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Loop-ileostomy reversal in a 23-h stay setting is safe with high patient satisfaction
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.ORCID iD: 0000-0001-6663-5242
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.ORCID iD: 0000-0002-5949-3810
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.ORCID iD: 0000-0002-7056-670x
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland.ORCID iD: 0000-0001-9662-5045
2021 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 56, no 9, p. 1126-1130Article in journal (Refereed) Published
Abstract [en]

Introduction: This study aimed to determine whether day-case closure of loop ileostomy with discharge within 23 h was both feasible and accepted by patients.

Materials and methods: We conducted a prospective pilot study where selected rectal cancer patients with diverting loop ileostomy underwent stoma closure in a 23-h stay setting. Patients were followed up on the third, seventh, and 30th postoperative day and phoned daily during the first week. A comparable group of 30 patients who underwent standard in-hospital stoma closure prior to the start of the study were selected retrospectively as historical controls.

Results: In total, 30 patients (median age, 67 years; range, 41-79 years) were included. All patients met discharge criteria and were discharged within 23 h of surgery, except one. In total, seven patients (23%) were admitted. Two of these patients underwent laparotomy because of anastomotic leakage and small bowel obstruction, respectively. The mean total length of stay was 1.7 days. Most patients (87%) were satisfied with the treatment without feeling neglected or anxious and preferred the 23-h stay setting. In the control group, the mean length of stay was 5 days. Seven patients (23%) were readmitted. Two of these patients underwent laparotomy because of small bowel obstruction and abscess, respectively.

Conclusion: Ileostomy closure in a 23-h stay setting in selected patients with meticulous follow up is feasible and safe with high patient satisfaction.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2021. Vol. 56, no 9, p. 1126-1130
Keywords [en]
Ileostomy closure, ileostomy reversal, day-case, ·23-h stay, diverting ileostomy closure, patient experience
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-449442DOI: 10.1080/00365521.2021.1947367ISI: 000669733700001PubMedID: 34224302OAI: oai:DiVA.org:uu-449442DiVA, id: diva2:1581840
Funder
Region Västmanland, LTV-943053Available from: 2021-07-26 Created: 2021-07-26 Last updated: 2022-04-27Bibliographically approved
In thesis
1. Surgical Aspects and Prognostic Factors in the Management of Rectal Cancer
Open this publication in new window or tab >>Surgical Aspects and Prognostic Factors in the Management of Rectal Cancer
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Survival among patients with stage IV rectal cancer is poor and surgical treatment for this disease is associated with morbidities such as small bowel obstruction, complications with a diverting loop ileostomy, and functional bowel disturbances. The overall aim of this thesis was to assess risk factors and morbidity after surgery for rectal cancer and to evaluate factors affecting survival in patients with stage IV rectal cancer.

Paper I a prospective study on patients with rectal cancer with loop ileostomy who underwent stoma closure in a 23-hour hospital stay setting. Results were compared with a group who underwent standard in-hospital stoma closure prior to the start of the study, selected retrospectively as controls. No differences were found in the number of complications or the frequency of re-hospitalization or re-operation, indicating that ileostomy closure in a 23-hour hospital stay setting in these selected patients was feasible and safe with high patient satisfaction.

Paper II a population-based study with data gathered prospectively. In total, 11% of the patients developed small bowel obstruction (SBO), mostly during the first year after rectal cancer surgery. Surgical treatment for SBO was performed in 4.2% of the patients, and the mechanism was stoma-related in one-fourth. Rectal resection without anastomoses, age, morbidity, and previous radiotherapy (RT) was not associated with admission to the hospital or surgery for SBO. Re-laparotomy due to complications after rectal cancer surgery was an independent risk factor for admission for treating SBO.

Paper III a population-based study with data gathered prospectively on bowel function at 1 year after anterior resection or stoma reversal. No associations were found between any defecatory dysfunction and the part of the colon used for anastomosis, the level of the vascular tie, or gender. An association was observed between higher anastomotic level and a lower risk of incontinence and clustering. At 1 year after loop ileostomy closure, the risks of incontinence, clustering, and urgency increased by up to fourfold.

Paper IV a case-control study aiming to identify patient-, tumor-, and treatment-related prognostic factors for 5-year survival in patients with rectal cancer with synchronous stage IV disease. Patient-related factors did not differ between groups. Among the tumor-related factors, multiple site metastases, bilobar liver metastases, and increasing numbers of liver metastases were associated with poor survival. Prognostic treatment-related factors were preoperative RT, metastasectomy, and radical resection of the primary tumor. The most important prognostic factor for long-term survival was metastasectomy.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2021. p. 73
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1764
Keywords
Loop ileostomy, Small bowel obstruction, Defecatory dysfunction, Stage IV rectal cancer
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-450799 (URN)978-91-513-1268-2 (ISBN)
Public defence
2021-10-08, Centrum för klinisk forskning Västerås,, Ingång 29, Västmanlands sjukhus, Västerås, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2021-09-17 Created: 2021-08-18 Last updated: 2021-10-19

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Afshari, KevinNikberg, MaziarSmedh, KennetChabok, Abbas

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