Early ileostomy reversal after minimally invasive surgery and ERAS program for mid and low rectal cancer
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Diverting loop ileostomy following low anterior resection (LAR) is known to decrease quality of life and prolongs the return back to patients’ baseline activity. The aim of this retrospective study was to explore feasibility and safety of an early ileostomy reversal strategy in a cohort of patients undergoing minimally invasive LAR within an enhanced recovery after surgery (ERAS) program. Prospectively collected data from 15 patients who underwent minimally invasive LAR and diverting ileostomy at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust between September 2015 and December 2016 were retrospectively analyzed. Of 15 patients, 10 patients underwent laparoscopic LAR and 5 patients a robot-assisted procedure. Post-operative complications were observed in 5 patients. Four patients suffered Clavien-Dindo grade 1 or 2 complications, and one patient required redo surgery due to bowel obstruction at the ileostomy site (grade 3b). Following ileostomy reversal, 10 out of 15 patients experienced complications. Two patients required redo surgery for bowel obstruction (grade 3b), whilst eight patients suffered grade 1 or 2 complications, being surgical site infection the most frequently observed (6 cases). Despite that, 80% of patients had their ileostomy reversed within 30 days and median time from initial surgery to ileostomy reversal was 22 days (range 10–150). Early ileostomy closure after minimally invasive LAR and ERAS program is feasible although it carries non-negligible risk of severe complications which, however, does not hinder its accomplishment.
KeywordsRectal cancer Low anterior resection Laparoscopic surgery Robotic surgery Ileostomy closure
Drs. Corrado Pedrazzani and Alfredo Guglielmi want to thank Dr. Lidia Biondani for the valuable help in the management of patients with ostomy and for cooperating in this study.
Compliance with ethical standards
Conflict of interest
Drs. Corrado Pedrazzani, Federica Secci, Eduardo Fernandes, Ivans Jelovskijs, Guido Mantovani, Cristian Conti, Enrico Lazzarini, Giulia Turri, and Alfredo Guglielmi have no conflicts of interest or financial ties to disclose.
Research involving human participants and/or animals
The research has complied with all National and institutional policies on the use of human subjects.
Informed consent was obtained from all patients, and the study was approved by the local ethic committee.
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