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Blogger's Note: abstract does not detail adverse event/s of adhesions based on abdominal/pelvic surgeries
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A prospective algorithm to reduce anastomotic leaks after rectosigmoid resection for gynecologic malignancies
Abstract
Highlights
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- Criteria-based temporary bowel diversion following rectosigmoid resection may reduce anastomotic leak rate and morbidity.
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- No anastomotic leaks were observed among diversions.
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- Prophylactic bowel diversion carries acceptable morbidity, but requires an additional surgery.
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- Bowel diversion reversal rates were high even after debulking surgery for gynecologic malignancies.
Objective
Determine
whether a standardized protocol for temporary bowel diversion after
rectosigmoid resection (RSR) for cytoreduction can reduce the rate of
anastomotic leak (AL).
Methods
A
prospective quality improvement project for patients undergoing RSR
during debulking surgery from 07/2013 to 01/2016 was conducted. Patients
with any of the following underwent temporary diversion: preoperative
albumin ≤ 3.0 g/dL, prior pelvic radiation, RSR plus additional large
bowel resection (LBR), anastomosis (AS) ≤ 6 cm from the anal verge,
failed leak test or contamination of the pelvis with stool. The AL rate
was compared to the historic AL rate from 01/04–06/11.
Results
Seventy-seven
patients underwent RSR, with 27 (35.1%) receiving diverting stomas vs.
25/309 (8.1%) in the historic cohort. Additional LBR (33.3%) and AS at
≤ 6 cm from anal verge (26.3%) were the most common indications for
diversion. No AL was observed among diverted patients. If one AL which
occurred following protocol violation (failed leak test but not
diverted) is excluded, the theoretical AL rate is 1.3% (1/77) vs. 7.8%
(24/309; P = 0.039) in the historic cohort. Not excluding this case, the AL rate was 2.6% (2/77) vs. 7.8% (P = 0.11).
Short-term outcomes following primary surgery were not different
between diverted and non-diverted patients. Stoma-related complications
were observed in 7/27 (25.9%) patients, primarily related to
dehydration. Reversal surgery was successfully performed in 24/75
(88.9%) patients.
Conclusions
Criteria-based
temporary bowel diversion for patients undergoing RSR for gynecologic
cancer reduced the AL rate. Diversion was associated with acceptable
morbidity and high reversal rate.
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