Stoma reversal after surgery for complicated acute diverticulitis: A multicentre retrospective study
Por:
Vicente Roig, J, Salvador, A, Frasson, M, Garcia-Mayor, L, Espinosa, J, Rosello, V, Hernandis, J, Dolores Ruiz-Carmona, M, Uribe, N, Garcia-Calvo, R, Carlos Bernal, J, Garcia-Armengol, J, Garcia-Granero, E and Soc Valenciana Cirugia
Publicada:
1 may 2018
Categoría:
Surgery
Resumen:
Introduction: The aim was to analyse the stoma reversal rate after surgery for complicated acute diverticulitis (CAD), and more specifically the end-stoma-reversal, as well as the delay, feasibility, complications and risk factors for stoma maintenance.
Methods: A multicentre retrospective study of patients who had undergone urgent surgery for CAD with stoma formation in ten hospitals during a period of 6 years. The frequency of reversal over time and the factors affecting the decision for reversal were analysed.
Results: Out of 385 patients operated for CAD, 312 underwent stoma creation: 292 end colostomies and 20 diverting stomas. During follow-up, stoma reversal surgery was performed in 161 patients (51.6%) after a median of 9 months. The main causes for not performing stoma reversal were comorbidities and the death of the patient. Advanced age was an adverse factor in the multivariate analysis, and the actuarial rate of reversal was higher in men and in patients with no previous Hartmann's operation. Stoma reversal surgery was completed in all but one patient, and a loop ileostomy was associated in four. Morbidity and mortality rates were 35.7% and 1.9%, respectively. A total of 8.4% of patients underwent re-operation, and 6% experienced an anastomotic leak. Twelve patients remained with a stoma after the attempted reconstruction surgery.
Conclusions: Surgery for CAD is frequently associated with an end stoma, which will ultimately not be reversed in almost 50% of patients. Moreover, reversal surgery is frequently delayed and is associated with significant morbidity and mortality. (C) 2018 AEC. Published by Elsevier Espana, S.L.U. All rights reserved.
Filiaciones:
Vicente Roig, J:
Consorcio Hosp Gen Univ Valencia, Serv Cirugia Gen, Valencia, Spain
Consorcio Hosp Gen Univ Valencia, Serv Aparato Digest, Valencia, Spain
Hosp Nisa 9 Octubre, Valencia, Spain
Salvador, A:
Consorcio Hosp Gen Univ Valencia, Serv Cirugia Gen, Valencia, Spain
Consorcio Hosp Gen Univ Valencia, Serv Aparato Digest, Valencia, Spain
Frasson, M:
Hosp Univ & Politecn La Fe, Serv Cirugia Gen, Valencia, Spain
Hosp Univ & Politecn La Fe, Serv Aparato Digest, Valencia, Spain
Hosp Clin Univ Valencia, Serv Cirugia Gen, Valencia, Spain
Hosp Clin Univ Valencia, Serv Aparato Digest, Valencia, Spain
Garcia-Mayor, L:
Hosp Univ & Politecn La Fe, Serv Cirugia Gen, Valencia, Spain
Hosp Univ & Politecn La Fe, Serv Aparato Digest, Valencia, Spain
:
Hosp Gen Univ Alicante, Serv Cirugia Gen, Alicante, Spain
Hosp Gen Univ Alicante, Serv Aparato Digest, Alicante, Spain
Rosello, V:
Hosp Lluis Alcanyis de Xativa, Serv Cirugia Gen, Valencia, Spain
Hosp Lluis Alcanyis de Xativa, Serv Aparato Digest, Valencia, Spain
Hernandis, J:
Hosp Gen Elda, Serv Cirugia Gen, Alicante, Spain
Hosp Gen Elda, Serv Aparato Digest, Alicante, Spain
Dolores Ruiz-Carmona, M:
Hosp Sagunto, Serv Cirugia Gen, Valencia, Spain
Hosp Sagunto, Serv Aparato Digest, Valencia, Spain
Uribe, N:
Hosp Arnau Vilanova, Serv Cirugia Gen, Valencia, Spain
Hosp Arnau Vilanova, Serv Aparato Digest, Valencia, Spain
Garcia-Calvo, R:
Hosp Gen Univ Castellon, Serv Cirugia Gen, Castellon De La Plana, Spain
Hosp Gen Univ Castellon, Serv Aparato Digest, Castellon De La Plana, Spain
Carlos Bernal, J:
Hosp Gen Requena, Serv Cirugia Gen, Valencia, Spain
Hosp Gen Requena, Serv Aparato Digest, Valencia, Spain
Garcia-Armengol, J:
Hosp Nisa 9 Octubre, Valencia, Spain
Garcia-Granero, E:
Hosp Univ & Politecn La Fe, Serv Cirugia Gen, Valencia, Spain
Hosp Univ & Politecn La Fe, Serv Aparato Digest, Valencia, Spain
Hosp Clin Univ Valencia, Serv Cirugia Gen, Valencia, Spain
Hosp Clin Univ Valencia, Serv Aparato Digest, Valencia, Spain
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