title: Complications of Diverting Ileostomy after Low Anterior Resection for Rectal Carcinoma.
abstract: There have been few studies directly comparing the postoperative complications in patients with a diverting ileostomy to patients who were not diverted after low anterior resection (LAR) for rectal carcinoma. This study is a retrospective chart review of all rectal carcinoma patients (99) who underwent a LAR from January 2009 to December 2014 at Loma Linda University Medical Center and Veterans Affairs Loma Linda Healthcare System. A majority of patients were diverted (58% vs 42%). The diverted patients were more likely to have a low tumor location (P < 0.01), preoperative chemoradiation (P < 0.01), and more intraoperative blood loss (P < 0.01). Our study shows a statistically significant higher overall complication rate among patients receiving a diverting ileostomy in the six months after LAR (61% vs 38%, P = 0.02). The difference is due to a higher rate of readmission (27% vs 14%) and acute kidney injury (14% vs 5%) in patients with a diverting ileostomy. It also shows that there is a higher rate of unplanned reoperation (11% vs 6%) due to anastomotic leak (17% vs 5%) in nondiverted patients. Further studies are needed to refine the specific indications to maximize the benefit of diverting ileostomy after LAR for rectal carcinoma.
authors: Loma Linda University Health, VA Loma Linda Healthcare System, Loma Linda, California, USA.
authors: Sean
authors: S
authors: Maroney
authors: Carlos
authors: C
authors: Chavez de Paz
authors: Marjunphilip
authors: M
authors: Duldulao
authors: Tracey
authors: T
authors: Kim
authors: Mark E
authors: ME
authors: Reeves
authors: Kevork K
authors: KK
authors: Kazanjian
authors: Naveenraj
authors: N
authors: Solomon
authors: Carlos
authors: C
authors: Garberoglio
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000453:epidemiology; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects* / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis