FECAL DIVERSION is often required

Size: px
Start display at page:

Download "FECAL DIVERSION is often required"

Transcription

1 Temporary Transverse Colostomy vs Loop Ileostomy in Diversion A Case-Matched Study ORIGINAL ARTICLE Yasuo Sakai, MD, PhD; Heidi Nelson, MD; Dirk Larson; Laurie Maidl, RN; Tonia Young-Fadok, MD, MS; Duane Ilstrup Hypothesis: For temporary fecal diversion, transverse colostomy () has superior safety, but loop ileostomy () has superior management qualities. Methods: Of patients with or seen between 1988 and 1997, 63 patients were matched for diagnosis, operative procedure, and date of surgery. The 2 groups were then compared for hospital/postoperative mortality and morbidity and stoma complications. Results: Mortality rates were 6.3% for the group and 1.6% for the group (P=.25). Morbidity rates for stoma creation and for stoma closure were 47.6% and 10% (P=.19), respectively, for the group, and 36.5% and 6.3% (P.99), respectively, for the group. Most morbidity events were minor, and neither procedurerelated nor other medical complications showed a significant difference between the groups. However, patients with a were significantly more likely to experience skin trouble around the stoma ( vs, 15.9% vs 3.2%) and leakage around the stoma ( vs, 12.7% vs 1.6%). Conclusions: Regarding safety, and should be considered equivalent options for temporary fecal diversion. We recommend further study comparing the 2 procedures with regard to patient perception and quality of life. Arch Surg. 2001;136: From the Division of Colon and Rectal Surgery (Drs Sakai, Nelson, and Young-Fadok and Ms Maidl); the Section of Biostatistics (Messrs Larson and Ilstrup), Mayo Clinic and Mayo Foundation; Rochester, Minn; and the Department of Surgery, Niigata University School of Medicine, Niigata, Japan (Dr Sakai). FECAL DIVERSION is often required for the treatment of diseases affecting the large intestine. While options may be limited for technical or therapeutic reasons, in many circumstances the surgeon is at liberty to select a site according to his or her preference. Preference biases should be influenced by objective data based on the ease of construction, the ease of the reversal procedure, and minimizing rates of morbidities. Equally important are the patient s perception regarding ease of use, management, and quality of life. For left-sided colonic diseases and procedures, the 2 most common stoma options include the loop transverse colostomy () and loop ileostomy (). Historically, the loop was widely adopted for the convenience of exteriorization. However, the placement of the stoma between the costal margin and waistline and its relative bulk make it difficult to manage. 1 Further, the waste matter from the is both wet and odoriferous. In contrast, the can be placed below the belt line, away from bony prominences, and although the effluent is liquid, it typically has a less feculent odor. Current reports suggest a conflict between quality of life outcomes, which favor, 1,2 and morbidity results, which favor the loop. 3,4 Because previous studies have been based on small sample sizes, we chose a larger sample of patients and made further comparisons using matching criteria to ensure equivalent groups of patients. RESULTS The total analysis sample consisted of 126 patients, 63 of whom had temporary and 63 of whom had. The matching variables of the 2 groups are presented in Table 2. There were 54 loop (85.7%) and 9 end-temporary s, and 63 s identified. Fifty-two patients (83%) in each group underwent elective operations, with preoperative stoma site marking performed by an ET nurse. The median ages for the and groups were 64 years (range, years) and 64 years (range, years), respectively (P<.12). There were almost equal numbers of men and 338

2 PATIENTS AND METHODS Between 1988 and 1997, 314 patients undergoing diverting stomas after pelvic surgery were identified, including 142 patients with and 172 patients with. We wanted to compare with in patients with a residual colon or rectum, so patients with ileal-pouch anal anastomosis with diverting for ulcerative colitis and familial adenomatous polyposis were not considered. Of the 314 cases remaining, 49 patients with (34.5%) and 41 patients with (23.8%) had palliative decompression of obstruction or fistula of the distal colon and rectum, and thus were excluded from this study. Of the remaining 224 cases, patients with potentially reversible (ie, a temporary stoma) were matched to patients with temporary, according to pathological diagnosis, the type of primary operation, and timing of operation (elective or emergent). Procedures for primary lesions were categorized into resection with or without anastomosis (the Hartmann operation) and diverting stoma. The need to create a diverting stoma and the appropriate type of diverting stoma were decided at the discretion of the individual surgeon. Indications for stoma creation are presented in Table 1. Protection of low anastomoses of the prepared bowel was the most common indication in both stoma groups, followed by diversion for the leakage of colorectal anastomosis. Decompression of distal mass or inflammation, diversion of fistula, and peritonitis with fecal contamination were more frequent in than in. For 3 patients in the group and 1 patient in the group, it was necessary to create diverting stomas in response to positive leak tests of the anastomosis or incomplete donut in stapling that was found at surgery. Complications and mortality were identified by medical record review for the in-hospital period of both stoma creation and stoma closure. Construction of either a loop stoma or an end stoma includes eversion of the end with sutures to maintain stoma appliance. Patients are given preoperative instruction in the outpatient clinic or a brief session in the hospital just after admission or before the operation. These sessions are instructed by an enterostomal therapy (ET) nurse and include information about the surgery, the stoma, and stoma site marking. During the postoperative period, patients are seen every day by ET nurses to evaluate the stoma and appliance management. The appliance is usually changed every other day to assess the stoma, appliance fit, and skin. Closure of each type of temporary stoma involved a peristomal incision and either excision of both limbs with an end-to-end anastomosis or trimming of the edges and closure of the anterior wall by 2 layers of hand-sewn sutures. Forty-seven and 37 were closed by hand-sewn sutures, and 4 stomas (1 and 3 ) were closed by stapled side-to-side anastomoses. Midline abdominal incisions were reopened only for patients in whom mobilization of the stoma through the peristomal incision proved technically difficult due to adhesions, or whose stoma was an end with a Hartmann pouch. Operation time and estimated blood loss with temporary closure were also compared with those of temporary closure as a measure of the degree of difficulty of the operations. Summary statistics are presented as median ± SD for continuous variables and as frequencies and percentages for discrete variables. In-hospital complication rates for the group and the group (for both stoma creation and stoma closure) were compared using the signed rank test. Between-group comparison of continuous data was also performed using the signed rank test. All statistical tests were 2 sided and the threshold of statistical significance was set at P=.05. All analysis was carried out with SAS 6.12 (SAS Institute Inc, Cary, NC) on a Sun Ultra II computer (Sun Microsystems Inc, Palo Alto, Calif). With an analysis set of 126 patients (63 in each group, matched), there was an 80% power to detect a difference in the overall complication rate between the 2 groups equal to 35% vs 52%. Also, there was an 80% power to detect a difference in the procedure-related complication rate between the 2 groups equal to 19% vs 34%. women in this study, 62 and 64, respectively; however, there were more women in the group than in the group (43 and 21, respectively [P.001]). The median body mass index (calculated as weight in kilograms divided by the square of height in meters) of the group was 25.4 kg/m 2 (range, kg/m 2 ), and that of the group was 25.9 kg/m 2 (range, kg/m 2 )(P=.38). No significant difference was identified in the proportion of obese patients in each group, with 16 of the patients (25.4%) and 15 of the patients (23.8%) having a body mass index of 30 kg/m 2 or higher. Five patients died (4 from the group, 1 from the group) during the hospital stay after their stomas were created, but none as a result of the stoma or the procedure directly. In the group, 3 patients died of pulmonary complications (1 of respiratory failure with chronic obstructive pulmonary disease, and 2 of pulmonary edema), and 1 died of bowel dysfunction after poor appetite and severe uncontrolled diarrhea resulted in general malaise and nutritional failure. One patient in the group died of adult respiratory distress syndrome with acute renal failure. All 5 cases were associated with distinct pelvic abscess prior to the primary surgery. No deaths were observed after stoma closure in either group. Hence, overall mortality rates for stoma creation were 6.3% for the group and 1.6% for the group (P=.25), and for stoma closure, 0% for each group. Operative and perioperative results are presented in Table 3. There was a significant difference between the groups in the days to the first bowel movement after stoma creation (P.001). No statistically significant differences were found between the 2 groups with regard to median postoperative hospital stay for both stoma creation (P<.29) and stoma closure (P.43), or median interval days between stoma creation and closure (P<.88). Seventy percent of 40 patients with and 70.9% of 48 patients with underwent stoma takedown within 6 months after stoma creation, with a median of 96 days in the group and 97 days in the group; 42.5% of patients with and 39.6% of patients with had stoma closure, with the most frequent interval between 1 and 3 months. Neither the operation time (P>.22) nor the estimated blood loss (P.99) with stoma closure showed significant differences between the groups. 339

3 Table 1. Patient Indications Requiring a Diverting Stoma* Indications Protect anastomosis/low anastomosis 35 (55.6) 45 (71.4) Anastomotic leakage 10 (15.9) 14 (22.2) Bowel obstruction due to distal 5 (7.9) 1 (1.6) mass/inflammation Peritonitis/fecal contamination/abscess 7 (11.1) 1 (1.6) Fistula/bleeding of distal colorectum 5 (7.9) 2 (3.2) Others 1 (1.6) 0 Table 2. Patients Matched by Variables* Diagnosis Pelvic malignancy 48 (76.2) 48 (76.2) Diverticulitis 13 (20.6) 13 (20.6) Functional disorders of defecation 2 (3.2) 2 (3.2) Timing of operation Elective 52 (82.5) 52 (82.5) Emergency 11 (17.5) 11 (17.5) Procedures Resection with or without anastomosis 45 (71.4) 45 (71.4) plus diverting stoma Diverting stoma alone 18 (28.6) 18 (28.6) Table 3. Operative and Perioperative Data* Median length of stay, d (range) Stoma creation 11 (4-45) 10 (5-49) Stoma closure 8 (1-15) 7 (4-29) Median days from stoma creation to 95.5 (38-526) 97.0 (20-453) closure (range) Median days to first bowel 4 (2-8) 3 (1-6) movement after stoma creation (range) Median operative time for stoma 90 (50-344) 98.5 (60-571) closure, min (range) Estimated blood loss at stoma closure, ml (%) (85.0) 42 (87.5) (15.0) 5 (10.4) 500 required blood transfusion 0 (0.0) 1 (2.1) * indicates P.001 vs ; otherwise all comparisons are nonsignificant. Sample sizes for this variable were 40 for the group and 48 for the group. Table 4. Complications Following Primary Stoma Creation* Complication Procedure-related 12 (19.0) 13 (20.6) Abdominal wound infection 9 (14.3) 8 (12.7) Intra-abdominal infection/abscess 5 (7.9) 2 (3.2) Postoperative bleeding/hematoma 0 2 (3.2) Bowel obstruction treated with surgery 0 1 (1.6) Bowel obstruction treated without surgery 2 (3.2) 3 (4.8) Others 3 (4.8) 0 Medical 12 (19.0) 6 (9.5) Cardiovascular 4 (6.3) 0 Pulmonary 6 (9.5) 3 (4.8) Urinary 3 (4.8) 3 (4.8) Sepsis/DIC 2 (3.2) 1 (1.6) Others 2 (3.2) 1 (1.6) *Data are given as number (percentage) of patients. All P values are nonsignificant. indicates transverse colostomy;, loop ileostomy; and DIC, disseminated intravascular coagulation. The overall incidence of complications in stoma creation, excluding overlapping cases (ie, those patients with more than 1 complication were included only once), was 47.6% (30/63) in (95% confidence interval [CI], 34.9%-60.6%) and 34.9% (22/63) in (95% CI, 23.3%-48.0%); this was not found to be a statistically significant difference (P>.18). Furthermore, no significant differences were identified in procedurerelated complications and medical complications (P.99 and P=.18) (Table 4). Abdominal wound infection was the most common operative complication in both groups. Intra-abdominal infection/abscess was the next most common, and occurred more often in the group, but the comparison was not statistically different. No stoma wound infections were observed in the stoma creation procedure. Small-bowel obstruction was seen in 3 patients with and 2 with. One of the 3 patients with required surgery owing to adhesions around the stoma that resulted in kinking of the proximal limb. Overall rates of stoma-related complications showed no significant difference (P.48). Skin trouble around the stoma and leakage of the appliance were significantly more common in than in (P=.04, P=.04) (Table 5). Because of the high output and excessive electrolyte loss through the stoma, prolonged intravenous infusion therapy, orally administered drugs, and diet therapy were required in 4 patients with (P>.12). Two patients with experienced retraction of the stoma resulting in skin trouble and leakage of the appliance, and 1 patient with developed a parastomal hernia and required surgery later. Other complications such as bleeding or hematoma requiring treatment, prolapse, and fistula were not seen in either stoma group. Forty patients (63.5%) and 48 patients (76.2%) had stoma closure (P>.13). Overall complications after stoma closure were recognized in 10% of patients with (95% confidence interval, 2.8%-23.7%) and in 6.3% of patients with (95% CI, 1.3%-17.2%) (P.9) (Table 6). All but 1 of the complications were procedurerelated, such as wound infection and small-bowel obstruction. Transient small-bowel obstruction occurred in 2 patients with but was not related to the anastomosis. No anastomotic leakage, intra-abdominal infection or abscess, nor postoperative bleeding were observed in either group. 340

4 COMMENT Results from this study did not identify any statistically significant differences in the incidence of complications between and in both stoma creation and closure. The present study was not a randomized trial but a retrospective case-matched study, which was controlled for the variables of diagnosis, operative procedure, and date of surgery. It consisted of a total of 126 cases in the 2 matched cohorts and compared the 2 temporary stomas in terms of morbidity and mortality experienced during the hospital stay. Results suggest that from a surgical standpoint (ie, parameters of recovery and complications) the 2 stoma procedures are equivalent. Past studies have not been in agreement as to whether or is preferable for temporary fecal diversion. Some authors have advocated that is best for temporary diversion because of its ease of construction and management and the infrequency of complications. 5-8 Others support routine use of, claiming fewer complications from this procedure. 3,4 The lack of agreement between these studies may be due to any number of variables regarding patient background (diagnosis, general conditions) 9-11 and operative factors (procedures and timing of surgery). 12,13 Furthermore, several studies either failed to directly compare the 2 options or compared the techniques but did not assure equal surgeon experience with both. 7,8,14,15 The reports that did provide direct comparisons contained relatively small numbers of patients in each group. 1-4,16 This case-matched study was undertaken to help resolve this conflict. Because our findings indicate little difference between and in terms of complications and safety, surgeons should select the procedure with which they are most familiar. Alternatively, the stoma should be chosen because of the stoma-related complications. Data from this study demonstrate significantly more problems with skin trouble and leakage around the stoma for the procedure. Both of these procedures can seriously impair a patient s lifestyle and therefore, these issues should seriously be considered. Stoma closure was not indicated in 30% of the patients in each group because of poor general health, limited life expectancy, recurrence of neoplasm, or patients preference. It is said that at least 15% of intended temporary stomas will turn out to be permanent. 1 If the surgeon chose a position for the stoma during surgery without the benefit of discussion with the patient and stoma site marking, poor stomal positioning could have related to the significantly higher incidence of stoma complications and resulted in adversely affecting the patient s quality of life. Preoperative stoma therapy education by a certified ET nurse should have a positive effect on the outcome. Having established the procedures as equally safe, we are now in the process of scrutinizing quality of life issues. Survey instruments are being developed to examine in a reproducible fashion the patients perceptions of each stoma type. Classically, the has been less desirable owing to the feculent odor factor and the subcostal location. 1 The location of the is particularly challenging for patients with a narrow width of the Table 5. Stoma-Related Complications* Complication Stoma retraction 2 (3.2) 0 Skin trouble around the stoma 10 (15.9) 2 (3.2) Leakage around the stoma 8 (12.7) 1 (1.6) Parastomal hernia 0 1 (1.6) Dehydration due to high output 0 4 (6.3) Total 12 (19.0) 8 (12.7) P.04 vs ; all other comparisons are nonsignificant. Table 6. Complications of Stoma Closure* (n = 40) (n = 48) Procedure related 4 (10.0) 2 (4.2) Abdominal wound infection 1 (2.5) 0 Stoma wound infection 1 (2.5) 2 (4.2) Bowel obstruction treated 2 (5.0) 0 without surgery Medical 0 1 (2.1) Pulmonary 1 (2.1) costal margin, with previous incisions, or with irregularities or concavities of the upper abdominal wall. In contrast, the convexity of the subcutaneous tissues around the right lower quadrant is often ideally suited for appliance adherence. The literature suggests that may be superior in maintenance of hydration status based on the additional absorption capacity of the right colon. 1,3 We did not find a significant difference between and in the frequency of high-output dehydration, there were no episodes in the group but 6.3% of patients in the group did experience episodes, suggesting a trend. The fact that differences in the occurrence of high-output dehydration were not detected between the 2 groups could represent underreporting, since detailed measurements were not prospectively collected. Relying on recall would underestimate such events. Furthermore, this article cannot comment on long-term risks of hydration problems, since these were all temporary stomas. Both and were associated with surprisingly few complications in stoma closure. A few reports have described such high rates of stoma closure complications to discourage the use of fecal diversion for protecting low rectal or coloanal anastomosis. 17,18 In this study, neither operation time nor estimated blood loss revealed significant differences between both groups at stoma closure, although 5 of 48 patients with closure and no patients with loop closure required an approach through midline incision because of extensive adhesions. These acceptably low rates of morbidity for both procedures in our study suggest that stoma closure is safe. However, reversal of the stoma, especially an, is not always just a local procedure. Current techniques, greater familiarity, and attention to detail contribute to the ac- 341

5 ceptable complication rates for stomal reversal. Timing of closure is probably also important, and although not specifically examined in this study, we agree with the observations of other authors that closure after 3 months is preferable to earlier closure. 11,13,19 Although was equivalent to when measuring parameters of safety, showed significant advantages in stoma management. Since both stomas are equally feasible as methods of fecal diversion, the selection process should be left to the surgeon and patient. Further studies examining the patients preferences are under way. Presented at the annual meeting of the American Society of Colon and Rectal Surgeons, Boston, Mass, June 27, Corresponding author: Heidi Nelson, MD, Division of Colon and Rectal Surgery, Mayo Clinic, 200 First St SW, Rochester, MN ( nelson.heidi@mayo.edu). REFERENCES 1. Williams NS, Nasmyth DG, Jones D, Smith AH. De-functioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy. Br J Surg. 1986;73: Khoury GA, Lewis MC, Meleagros L, Lewis AA. Colostomy or ileostomy after colorectal anastomosis? a randomized trial. Ann R Coll Surg Engl. 1987;69: Gooszen AW, Geelkerken RH, Hermans J, et al. Temporary decompression after colorectal surgery: randomized comparison of loop ileostomy and loop colostomy. Br J Surg. 1998;85: Rutegard J, Dahlgren S. Transverse colostomy or loop ileostomy as diverting stoma in colorectal surgery. Acta Chir Scand. 1987;153: Metcalf AM, Dozois RR, Beart RW Jr, et al. Temporary ileostomy for ileal pouchanal anastomosis: function and complications. Dis Colon Rectum. 1986;29: Khoo RE, Cohen MM, Chapman GM, et al. Loop ileostomy for temporary fecal diversion. Am J Surg. 1994;167: Fasth S, Hulten L. Loop ileostomy: a superior diverting stoma in colorectal surgery. World J Surg. 1984;8: Senapati A, Nicholls RJ, Ritchie JK, et al. Temporary loop ileostomy for restorative proctocolectomy. Br J Surg. 1993;80: Post S, Herfarth CH, Schumacher H, et al. Experience with ileostomy and colostomy in Crohn s disease. Br J Surg. 1995;82: Leenen LP, Kuypers JH. Some factors influencing the outcome of stoma surgery. Dis Colon Rectum. 1989;32: Beck PH, Conklin HB. Closure of colostomy. Ann Surg. 1975;181: Stothert JC, Brubacher L, Simonowitz DA. Complications of emergency stoma formation. Arch Surg. 1982;117: Rosen L, Friedman IH. Morbidity and mortality following intraperitoneal closure of transverse loop colostomy. Dis Colon Rectum. 1980;23: van de Pavoordt HDWM, Fazio VW, Jagleman DG, et al. The outcome of loop ileostomy closure in 293 cases. Int J Colorect Dis. 1987;2: Riesener KP, Lehnen W, Hoefer M, et al. Morbidity of ileostomy and colostomy closure: impact of surgical technique and perioperative treatment. World J Surg. 1997;21: Chen F, Stuart M. The morbidity of defunctioning stomata. Aust N Z JSurg. 1996; 66: Foster ME, Leaper DJ, Williamson RC. Changing patterns in colostomy closure: the Bristol experience, Br J Surg. 1985;72: Demetriades D, Pezikis A, Melissas J, et al. Factors influencing the morbidity of colostomy closure. Am J Surg. 1988;155: Knox AJS, Birkett FD, Collins CD. Closure of colostomy. Br J Surg. 1971;58: Announcement T he Archives of Surgery will give priority review and early publication to seminal works. This policy will include basic science advancements in surgery and critically performed clinical research. 342

Complications of laparoscopic protective loop ileostomy in patients with colorectal cancer

Complications of laparoscopic protective loop ileostomy in patients with colorectal cancer ISPUB.COM The Internet Journal of Surgery Volume 19 Number 2 Complications of laparoscopic protective loop ileostomy in patients with colorectal cancer F Puccio, M Solazzo, G Pandolfo, P Marcianò Citation

More information

Colostomy & Ileostomy

Colostomy & Ileostomy Colostomy & Ileostomy Indications, problems and preference By Waleed Omar Professor of Colorectal surgery, Mansoura University. Disclosure I have no disclosures. Presentation outline Stoma: Definition

More information

ILEOSTOMY VERSUS COLOSTOMY searchers conducted the data search independently using the key words ileostomy AND colostomy, and loop ileostomy AND loop

ILEOSTOMY VERSUS COLOSTOMY searchers conducted the data search independently using the key words ileostomy AND colostomy, and loop ileostomy AND loop Original Article Temporary Ileostomy Versus Temporary Colostomy: A Meta-analysis of Complications Panuwat Lertsithichai and Pudsaporn Rattanapichart, Department of Surgery, Ramathibodi Hospital Medical

More information

STOMA SITING & PARASTOMAL HERNIA MANAGEMENT

STOMA SITING & PARASTOMAL HERNIA MANAGEMENT STOMA SITING & PARASTOMAL HERNIA MANAGEMENT Professor Hany S. Tawfik Head of the Department of Surgery & Chairman of Colorectal Surgery Unit Benha University Disclosure No financial affiliation to disclose

More information

Rectal Cancer. About the Colon and Rectum. Symptoms. Colorectal Cancer Screening

Rectal Cancer. About the Colon and Rectum. Symptoms. Colorectal Cancer Screening Patient information regarding care and surgery associated with RECTAL CANCER by Robert K. Cleary, M.D., John C. Eggenberger, M.D., Amalia J. Stefanou., M.D. location: Michigan Heart and Vascular Institute,

More information

Loop ostomy following laparoscopic low anterior resection for rectal cancer after neoadjuvant chemoradiotherapy

Loop ostomy following laparoscopic low anterior resection for rectal cancer after neoadjuvant chemoradiotherapy https://doi.org/10.1186/s40001-018-0325-x European Journal of Medical Research RESEARCH Open Access Loop ostomy following laparoscopic low anterior resection for rectal cancer after neoadjuvant chemoradiotherapy

More information

Surgery for Inflammatory Bowel Disease

Surgery for Inflammatory Bowel Disease Surgery for Inflammatory Bowel Disease Emily Steinhagen, MD Assistant Professor Department of Surgery, Division of Colorectal Surgery University Hospitals Cleveland Medical Center Common Questions Why

More information

Comparison of Loop Ileostomy and Loop Colostomy as Defunctioning Stoma in Low Rectal Cancer Surgery NCI Experience

Comparison of Loop Ileostomy and Loop Colostomy as Defunctioning Stoma in Low Rectal Cancer Surgery NCI Experience Kasr El Aini Journal of Surgery VOL., 12, NO 1 January 2011 75 Comparison of Loop Ileostomy and Loop Colostomy as Defunctioning Stoma in Low Rectal Cancer Surgery NCI Experience Ahmed Abbas, MD MRCS General

More information

Index. Note: Page numbers of article title are in boldface type.

Index. Note: Page numbers of article title are in boldface type. Index Note: Page numbers of article title are in boldface type. A Abscess(es) in Crohn s disease, 168 169 IPAA and, 110 114 as unexpected finding in colorectal surgery, 46 Adhesion(s) trocars-related laparoscopy

More information

Outcomes of Colostomy Reversal Procedures in Two Teaching Hospitals in Addis Ababa, Ethiopia A. Bekele, B. Kotisso, H. Biluts Correspondence to

Outcomes of Colostomy Reversal Procedures in Two Teaching Hospitals in Addis Ababa, Ethiopia A. Bekele, B. Kotisso, H. Biluts Correspondence to East and Central African Journal of Surgery http://www.bioline.org.br/js 9 Outcomes of Colostomy Reversal Procedures in Two Teaching Hospitals in Addis Ababa, Ethiopia A. Bekele, B. Kotisso, H. Biluts

More information

Restorative Proctocolectomy For Ulcerative Colitis IN

Restorative Proctocolectomy For Ulcerative Colitis IN 590540SJS0010.1177/1457496915590540Restorative proctocolectomyi. Helavirta, H. Huhtala, M. Hyöty, P. Collin, P. Aitola research-article2015 Original article Restorative Proctocolectomy For Ulcerative Colitis

More information

11/13/11. Biologics for CD and CUC: The Impact on Surgical Outcomes. Principles of Successful Intestinal Surgery

11/13/11. Biologics for CD and CUC: The Impact on Surgical Outcomes. Principles of Successful Intestinal Surgery Biologics for CD and CUC: The Impact on Surgical Outcomes Robert R. Cima, M.D., M.A. Associate Professor of Surgery Division of Colon and Rectal Surgery Overview Antibody based medications (biologics)

More information

Colorectal Surgery. Patient Care. Goals and Objectives

Colorectal Surgery. Patient Care. Goals and Objectives Colorectal Surgery Patient Care 1) Interpret the results of clinical evaluations (history, physical examination) performed on patients with a) Hemorrhoids b) Perianal abscess/fistula c) Anal fissure d)

More information

Incidence and risk factors of anastomotic leaks. By: khaled Said Assistant professor of colorectal surgery Alexandria

Incidence and risk factors of anastomotic leaks. By: khaled Said Assistant professor of colorectal surgery Alexandria Incidence and risk factors of anastomotic leaks By: khaled Said Assistant professor of colorectal surgery Alexandria Anastomotic leakage after colorectal surgery is a major and potentially life-threatening

More information

DIVERTICULAR DISEASE. Dr. Irina Murray Casanova PGY IV

DIVERTICULAR DISEASE. Dr. Irina Murray Casanova PGY IV DIVERTICULAR DISEASE Dr. Irina Murray Casanova PGY IV Diverticular Disease Colonoscopy Abdpelvic CT Scan Surgical Indications Overall, approximately 20% of patients with diverticulitis require surgical

More information

Acute Diverticulitis. Andrew B. Peitzman, MD Mark M. Ravitch Professor of Surgery University of Pittsburgh

Acute Diverticulitis. Andrew B. Peitzman, MD Mark M. Ravitch Professor of Surgery University of Pittsburgh Acute Diverticulitis Andrew B. Peitzman, MD Mark M. Ravitch Professor of Surgery University of Pittsburgh Focus today: when to operate n Recurrent, uncomplicated diverticulitis; after how many episodes?

More information

Acute Care Surgery: Diverticulitis

Acute Care Surgery: Diverticulitis Acute Care Surgery: Diverticulitis Madhulika G. Varma, MD Associate Professor and Chief Section of Colorectal Surgery University of California, San Francisco Modern Treatment of Diverticular Disease Increasing

More information

Abdominal Wall Modification for the Difficult Ostomy

Abdominal Wall Modification for the Difficult Ostomy Abdominal Wall Modification for the Difficult Ostomy David E. Beck, M.D. 1 ABSTRACT A select group of patients with major stomal problems may benefit from operative modification of the abdominal wall.

More information

CLINICAL IMPACT OF SEPRAFILM SAFETY AND EFFICACY

CLINICAL IMPACT OF SEPRAFILM SAFETY AND EFFICACY CLINICAL IMPACT OF Post-surgical ADHESIONS SEPRAFILM SAFETY AND EFFICACY Clinical Reviews Clinical studies contents OVERVIEW 3. REDUCED INCIDENCE AND SEVERITY OF ADHESIONS 3.1 Becker JM et al. (1996) 3.2

More information

Inflammatory Bowel Disease and Surgery: What You Should Know

Inflammatory Bowel Disease and Surgery: What You Should Know Inflammatory Bowel Disease and Surgery: What You Should Know Ask the Experts March 9, 2019 Kristen Blaker, MD Colon and Rectal Surgery MetroHealth Medical Center Disclosures None Outline Who undergoes

More information

The Role of Surgery in Inflammatory Bowel Disease. Cory D Barrat, MD Colon and Rectal Surgeon Mercy Health

The Role of Surgery in Inflammatory Bowel Disease. Cory D Barrat, MD Colon and Rectal Surgeon Mercy Health The Role of Surgery in Inflammatory Bowel Disease Cory D Barrat, MD Colon and Rectal Surgeon Mercy Health THANKS FOR INVITING ME! I have no financial disclosures Outline - Who am I and what do I do? -

More information

University of Groningen. Colorectal Anastomoses Bakker, Ilsalien

University of Groningen. Colorectal Anastomoses Bakker, Ilsalien University of Groningen Colorectal Anastomoses Bakker, Ilsalien IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document

More information

Ostomy A to Z From the Phoenix Magazine March 2010 & Robyn Home, RGN, BSN, WOCN, DMU

Ostomy A to Z From the Phoenix Magazine March 2010 & Robyn Home, RGN, BSN, WOCN, DMU Ostomy A to Z From the Phoenix Magazine March 2010 & Robyn Home, RGN, BSN, WOCN, DMU Adhesions: Scar tissue from an abdominal surgery can generate adhesions, which are fibrous bands that may attach to

More information

Technical Tips for Stoma Creation in the Challenging Patient

Technical Tips for Stoma Creation in the Challenging Patient Technical Tips for Stoma Creation in the Challenging Patient Peter A. Cataldo, M.D. 1 ABSTRACT Stoma creation is a mental and technical exercise, often straightforward without any difficulty. However,

More information

Management of colorectal anastomotic leakage: differences between salvage and anastomotic takedown

Management of colorectal anastomotic leakage: differences between salvage and anastomotic takedown The American Journal of Surgery (2012) 204, 671 676 Clinical Science Management of colorectal anastomotic leakage: differences between salvage and anastomotic takedown Domenico Fraccalvieri, M.D., Sebastiano

More information

Motility Disorders. Pelvic Floor. Colorectal Center for Functional Bowel Disorders (N = 701) January 2010 November 2011

Motility Disorders. Pelvic Floor. Colorectal Center for Functional Bowel Disorders (N = 701) January 2010 November 2011 Motility Disorders Pelvic Floor Colorectal Center for Functional Bowel Disorders (N = 71) January 21 November 211 New Patients 35 3 25 2 15 1 5 Constipation Fecal Incontinence Rectal Prolapse Digestive-Genital

More information

Laparoscopic vs Robotic Rectal Cancer Surgery: Making it better!

Laparoscopic vs Robotic Rectal Cancer Surgery: Making it better! Laparoscopic vs Robotic Rectal Cancer Surgery: Making it better! Francis Seow- Choen Medical Director Seow-Choen Colorectal Centre Singapore In all situations: We have to use the right tool for the job

More information

Surgery and Crohn s. Crohn s Disease 70 % Why Operate? Complications of Disease. The Gastrointestinal Tract. Surgery for Inflammatory Bowel Disease

Surgery and Crohn s. Crohn s Disease 70 % Why Operate? Complications of Disease. The Gastrointestinal Tract. Surgery for Inflammatory Bowel Disease The Gastrointestinal Tract Surgery for Inflammatory Bowel Disease Jonathan Chun, MD The regon Clinic Gastrointestinal and Minimally Invasive Surgery Crohn s Disease Can affect anywhere in the GI tract,

More information

Chapter I 7. Laparoscopic versus open elective sigmoid resection in diverticular disease: six months follow-up of the randomized control Sigma-trial

Chapter I 7. Laparoscopic versus open elective sigmoid resection in diverticular disease: six months follow-up of the randomized control Sigma-trial Chapter I 7 Laparoscopic versus open elective sigmoid resection in diverticular disease: six months follow-up of the randomized control Sigma-trial Bastiaan R. Klarenbeek Roberto Bergamaschi Alexander

More information

Ileo-rectal anastomosis for Crohn's disease of

Ileo-rectal anastomosis for Crohn's disease of Ileo-rectal anastomosis for Crohn's disease of the colon W. N. W. BAKER From the Research Department, St Mark's Hospital, London Gut, 1971, 12, 427-431 SUMMARY Twenty-six cases of Crohn's disease of the

More information

9/10/2018. No financial or off label use disclosures. 1. Describe skin problems for an ostomate and interventions for management

9/10/2018. No financial or off label use disclosures. 1. Describe skin problems for an ostomate and interventions for management Debra Netsch DNP,APRN,FNP-BC,CWOCN-AP,CFCN WEB WOC Nurse Education Programs: Co-Director & Faculty Ridgeview Medical Center, Wound & Hyperbaric Clinic: NP & CWOCN-AP JWOCN: Clinical Challenges Section

More information

LONG TERM OUTCOME OF ELECTIVE SURGERY

LONG TERM OUTCOME OF ELECTIVE SURGERY LONG TERM OUTCOME OF ELECTIVE SURGERY Roberto Persiani Associate Professor Mini-invasive Oncological Surgery Unit Institute of Surgical Pathology (Dir. prof. D. D Ugo) Dis Colon Rectum, March 2000 Dis

More information

Version 1 (08/01/2018) Page 1 of 5

Version 1 (08/01/2018) Page 1 of 5 PATIENT NAME: BRN: OSTOMY: An ostomy refers to a surgical opening in the abdomen, known as a stoma. The purpose of the ostomy is to divert waste out of the body through the stoma. The four most commonly

More information

Research Article Temporary Fecal Diversion in the Management of Colorectal and Perianal Crohn s Disease

Research Article Temporary Fecal Diversion in the Management of Colorectal and Perianal Crohn s Disease Hindawi Publishing Corporation Gastroenterology Research and Practice Volume 2015, Article ID 286315, 5 pages http://dx.doi.org/10.1155/2015/286315 Research Article Temporary Fecal Diversion in the Management

More information

Citation for published version (APA): Bartels, S. A. L. (2013). Laparoscopic colorectal surgery: beyond the short-term effects

Citation for published version (APA): Bartels, S. A. L. (2013). Laparoscopic colorectal surgery: beyond the short-term effects UvA-DARE (Digital Academic Repository) Laparoscopic colorectal surgery: beyond the short-term effects Bartels, S.A.L. Link to publication Citation for published version (APA): Bartels, S. A. L. (2013).

More information

Longterm Complications of Hand-Assisted Versus Laparoscopic Colectomy

Longterm Complications of Hand-Assisted Versus Laparoscopic Colectomy Longterm Complications of Hand-Assisted Versus Laparoscopic Colectomy Toyooki Sonoda, MD, Sushil Pandey, MD, Koiana Trencheva, BSN, Sang Lee, MD, Jeffrey Milsom, MD, FACS BACKGROUND: STUDY DESIGN: Hand-assisted

More information

Poor Outcomes of Complicated Pouch-Related Fistulas after Ileal Pouch-Anal Anastomosis Surgery

Poor Outcomes of Complicated Pouch-Related Fistulas after Ileal Pouch-Anal Anastomosis Surgery Syddansk Universitet Poor Outcomes of Complicated Pouch-Related Fistulas after Ileal Pouch-Anal Anastomosis Surgery Kjaer, M D; Kjeldsen, Jens; Qvist, Niels Published in: Scandinavian Journal of Surgery

More information

Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic Surgery for Colorectal Disease

Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic Surgery for Colorectal Disease ORIGINAL ARTICLE pissn 2234-778X eissn 2234-5248 J Minim Invasive Surg 2018;21(1):38-42 Journal of Minimally Invasive Surgery Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic

More information

Surgical Therapies for the Treatment of IBD!

Surgical Therapies for the Treatment of IBD! Surgical Therapies for the Treatment of IBD! Andrew A Shelton, MD Clinical Professor of Surgery Stanford Hospital and Clinics Section of Colon and Rectal Surgery! Ulcerative Colitis v. Crohn s! 30% of

More information

Anus,Rectum and Colon

Anus,Rectum and Colon JOURNAL OF THE Anus,Rectum and Colon dx.doi.org/1.23922/jarc.216-14 http://journal-arc.jp ORIGINAL RESEARCH ARTICLE Laparoscopic versus Open stoma creation: A retrospective analysis Kengo Hayashi, Masanori

More information

Safety of short stay Hospitalization in Reversal of Loop Ileostomy

Safety of short stay Hospitalization in Reversal of Loop Ileostomy Original Article Safety of short stay Hospitalization in Reversal of Loop Ileostomy Tayyab Abbas, Abid Nazir, Muhammad Lateef, Faisal Rauf, Zafar Ali Choudhary Abstract Study Design: Prospective, randomized

More information

Case discussion. Anastomotic leakage. intern superviser

Case discussion. Anastomotic leakage. intern superviser Case discussion Anastomotic leakage intern superviser Basic data Name : XX ID: M101881671 Age:51 Y Gender: male Past history: Hospitalized for acute diverticulitis on 2004/7/17, 2005/5/28 controlled by

More information

Surgical Approach to Crohn s Colitis Segmental or Total Colectomy? Can We Avoid the Stoma?

Surgical Approach to Crohn s Colitis Segmental or Total Colectomy? Can We Avoid the Stoma? 17 th Panhellenic IBD Congress Thessaloniki May 2018 Surgical Approach to Crohn s Colitis Segmental or Total Colectomy? Can We Avoid the Stoma? Janindra Warusavitarne Consultant Colorectal Surgeon, St

More information

Management of Perforated Colon Cancers

Management of Perforated Colon Cancers Management of Perforated Colon Cancers Introduction Colon and rectal cancers are the most common gastrointestinal cancers. They are 3 rd most common and 2 nd most common causes of cancer deaths among men

More information

Surgical Management of Advanced Stage Colon Cancer. Nathan Huber, MD 6/11/14

Surgical Management of Advanced Stage Colon Cancer. Nathan Huber, MD 6/11/14 Surgical Management of Advanced Stage Colon Cancer Nathan Huber, MD 6/11/14 Colon Cancer Overview Approximately 50,000 attributable deaths per year Colorectal cancer is the 3 rd most common cause of cancer-related

More information

The role of Surgery and Stomas in IBD

The role of Surgery and Stomas in IBD The role of Surgery and Stomas in IBD When do I need it? Can I avoid it? How do I live with it? Kyle G. Cologne, MD Assistant Professor of Surgery USC Division of Colorectal Surgery Topics Surgical Differences

More information

Key words: colostomy closure, colostmy, temporary colostomy, complications, complications of colon surgery

Key words: colostomy closure, colostmy, temporary colostomy, complications, complications of colon surgery Key words: colostomy closure, colostmy, temporary colostomy, complications, complications of colon surgery Carcinoma of colon and rectum Trauma Burn Iatrogenic Pelvic abscess Diverticular disease No. of

More information

Surgical Management of IBD in the Age of Biologics

Surgical Management of IBD in the Age of Biologics Surgical Management of IBD in the Age of Biologics Lisa S. Poritz, M.D Associate Professor of Surgery Division of Colon and Rectal Surgery Objectives Discuss surgical management of IBD When to operate

More information

SOUTHERN WEST MIDLANDS NEWBORN NETWORK

SOUTHERN WEST MIDLANDS NEWBORN NETWORK SOUTHERN WEST MIDLANDS NEWBORN NETWORK Hereford, Worcester, Birmingham, Sandwell & Solihull Title : Person Responsible for Review : Management of Gastro-Intestinal Stomata In Neonates R. Wragg & G.Jawaheer

More information

World Journal of Colorectal Surgery

World Journal of Colorectal Surgery World Journal of Colorectal Surgery Volume 5, Issue 1 2015 Article 1 Ileal U Pouch Reconstruction Proximal To Straight Sublevator Ileoanal Anastomosis Following Total Proctocolectomy For Low Rectal Cancer

More information

Laparoscopic Resection Of Colon & Rectal Cancers. R Sim Centre for Advanced Laparoscopic Surgery, TTSH

Laparoscopic Resection Of Colon & Rectal Cancers. R Sim Centre for Advanced Laparoscopic Surgery, TTSH Laparoscopic Resection Of Colon & Rectal Cancers R Sim Centre for Advanced Laparoscopic Surgery, TTSH Feasibility and safety Adequacy - same radical surgery as open op. Efficacy short term benefits and

More information

The management and outcome of anastomotic leaks in colorectal surgery

The management and outcome of anastomotic leaks in colorectal surgery Original article doi:10.1111/j.1463-1318.2007.01417.x The management and outcome of anastomotic leaks in colorectal surgery A. A. Khan*, J. M. D. Wheeler, C. Cunningham, B. George, M. Kettlewell and N.

More information

Prevention and Surgical management of Parastomal hernias; When to treat?

Prevention and Surgical management of Parastomal hernias; When to treat? Prevention and Surgical management of Parastomal hernias; When to treat? Sabry A. Mahmoud (MD) Prof of General & Colorectal Surgery Mansoura University It is an incisional hernia that develops at the site

More information

Ileal pouchyanal anastomosis (IPAA) is the procedure

Ileal pouchyanal anastomosis (IPAA) is the procedure ORIGINAL CONTRIBUTION Proximal Diversion at the Time of Ileal Pouch Anal Anastomosis for Ulcerative Colitis: Current Practices of North American Colorectal Surgeons Sandra L. de Montbrun, M.D. & Paul M.

More information

Laparoscopic Bladder-Preserving Surgery for Enterovesical Fistula Complicated with Benign Gastrointestinal Disease

Laparoscopic Bladder-Preserving Surgery for Enterovesical Fistula Complicated with Benign Gastrointestinal Disease This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (www.karger.com/oa-license), applicable to the online version of the article

More information

preparing for surgery

preparing for surgery preparing for surgery Facing the news that you need to have a stoma is very difficult but with thousands of people having stoma surgery each year, it is important to remember that you are not alone and

More information

St Mark's Hospital from 1953 to 1968

St Mark's Hospital from 1953 to 1968 Gut, 1970, 11, 235-239 The results of ileorectal anastomosis at St Mark's Hospital from 1953 to 1968 W. N. W. BAKER From St Mark's Hospital, London SUMMARY The popular view of ileorectal anastomosis for

More information

Listed below are some of the words that you might come across concerning diseases and conditions of the bowels.

Listed below are some of the words that you might come across concerning diseases and conditions of the bowels. Listed below are some of the words that you might come across concerning diseases and conditions of the bowels. Abscess A localised collection of pus in a cavity that is formed by the decay of diseased

More information

Risk factors for future repeat abdominal surgery

Risk factors for future repeat abdominal surgery Langenbecks Arch Surg (2016) 401:829 837 DOI 10.1007/s00423-016-1414-3 ORIGINAL ARTICLE Risk factors for future repeat abdominal surgery Chema Strik 1 & Martijn W. J. Stommel 1 & Laura J. Schipper 1 &

More information

Incidence of Colorectal Cancers- Australia. Anterior Resection 5/23/2018. What spurs us to investigate?

Incidence of Colorectal Cancers- Australia. Anterior Resection 5/23/2018. What spurs us to investigate? Incidence of Colorectal Cancers- Australia 17,000 Colorectal cancers in 2018 20% of Colorectal cancers are in the Rectum 12.3% of all new cancers Anterior Resection Syndrome (ARS) Lisa Wilson. Colorectal

More information

COLORECTAL RESECTIONS

COLORECTAL RESECTIONS COLORECTAL RESECTIONS What is a colorectal (bowel) resection? Surgery to remove a part of the large bowel is called a resection. Different parts of the colon require different operations and have different

More information

ORIGINAL ARTICLE. See Invited Critique at end of article

ORIGINAL ARTICLE. See Invited Critique at end of article ORIGINAL ARTICLE Loop Ileostomy Reversal After Colon and Rectal Surgery A Single Institutional 5-Year Experience in 944 Patients Gaetano Luglio, MD; Rajesh Pendlimari, MBBS; Stefan D. Holubar, MD; Robert

More information

Surgery and Stomas in IBD When do I need it? Can I avoid it? How do I live with it?

Surgery and Stomas in IBD When do I need it? Can I avoid it? How do I live with it? Surgery and Stomas in IBD When do I need it? Can I avoid it? How do I live with it? Kyle G. Cologne, MD Assistant Professor of Surgery USC Division of Colorectal Surgery Topics Surgical Differences between

More information

Homayoon Akbari, MD, PhD

Homayoon Akbari, MD, PhD Recent Advances in IBD Surgery Homayoon M. Akbari, MD, PhD, FRCS(C), FACS Associate Professor of Surgery Virginia Commonwealth University Crohn s disease first described as a surgical condition, with the

More information

Anus,Rectum and Colon

Anus,Rectum and Colon JOURNAL OF THE Anus,Rectum and Colon http://journal-arc.jp ORIGINAL RESEARCH ARTICLE Incidence and risk factor of outlet obstruction after construction of ileostomy Gaku Ohira, Hideaki Miyauchi, Koichi

More information

Small Bowel and Colon Surgery

Small Bowel and Colon Surgery Small Bowel and Colon Surgery Why Do I Need a Small Bowel Resection? A variety of conditions can damage your small bowel. In severe cases, your doctor may recommend removing part of your small bowel. Conditions

More information

Prospective analysis of indications and early complications of emergency temporary loop ileostomies for perforation peritonitis

Prospective analysis of indications and early complications of emergency temporary loop ileostomies for perforation peritonitis ORIGINAL ARTICLE Annals of Gastroenterology (2014) 27, 1-6 Prospective analysis of indications and early complications of emergency temporary loop ileostomies for perforation peritonitis Poras Chaudhary,

More information

Early Vs Delayed Loop Ileostomy Closure: A Comparative Study

Early Vs Delayed Loop Ileostomy Closure: A Comparative Study IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 7 Ver. VI (July. 2017), PP 08-13 www.iosrjournals.org Early Vs Delayed Loop Ileostomy Closure:

More information

Abscess and fistulae in Crohn's disease

Abscess and fistulae in Crohn's disease Abscess and fistulae in Crohn's disease DAVID M. STEINBERG1, W. TREVOR COOKE, AND J. From the Nutritional and Intestinal Unit, General Hospital, Birmingham Gut, 1973, 14, 865-869 ALEXANDER-WILLIAMS summary

More information

INTESTINAL STOMAS. J. Graham Williams, MCh, FRCS. Loop Ileostomy versus Loop Colostomy. gastrointestinal tract and abdomen

INTESTINAL STOMAS. J. Graham Williams, MCh, FRCS. Loop Ileostomy versus Loop Colostomy. gastrointestinal tract and abdomen gastrointestinal tract and abdomen INTESTINAL STOMAS J. Graham Williams, MCh, FRCS The formation of an intestinal stoma is frequently a component of surgical intervention for diseases of the small bowel

More information

Surgery for Ulcerative Colitis 11/14/10. Colectomy for Ulcerative Colitis: What your patient should know. Surgery for Ulcerative Colitis

Surgery for Ulcerative Colitis 11/14/10. Colectomy for Ulcerative Colitis: What your patient should know. Surgery for Ulcerative Colitis Colectomy for Ulcerative Colitis: What your patient should know Madhulika G. Varma MD Associate Professor and Chief Section of Colorectal Surgery University of California, San Francisco Surgery for Ulcerative

More information

The incidence of incisional hernias following ileostomy reversal in colorectal cancer patients treated with anterior resection

The incidence of incisional hernias following ileostomy reversal in colorectal cancer patients treated with anterior resection GENERAL SURGERY Ann R Coll Surg Engl 2017; 99: 319 324 doi 10.1308/rcsann.2016.0347 The incidence of incisional hernias following ileostomy reversal in colorectal cancer patients treated with anterior

More information

University College Hospital. Laparoscopic colorectal surgery. Gastrointestinal Services Division

University College Hospital. Laparoscopic colorectal surgery. Gastrointestinal Services Division University College Hospital Laparoscopic colorectal surgery Gastrointestinal Services Division 2 Colon 3 If you would like a large print, audio or translated version of this document contact us on 0845

More information

Ileal Pouch Anal Anastomosis: The Preferred Method of Reconstruction after Proctocolectomy in Children

Ileal Pouch Anal Anastomosis: The Preferred Method of Reconstruction after Proctocolectomy in Children Ileal Pouch Anal Anastomosis: The Preferred Method of Reconstruction after Proctocolectomy in Children Stephanie Jones, D.O. Surgical Fellow March 21, 2011 Ulcerative Colitis Spectrum of inflammatory bowel

More information

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of reinforcement of a permanent stoma with mesh to prevent a parastomal hernia A

More information

Colorectal procedure guide

Colorectal procedure guide Colorectal procedure guide Illustrations by Lisa Clark Biodesign ADVANCED TISSUE REPAIR cookmedical.com 2 INDEX Anal fistula repair Using the Biodesign plug with no button.... 4 Anal fistula repair Using

More information

UvA-DARE (Digital Academic Repository) Surgical treatment of perianal and rectal fistula van Koperen, P.J. Link to publication

UvA-DARE (Digital Academic Repository) Surgical treatment of perianal and rectal fistula van Koperen, P.J. Link to publication UvA-DARE (Digital Academic Repository) Surgical treatment of perianal and rectal fistula van Koperen, P.J. Link to publication Citation for published version (APA): van Koperen, P. J. (2010). Surgical

More information

Complications and Functional Results after Ileoanal Pouch Formation in Obese Patients

Complications and Functional Results after Ileoanal Pouch Formation in Obese Patients J Gastrointest Surg (2008) 12:668 674 DOI 10.1007/s11605-008-0465-3 Complications and Functional Results after Ileoanal Pouch Formation in Obese Patients R. P. Kiran & F. H. Remzi & V. W. Fazio & I. C.

More information

Surgery for ulcerative colitis in the era of the pouch: The St Mark's Hospital experience

Surgery for ulcerative colitis in the era of the pouch: The St Mark's Hospital experience 1076 St Mark's Hospital, London D M Melville J K Ritchie R J Nicholls P R Hawley Correspondence to: Mr P R Hawley, St Mark's Hospital, City Road, London EC1V 2PS. Accepted for publication 29 October 1993

More information

A Comprehensive Multi-disciplinary Approach to Improve Surgical Outcomes Following Elective Colon and Rectal Surgery

A Comprehensive Multi-disciplinary Approach to Improve Surgical Outcomes Following Elective Colon and Rectal Surgery A Comprehensive Multi-disciplinary Approach to Improve Surgical Outcomes Following Elective Colon and Rectal Surgery Tripurari Mishra MD, Deepa Bhat MD, Mina Saeed MD, Jan Kaminski MD, Mihaela Banulescu

More information

Ein Leben nach tiefer Rektumresektion: Was erwartet unsere Patienten im Langzeitverlauf?

Ein Leben nach tiefer Rektumresektion: Was erwartet unsere Patienten im Langzeitverlauf? Ein Leben nach tiefer Rektumresektion: Was erwartet unsere Patienten im Langzeitverlauf? Dieter Hahnloser Klinik für Viszeral- und Transplantationschirurgie UniverstätsSpital Zürich Low Rectal Resection

More information

ORIGINAL ARTICLE. Surgery for Ulcerative Colitis in Elderly Persons. Changes in Indications for Surgery and Outcome Over Time

ORIGINAL ARTICLE. Surgery for Ulcerative Colitis in Elderly Persons. Changes in Indications for Surgery and Outcome Over Time ORIGINAL ARTICLE Surgery for Ulcerative Colitis in Elderly Persons Changes in Indications for Surgery and Outcome Over Time Gidon Almogy, MD; David B. Sachar, MD; Carol A. Bodian, DrPH; Adrian J. Greenstein,

More information

Laparoscopic reversal of Hartmann's procedure

Laparoscopic reversal of Hartmann's procedure J Korean Surg Soc 2012;82:256-260 http://dx.doi.org/10.4174/jkss.2012.82.4.256 CASE REPORT JKSS Journal of the Korean Surgical Society pissn 2233-7903 ㆍ eissn 2093-0488 Laparoscopic reversal of Hartmann's

More information

Gastrointestinal Imaging Original Research

Gastrointestinal Imaging Original Research Contrast Enema for Detecting nastomotic Strictures Gastrointestinal Imaging Original Research David Dolinsky 1 Marc S. Levine 1 Stephen E. Rubesin 1 Igor Laufer 1 John L. Rombeau 2 Dolinsky D, Levine MS,

More information

DIGESTIVE SYSTEM SURGICAL PROCEDURES May 1, 2015 INTESTINES (EXCEPT RECTUM) Asst Surg Anae

DIGESTIVE SYSTEM SURGICAL PROCEDURES May 1, 2015 INTESTINES (EXCEPT RECTUM) Asst Surg Anae ENDOSCOPY Z50 Duodenoscopy (not to be claimed if Z399 and/or Z00 performed on same patient within 3 months)... 92.10 Z9 Subsequent procedure (within three months following previous endoscopic procedure)...

More information

LAPAROCELI: LAPAROSCOPY LIVE SURGERY PARASTOMAL HERNIA: WHAT TO DO? OSPEDALE DI PORTOGRUARO U.O.C. CHIRURGIA GENERALE FRANCESCO FIDANZA

LAPAROCELI: LAPAROSCOPY LIVE SURGERY PARASTOMAL HERNIA: WHAT TO DO? OSPEDALE DI PORTOGRUARO U.O.C. CHIRURGIA GENERALE FRANCESCO FIDANZA LAPAROCELI: LAPAROSCOPY LIVE SURGERY PARASTOMAL HERNIA: WHAT TO DO? OSPEDALE DI PORTOGRUARO U.O.C. CHIRURGIA GENERALE FRANCESCO FIDANZA PARASTOMAL HERNIA Some degree of herniation around a colostomy is

More information

National Bowel Cancer Audit Supplementary Report 2011

National Bowel Cancer Audit Supplementary Report 2011 National Bowel Cancer Audit Supplementary Report 2011 This Supplementary Report contains data from the 2009/2010 reporting period which covers patients in England with a diagnosis date from 1 August 2009

More information

UNDERSTANDING X-RAYS: ABDOMINAL IMAGING THE ABDOMEN

UNDERSTANDING X-RAYS: ABDOMINAL IMAGING THE ABDOMEN UNDERSTANDING X-RAYS: ABDOMINAL IMAGING THE ABDOMEN Radiology Enterprises radiologyenterprises@gmail.com www.radiologyenterprises.com STOMACH AND SMALL BOWEL STOMACH AND SMALL BOWEL Swallowed air is a

More information

DIGESTIVE SYSTEM SURGICAL PROCEDURES December 22, 2015 (effective March 1, 2016) INTESTINES (EXCEPT RECTUM) Asst Surg Anae

DIGESTIVE SYSTEM SURGICAL PROCEDURES December 22, 2015 (effective March 1, 2016) INTESTINES (EXCEPT RECTUM) Asst Surg Anae December 22, 2015 (effective March 1, 201) INTESTINES (EXCEPT RECTUM) Z513 Hydrostatic - Pneumatic dilatation of colon stricture(s) through colonoscope... 10.50 Z50 Fulguration of first polyp through colonoscope...

More information

A practical guide for Stoma problems. Developed by the Ostomy Forum. Dedicated to Stoma Care

A practical guide for Stoma problems. Developed by the Ostomy Forum. Dedicated to Stoma Care A practical guide for problems Developed by the Ostomy Forum Dedicated to Care A practical guide for and Peristomal skin problems Developed by: Frances McKenzie, Amanda Smith, Doreen Woolley, Beverley

More information

Inadvertent Enterotomy in Minimally Invasive Abdominal Surgery

Inadvertent Enterotomy in Minimally Invasive Abdominal Surgery SCIENTIFIC PAPER Inadvertent Enterotomy in Minimally Invasive Abdominal Surgery Steven J. Binenbaum, MD, Michael A. Goldfarb, MD ABSTRACT Background: Inadvertent enterotomy (IE) in laparoscopic abdominal

More information

CT and MRI Features of Ileostomies

CT and MRI Features of Ileostomies Gastrointestinal Imaging Pictorial Essay El Mouhadi et al. Imaging Features of Ileostomies Gastrointestinal Imaging Pictorial Essay Downloaded from www.ajronline.org by 37.44.198.187 on 12/27/17 from IP

More information

World Journal of Colorectal Surgery

World Journal of Colorectal Surgery World Journal of Colorectal Surgery Volume 6, Issue 5 2016 Article 8 Sigmoidocele: A Rare Cause Of Constipation In Males Noor Shah MD Milind Kachare MD Craig Rezac MD Rutgers Robert Wood Johnson Medical

More information

This is the portion of the intestine which lies between the small intestine and the outlet (Anus).

This is the portion of the intestine which lies between the small intestine and the outlet (Anus). THE COLON This is the portion of the intestine which lies between the small intestine and the outlet (Anus). 3 4 5 This part is responsible for formation of stool. The large intestine (colon- coloured

More information

Ileoanal Pouch Solves the Problem

Ileoanal Pouch Solves the Problem Ileoanal Pouch Solves the Problem Bruce D George Department of Surgery John Radcliffe Hospital, Falk Symposium 2-3 May 2008 Ileoanal Pouch Solves the Problem? Sometimes Not always Key Issues in Pouch Surgery

More information

Thirty-Day Outcomes of Laparoscopic vs. Open Total Proctocolectomy with Ileoanal Anastomosis in Children

Thirty-Day Outcomes of Laparoscopic vs. Open Total Proctocolectomy with Ileoanal Anastomosis in Children Thirty-Day Outcomes of Laparoscopic vs. Open Total Proctocolectomy with Ileoanal Anastomosis in Children Jeremy D. Kauffman MD, Paul D. Danielson MD, Nicole M. Chandler MD Johns Hopkins All Children s

More information

Current outcomes of emergency large bowel surgery

Current outcomes of emergency large bowel surgery COLORECTAL SURGERY Ann R Coll Surg Engl 2015; 97: 151 156 doi 10.1308/003588414X14055925059679 Current outcomes of emergency large bowel surgery HJ Ng 1, M Yule 2,MTwoon 2, NR Binnie 1,EHAly 1 1 NHS Grampian,

More information

Nikki Damen,* Katrina Spilsbury, Michael Levitt,* Gregory Makin,* Paul Salama,* Patrick Tan,* Cheryl Penter* and Cameron Platell* Abstract

Nikki Damen,* Katrina Spilsbury, Michael Levitt,* Gregory Makin,* Paul Salama,* Patrick Tan,* Cheryl Penter* and Cameron Platell* Abstract COLORECTAL ANZJSurg.com Anastomotic leaks in colorectal surgery Nikki Damen,* Katrina Spilsbury, Michael Levitt,* Gregory Makin,* Paul Salama,* Patrick Tan,* Cheryl Penter* and Cameron Platell* *Colorectal

More information

Chronic anastomotic sinus after low anterior resection: When can the defunctioning stoma be reversed?

Chronic anastomotic sinus after low anterior resection: When can the defunctioning stoma be reversed? Received Date : 15-Oct-2009 Revised Date : 10-Dec-2009 Accepted Date : 14-Dec-2009 Article type : Original Article 547-2009.R1 Original Article Chronic anastomotic sinus after low anterior resection: When

More information

The Role of Diverting Stoma After an Ultra-low Anterior Resection for Rectal Cancer

The Role of Diverting Stoma After an Ultra-low Anterior Resection for Rectal Cancer Original Article http://dx.doi.org/10.3393/ac.2013.29.2.66 pissn 2287-9714 eissn 2287-9722 The Role of Diverting Stoma After an Ultra-low Anterior Resection for Rectal Cancer Seok In Seo, Chang Sik Yu,

More information