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Diverting ileostomy

Quan Wang, Prof.

Weihua Tong

Analyze the occurrence of complications, rectal function and quality of life after anus-preserving surgery for middle and low rectal cancer, so as to evaluate the role of protective ileostomy.

Diverting Ileostomy and Anal Functional Outcomes After Anus Preservation Surgery

A Prospective Registration Study on Diverting Ileostomy and Anal Functional Outcomes After Anus Preservation Surgery in Middle and Low Rectal Cancer

Postoperative complications based on Clavien-Dindo

The First Hospital of Jilin University

Head of Department

Laparoscopic or robotic surgery with virtual ileostomy

Laparoscopic or robotic surgery with diverting ileostomy

Virtual ileostomy

fan li

This study aimed at comparing the Comprehensive Complication Index (CCI), readmission rates, postoperative hospitalization days, duration of bearing the stoma (months), hospitalization costs, the number of hospitalizations with ghost ileostomy versus conventional loop ileostomy after low anterior resection for rectal cancer.

Diverting ileostomy (DI) is a common procedure performed in patients undergoing low anterior resection for rectal cancer to protect the anastomosis and reduce the risk of complications. Although DI remains one of the most common methods used in clinical practice to prevent anastomotic leakage, there is still considerable debate in clinical practice about whether to perform a routine ileostomy. Despite temporary ileostomy fecal diversion can reduce the development of abdominal abscesses, wound inflammation, peritonitis, and sepsis after the occurrence of AL, however, it not only failed to reduce the incidence of AL but significantly increased the risk of non-elective readmissions and reinterventions as well as higher total costs. Meanwhile, stoma significantly increase the risk of stoma-related complication such as small bowel obstruction, postoperative ileus, dehydration from high-output stoma culminating in acute kidney injury, electrolyte imbalance, stoma stenosis/ necrosis, parastomal hernia, peristomal abscess, and fistula, etc.

Virtual Ileostomy Versus Conventional Loop Ileostomy

Virtual Ileostomy Versus Conventional Loop Ileostomy in Patients Undergoing Low Anterior Resection for Rectal Cancer: A Randomized Controlled Study

Hartmann's procedure or for example, abdominoperineal extirpation

Patients carrying stoma 6 months after low anterior resection for rectal cancer.

The virtual stoma required bedside or secondary surgery for diverting ileostomy due to complications.

Patient undergoes second abdominal surgery for complications after first surgery

Duration of days from the date of radical resection of rectal cancer to virtual stoma removed.

Abdominal abscess,Anastomotic bleeding,Pelvic infection,Surgical incision infection, Peritonitis,Interventional drainage ,ileostomy wounds/abscesses/edema/dermatitis/ ulcers,Parastomal hernia ,Stoma prolapse,Anastomotic separation/poor healing, Anastomotic stenosis,Anastomotic leakage,Bowel obstruction,Anastomotic bowel necrosis ,Wound dehiscence / bleeding / sinus tract / abscess/fat liquefaction,Acute kidney injury ,Dehydration/output \>1500 mL/day,Converted to permanent ileostomy,Intestinal fistula,Incisional hernia ,fecal incontinence.

Whether the patient has completed chemotherapy.

The Comprehensive Complication Index (CCI)summarises all postoperative complications based on the established Clavien-Dindo classification (ranging from mild complications not leading to a deviation from the normal clinical course (grade I) up to postoperative death (grade V)) at an individual patient level according to their grade of severity.

Patients in the virtual stoma group who did not have a second surgery due to complications recorded days of postoperative hospitalization after low anterior resection for rectal cancer, if the virtual stoma group required bedside or secondary surgery for diverting ileostomy due to complications and all patients in the diverting ileostomy group required reoperation for stoma reversal, record days of postoperative hospitalization due to complications and/or reoperation since the data of low anterior resection for rectal cancer.

Patients in the virtual stoma group who did not have a second surgery due to complications recorded the number of hospitalization after low anterior resection for rectal cancer. If the virtual stoma group required bedside or secondary surgery for diverting ileostomy due to complications and all patients in the diverting ileostomy group required reoperation for stoma reversal, record the number of hospitalization due to complications and/or reoperation since the data of low anterior resection for rectal cancer.

If the virtual stoma group required bedside or secondary surgery for diverting ileostomy due to complications and all patients in the diverting ileostomy group required reoperation for stoma reversal, record the duration of bearing the stoma since the data of surgery of diverting ileostomy.

Patient hospitalization costs for radical resection of rectal cancer.

Patients in the virtual stoma group who did not have a second surgery due to complications recorded the costs after low anterior resection for rectal cancer, if the virtual stoma group required bedside or secondary surgery for diverting ileostomy due to complications and all patients in the diverting ileostomy group required reoperation for stoma reversal, record the costs due to complications and reoperation since the data of low anterior resection for rectal cancer.

Daping Hospital and the Research Institute of Surgery of the Third Military Medical University

Professor

fan li, PhD

Virtual Ileostomy Versus Diverting Ileostomy

Comparing the Safety and Efficacy of Virtual Ileostomy Versus Diverting Ileostomy in Patients Undergoing Sphincter-saving Surgery for Rectal Cancer: a Propensity-matched Study

Patients undergo second abdominal surgery for complications after low anterior resection for rectal cancer.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Diverting Ileostomy and Anal Functional Outcomes After Anus Preservation Surgery	NCT04776421	Diverting Ileos... Middle and Low ... Functional Outc... Stoma Complicat...	Diverting ileos...	18 Years - 75 Years	The First Hospital of Jilin University
Virtual Ileostomy Versus Conventional Loop Ileostomy	NCT05985252	Rectal Neoplasm...	Virtual ileosto... Diverting ileos...	18 Years - 80 Years	Daping Hospital and the Research Institute of Surgery of the Third Military Medical University
Virtual Ileostomy Versus Diverting Ileostomy	NCT05985239	Rectal Cancer	VI DI	18 Years - 80 Years	Daping Hospital and the Research Institute of Surgery of the Third Military Medical University
Virtual Ileostomy Versus Diverting Ileostomy	NCT05985239	Rectal Cancer	VI DI	18 Years - 80 Years	Daping Hospital and the Research Institute of Surgery of the Third Military Medical University
Virtual Ileostomy Versus Diverting Ileostomy	NCT05985239	Rectal Cancer	VI DI	18 Years - 80 Years	Daping Hospital and the Research Institute of Surgery of the Third Military Medical University

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