Is a Diverting Stoma Always Necessary for a Low Anterior Resection in Rectal Cancer?

Chapter

Abstract

Anterior resection with total mesorectal excision is the standard operation for rectal cancer. The coloanal or colorectal anastomosis represents the critical step of this surgical procedure, with a risk of leakage between 3% and 27%. The occurrence of anastomotic leakage significantly increases the rate of early postoperative morbidity and mortality and also seems to negatively influence the long-term functional and oncological outcomes. Even if several features were evaluated as risk factors for leakage, the incidence of this adverse event cannot be totally avoided by a diverting stoma. Nevertheless, the creation of a diverting stoma can significantly reduce the clinical consequences of anastomotic leakage, improving the postoperative outcome. On the other hand, the creation and subsequent management of a stoma is burdened by complications, such as poor stoma location, prolapse, stenosis, peristomal dermatitis, dehydration, and peristomal hernia. Loop ileostomy may be a simpler management strategy with a lower rate of complications than a loop colostomy. The diverting stoma is generally closed after approximately 1 month from the anterior resection, but some authors have counseled a longer waiting period to reduce the risk of a late anastomotic leak and postoperative morbidity secondary to stoma closure. To reduce the morbidity of a stoma and achieve the same benefits of a diverting stoma, a ghost ileostomy has been proposed, but its utility is still unclear.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2018

Authors and Affiliations

  1. 1.Department of General SurgeryCatholic University of Sacred HeartRomeItaly
  2. 2.Fondazione Policlinico Gemelli - Presidio Columbus, U.O.C. Chirurgia GeneraleRomeItaly

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