI <25 olan hastalardan sadece ikisine saptýrýcý ostomi açýlýrken; BMI ≥25 olanlarýn 31’ine saptýrýcý ostomi açýlmýþtý ve aradaki bu fark istatiksel olarak anlamlý bulundu (p=0.0001). Cerrahi alan enfeksiyonu 24 hastada (%23.8) saptanan en sýk komplikasyondu. Stoma açýlan 33 hastanýn 23'ünde (%69.6) stoma iliþkili komplikasyonlarýn geliþtiði gözlendi. Saptýrýcý ostomi açýlan hastalarýn dördünde (%12.2) dehidratasyon bulgularý nedeniyle ek tedaviler uygulandýðý saptandý. Parastomal cilt infeksiyonlarýnýn ileostomi açýlan 31 hastanýn 14'ünde gözlendi (%45).
TARTIÞMA ve SONUÇ: Bu hasta serisinde, NAKRT uygulanan ve BMI ≥ 25 olan hastalarda saptýrýcý ostomi uygulama sýklýðýnýn yüksek olduðu saptanmýþtýr. Primer cerrahi sonrasý en sýk komplikasyon olarak cerrahi alan infeksiyonu 24 hastada (%23.8) saptanmýþtýr. Bu hasta serisinde en sýk rastlanan stoma komplikasyonlarý sýklýk sýrasýyla; deri irritasyonlarý (%42.4), dehidratasyon (%12,1), stoma kanamasý (%6.1), mükokütanöz ayrýþma (%6.1) ve stoma revizyonu (%3) ihtiyacýdýr. Saptýrýcý ostomi uygulanan hastalarda bu komplikasyonlar açýsýndan dikkatli olunmalýdýr.