Aim
This systematic review and meta‐analysis aimed to investigate the effect of preoperative stoma site marking on stoma‐related complications in patients with intestinal ostomy.
Methods
MEDLINE, ...Embase, CENTRAL, CINHAL, and Google Scholar were searched up to August 2021 for randomised controlled trials (RCTs) and nonrandomised studies of interventions (NRSI) that involved patients with intestinal ostomies comparing preoperative stoma site marking to no marking and which reported at least one patient‐relevant outcome. Outcomes were prioritised by stakeholder involvement. Random‐effects meta‐analyses produced odds ratios (ORs) or standardised mean differences (SMD) and 95% confidence intervals (CIs). The ROBINS‐I tool and the GRADE approach were used to assess the risk of bias and certainty of evidence, respectively.
Results
This review included two RCTs and 25 NRSI. The risk of bias was high in RCTs and serious to critical in NRSI. Although preoperative site marking reduced stoma‐related complications (OR: 0.45, 95% CI: 0.31–0.65), dependence on professional or unprofessional care (narrative synthesis), and increased health‐related quality of life (SMD: 1.13 0.38–1.88), the evidence is very uncertain. Preoperative site marking may probably reduce leakage (OR: 0.14 0.06–0.37) and may decrease dermatological complications (OR: 0.38 0.29–0.50) and surgical revision (OR: 0.09 0.02–0.49). The confidence in the cumulative evidence was moderate to very low.
Conclusion
Despite low quality evidence, preoperative stoma site marking can prevent stoma‐related complications and should be performed in patients undergoing gastrointestinal surgery given that this intervention poses no harm to patients.
Infants with ileostomies often suffer from sodium depletion, ultimately leading to a failure to thrive. Moreover, early-infantile microbial dysbiosis may potentially aggravate weight faltering. Given ...that sodium supplementation has been used to restore weight gain and feeding practices largely determine infantile microbiota, the current study investigated the effect of sodium chloride (NaCl) on weight gain and intestinal microbiome in infants with jejuno- and ileostomies.
A prospective cohort study including 24 neonates with enterostomies compared 19 subjects receiving oral NaCl (5.85%) to five subjects without supplementation with respect to postoperative changes in thrive and the intestinal microbiome.
Infants receiving NaCl after enterostomy-surgery showed vastly improved weight gain and an increased abundance of
in fecal samples, as compared to subjects without oral supplement who displayed decreasing percentiles for weight and did not reveal a higher abundance of probiotic strains within the ostomy effluent. Contrarily
was equally enriched in supplemented infants, reflecting a higher susceptibility for infections in preterm neonates.
Our findings support oral NaCl supplementation as a mainstay of postoperative treatment in infants with small bowel ostomies who are predisposed to suffer from a sodium depletion-associated failure to thrive. Not only does NaCl promote weight gain by increasing glucose resorption, but it also appears to induce microbial restoration by enhancing the abundance of health-promoting probiotic bacteria. This finding has an even greater significance when facing an elevated
(K/B) ratio, believed to represent an early-life microbial biomarker for development of allergic disease.
Purpose
The incidence of incisional hernia (IH) at ileostomy closure site has not been sufficiently evaluated. Temporary loop ileostomy is routinely used in patients after low anterior resection for ...rectal cancer. The goal of this study was to compare the IH rates of standard suture skin closure and purse-string skin closure techniques.
Patients and methods
Patients undergoing ileostomy reversal and follow-up CT scan at the University Hospital Frankfurt between January 2009 and December 2015 were retrospectively analyzed regarding IH and associated risk factors. Patients received either direct stitch skin closure (group DC) or purse-string skin closure (group PS).
Results
In total, 111 patients underwent ileostomy reversal in the aforementioned period. In 88 patients, a CT scan was performed 12–24 months after ileostomy reversal for cancer follow-up. Median follow-up was 12 months. Median time interval between ileostoma formation and closure was 12 (± 4 SD) weeks. In 19 of 88 patients (21.5%), an IH was detected. The incidence of IH detected by CT scan was significantly lower in the PS group (
n
= 7, 12.9%) compared to the DC group (
n
= 12, 35.2%,
p
= 0.017).
Conclusions
This retrospective study shows an advantage of the purse-string skin closure technique in ileostomy reversals. The use of this technique for skin closure following ileostomy reversals is recommended to reduce the IH rates. Randomized controlled trials are needed to confirm these findings.
The slow digestible disaccharide isomaltulose (iso; Palatinose) is available as novel functional carbohydrate ingredient for manufacturing of low glycaemic foods and beverages. Although basically ...characterised, various information on physiological effects of iso are still lacking. Thus, the objective of the present study was to expand scientific knowledge of physiological characteristics of iso by a set of three human intervention trials. Using an ileostomy model, iso was found to be essentially absorbed, irrespective of the nature of food (beverage and solid food). Apparent digestibility of 50 g iso from two different meals was 95·5 and 98·8 %; apparent absorption was 93·6 and 96·1 %, respectively. In healthy volunteers, a single dose intake of iso resulted in lower postprandial blood glucose and insulin responses than did sucrose (suc), while showing prolonged blood glucose delivery over 3 h test. In a 4-week trial with hyperlipidaemic individuals, regular consumption of 50 g/d iso within a Western-type diet was well tolerated and did not affect blood lipids. Fasting blood glucose and insulin resistance were lower after the 4-week iso intervention compared with baseline. This would be consistent with possible beneficial metabolic effects as a consequence of the lower and prolonged glycaemic response and lower insulinaemic burden. However, there was no significant difference at 4 weeks after iso compared with suc. In conclusion, the study shows that iso is completely available from the small intestine, irrespective of food matrix, leading to a prolonged delivery of blood glucose. Regular iso consumption is well tolerated also in subjects with increased risk for vascular diseases.
Zusammenfassung
In diesem Beitrag wird der Fall eines Patienten vorgestellt, bei welchem es im postoperativen Verlauf zum Verschluss der kolorektalen Anastomose kam. Mit einem Kombinationsverfahren ...von gleichzeitig flexibel-endoskopischer Sicht und klassisch-chirurgischer instrumenteller Dilatation wurde dieser erfolgreich behandelt.
Background Reducing the incidence of anastomotic leakages would benefit both patients and health care in general. Attempts to solve this problem have been disappointing thus far. SylysR Surgical ...Sealant was developed as an extraluminal adjunct to standard closure techniques for bowel anastomosis procedures. We describe the results of a first-in-man study in which SylysR Surgical Sealant is used. The aim of this study was to evaluate the safety of SylysR Surgical Sealant in stoma reversal procedures. Methods This prospective, multicenter, non-randomized, first-in-man industry initiated study was performed in two independent hospitals in the Netherlands. The study population consisted of adults who were scheduled for an open ileostomy reversal procedure. Exclusion critera were: patients with severe co-morbidities, patients receiving antibiotics, immunosuppressive agents or steroids for pre-existing conditions. Follow up was conducted during 3 months after surgery at the outpatient clinic. Results Sixteen patients were eligible for inclusion. Twenty adverse events were recorded in 12 of the 16 treated patients (75%). None of these events were considered to be related to SylysR Surgical Sealant. No clinical signs of anastomotic leakage were reported. Conclusions In conclusion, this first-in-man application of SylysR Surgical Sealant as an adjunct to standard bowel anastomosis closure techniques did not show any adverse effects in relation to the sealant in 16 patients. Keywords: SylysR surgical sealant, Anastomosis, Anastomotic leakage, Ileostoma, Colorectal disease
Purpose
The aim of this study was to compare three methods for closure of a diverting ileostoma according to development of postoperative small-bowel obstruction (SBO) and anastomotic leakage (AL).
...Methods
Complications arising within 30 days after closure of a defunctioning loop ileostomy in 351 patients during the period 1999–2006 were studied retrospectively by evaluation of case records. The techniques employed were: hand-sewn anastomosis without bowel resection, hand-sewn anastomosis with bowel resection and stapled anastomosis.
Results
Of the 351 patients, 149 had a hand-sewn anastomosis without bowel resection (HS), 70 had a hand-sewn anastomosis with bowel resection (HSR) and 132 patients had a stapled anastomosis (S). The total number of SBOs was 44 patients (12.5%). In the two hand-sewn groups, 15.5% (34 patients) suffered postoperative SBO compared to 7.6% (10 patients) in the stapled group (
p
= 0.029). No difference in AL could be found between the groups, where the overall frequency was 2.8% (10 patients). Median hospital stay was 6 days in the HS group, 5 days in the HSR group and 4 days in the S group (
p
= 0.001).
Conclusion
In the present study, stapled anastomosis was associated with a lower frequency of postoperative SBO and a shorter hospital stay compared to sutured anastomosis (either with or without a short small-bowel resection) after closure of a diverting ileostoma.
The article estimated the results of excision of temporary loop colo- and ileostomas using method of their formation with erfixation of parietal peritoneum to aponeurosis of abdominal external ...oblique muscle in 18 patients. The authors concluded that the formation of temporary loop stoma with fixation of parietal peritoneum to aponeurosis had many advantages and could ter mprve he rsuls of the resoraive operation.
Aim Several attempts have been made to construct a mechanical continent stoma without success. A system based on a titanium implant has been developed in an animal model. Following evaluation of ...this device in animals, the transcutaneous implant evacuation system (TIES) has now been tested in humans.
Method The implant consists of a titanium cylinder including a mesh and a plastic cap. This design allows the intestine and subcutaneous tissue to grow into the device. Four patients with inflammatory bowel disease underwent surgery. The indications for surgery were malfunctioning pouches or skin problems around the stoma. Following abdominal surgery, implantation of the device was made behind the external fascia with diversion of the ileum through the device to create a permanent stoma.
Results Primary surgery was uncomplicated. Skin tissue growth into the implant was delayed in one case and one patient had impaired healing between intestine and the device. In these cases minor surgical correction was necessary. The tested cap design in the current device was inconvenient and needs to be further developed. No local infections occurred.
Conclusion This first clinical study of the TIES device has shown few device‐related complications and no significant safety concerns. In our experience bridging of connective tissue between the intestine and skin is crucial for healing. Further development of the lid, the implant and the implantation method within clinical trials is necessary before the device can be introduced in general practice.
PDF
