TEMPORARY FECAL DIVERSION

STUDENTS’ SESSION, 10TH ANNUAL ESCP MEETING, DUBLIN

ANDERS MARK CHRISTENSEN ON BEHALF OF GROUP 2

TEMPORARY FECAL DIVERSION IN COLORECTAL RESECTIONS

CURRENT EVIDENCE:

IN LOW RECTAL CANCER (4 RCT’S, 358 PATIENTS): [ANN SURG 2008;248(1):52-60]

FEWER ANASTOMOTIC LEAKS (OR 0.32 (0.17; 0.59))FEWER REOPERATIONS (OR 0.27 (0.14; 0.51))NO EFFECT ON MORTALITYNO DATA ON LONG-TERM FUNCTIONAL OUTCOME (E.G. LOW ANTERIOR RESECTION SYNDROME LARS)

TEMPORARY FECAL DIVERSION IN COLORECTAL RESECTIONS

CURRENT EVIDENCE:

IN RESTORATIVE PROCTOCOLECTOMY 17 STUDIES (1 RCT), 1486 PATIENTS): [ARCH SURG 2008;143(4):406-412]

FEWER ANASTOMOTIC LEAKS (OR 0.44 (0.26; 0.75))FEWER POUCH FAILURES (OR 0.3 (0.12; 0.74)) FEWER STRICTURES (OR 0.31 (0.1; 0.98))NO DIFFERENCE IN FUNCTIONAL OUTCOME

TEMPORARY FECAL DIVERSION IN COLORECTAL RESECTIONS

UNANSWERED QUESTIONS IN RELATION TO TEMPORARY DIVERSION:

• COMPLICATIONS BEYOND 30 DAYS?

• LOOP STOMAS OR DOUBLE-BARREL STOMAS?

• EMERGENCY VS. ELECTIVE PROCEDURES?

• DIFFERENCES IN THE CONSEQUENCES OF ANASTOMOTIC LEAKS?

• HOW ARE LEAKS MANAGED?

TEMPORARY FECAL DIVERSION IN COLORECTAL RESECTIONSSET-UP:

• MULTICENTER PROSPECTIVE AUDIT

• TIME SPAN: ONE MONTH (?)

• VARIABLES OF INTEREST:

INTRAOPERATIVE:

PROCEDURE (LAR, IPAA, SIGMOID RESECTION, ILEOCECAL, ETC.)TME OR CRDLAPAROSCOPIC/ OPEN/ ROBOT/ TAMIS/ SILSHAND-SEWN OR STAPLED ANASTOMOSISFLUORESCENCE ANGIOGRAPHY/ OMENTOPLASTY/ SEALANTSSTOMA: LOOP/ DOUBLE BARREL, ILEOSTOMY/ COLOSTOMYPROPHYLACTIC DRAINAGE OF ANASTOMOSIS/ PELVISDURATION OF OPERATION

PREOPERATIVE:

AGEGENDERASA GROUPBMISMOKING AND ALCOHOLPREVIOUS ABDOMINAL SURGERYBLOOD TEST RESULTS (HEMOGLOBIN, ALBUMIN, ETC.)PREVIOUS PELVIC RADIOTHERAPYMEDICINE USEPREOPERATIVE BOWEL PREPARATION

POSTOPERATIVE:

COMPLICATIONSADMISSION LENGTHREADMISSIONSSTOMA REVERSAL RATESCOMPLICATIONS FOLLOWING STOMA REVERSALSTREATMENT AND OUTCOME OF ANASTOMOTIC LEAKS

(BOWEL FUNCTION AT 3 MONTHS/ 1 YEAR?)

THANK YOU!

• GROUP 2: MARTA DE LA ROSA, ANNA LYONS, RUTGER STIJNS, MICHAEL RYAN, AND ANDERS MARK