Document Detail

Diverting stoma after low anterior resection: more arguments in favor.
MedLine Citation:
PMID:  19333040     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The necessity of a protective stoma in patients undergoing low anterior resection with total mesorectal excision for primary rectal cancer is discussed controversially. We conducted a randomized, controlled, pilot-study to evaluate the need for diverting ileostomy in patients undergoing low anterior resection [NCT00457327]. METHODS: Forty patients after elective sphincter-saving low anterior resection were eligible for intraoperative randomization. The primary objective of this trial was to demonstrate similar risks after the resection with both techniques. A priori stopping rules were defined for early termination of the trial. RESULTS: Between July 4, 2006 and March 12, 2007, a total of 41 patients were screened and 34 patients were randomized. Eighteen patients were randomized to the stoma group and 16 patients to the nonstoma group The symptomatic anastomotic leakage rate was significantly higher in the nonstoma group (37.5 percent) than in the stoma group (5.5 percent, P = 0.02). In all six cases in the nonstoma group, reoperations were necessary. The study was stopped after 34 patients were included. A meta-analysis of the available data confirmed the value of a protective ostomy for patients undergoing low anterior resection. CONCLUSIONS: The data demonstrate a high risk for patients undergoing low anterior resection without diverting ileostomy.
Alexis B Ulrich; Christoph Seiler; Nuh Rahbari; Jürgen Weitz; Markus W Büchler
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  52     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-31     Completed Date:  2009-04-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  412-8     Citation Subset:  IM    
Department of General Surgery, Visceral Surgery, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
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MeSH Terms
Anastomosis, Surgical / adverse effects*
Middle Aged
Pilot Projects
Postoperative Complications / prevention & control
Rectal Neoplasms / surgery*

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