The effect of a diverting stoma on morbidity and risk of permanent stoma following anastomotic leakage after low anterior resection for rectal cancer: a nationwide cohort study.

International Journal of Colorectal Disease
Nis Hallundbæk Schlesinger, Henry Smith

Abstract

Diverting stomata (DS) have been shown to mitigate the clinical impact of anastomotic leakage (AL) but not without complications, and their routine use remains a matter of international debate. The objective of this study was to examine the association between stomata and the clinical consequences of AL. This was a nationwide retrospective cohort study including all patients suffering from AL after low anterior resection from 2001 to 2010. Four thousand sixty-three patients were treated in the period of whom 581 (11.9%) developed AL. In case of AL, patients without a diverting stoma had a slightly higher 90-day mortality rate (13.5% versus 8.7%, p = 0.089). Patients suffered more complications due to AL, both surgical (52% versus 28%, p < 0.001) and non-surgical (48% versus 35%, p = 0.004) with a higher Clavien-Dindo score. Twenty percent of patients developed stoma-related complications prior to stoma reversal. Mortality related to stoma reversal was 2.4%. Factors associated with a risk of a permanent stoma were age (HR 1.04, 95% CI 1.01-1.08), blood transfusion during primary surgery (HR 2.35, 95% CI 1.16-4-78), conserved anastomosis after AL (HR 0.019, 95% CI 0.009-0.04), and a diverting stoma fashioned at the index operatio...Continue Reading

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Citations

Feb 26, 2021·Therapeutics and Clinical Risk Management·Zhongbo HanChao Zhang
Aug 19, 2021·Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland·Anne-Loes K WarpsUNKNOWN Dutch ColoRectal Audit
Nov 11, 2021·BJS Open·Henry G SmithPeter-Martin Krarup

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