Geographical Variation in the Use of Diverting Loop Ileostomy in Australia and New Zealand Colorectal Surgeons

David A. Clark; Bree Stephensen; Aleksandra Edmundson; Daniel Steffens; Michael Solomon

doi:10.3393/ac.2020.09.14.1

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저자정보: David A. Clark (Royal Brisbane and Women’s Hospital) Bree Stephensen (Sunshine Coast University Hospital) Aleksandra Edmundson (Royal Brisbane and Women’s Hospital) Daniel Steffens (University of Sydney) Michael Solomon (University of Sydney)

저널정보: 대한대장항문학회 Annals of Coloproctology Annals of Coloproctolgy Vol.37 No.5

발행연도: 2021.10

수록면: 337 - 345 (9page)

DOI: 10.3393/ac.2020.09.14.1

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Purpose: Anastomotic leak (AL) after a low pelvic anastomosis is a devastating complication, with short- and long-term morbidity and increased mortality. Surgeons may employ various adjuncts in an attempt to reduce AL rates or mitigate their impact. These include the use of temporary diverting ileostomy (TDI), transanal or rectal tubes and pelvic drains. This questionnaire evaluates the preferences and routine use of these adjuncts in Australasian colorectal surgeons.Methods: A cross-sectional survey was administered to Australian and New Zealand colorectal surgeons on September 20, 2018. The study survey consisted of 15 questions exploring basic demographics and the number of rectal resections and ileal pouches performed in 12 months, along with the surgeon’s preference for the use of diverting stomas, rectal tubes, and pelvic drains.Results: There were 90 respondents to the survey (31.6%). Surgeons in Western Australia (71.4%) were more likely to use a mandatory TDI in colorectal extraperitoneal anastomoses than surgeons in Queensland (14.3%). South Australian surgeons are more likely to employ a mandatory TDI (100%) for ileal pouches than Queensland surgeons (42.9%). Rectal tubes are not commonly utilized (40.0% never use them), and pelvic drains are (45.6% in all cases). Surgeons consider a median AL rate of 15% was felt to justify the use of a TDI in low pelvic anastomoses and a median AL rate of 10% for ileal pouchesConclusion: There is considerable geographical variation in colorectal surgical practice throughout Australia and New Zealand. While surgeons interrogate the same literature, there are presumably other factors that see translation into variations in clinical practice.

#Ileostomy #Trans anal tube #Anastomotic leak #Pelvic drain #Restorative proctocolectomy

참고문헌 (26)

참고문헌 신청

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Shogan BD / 2013 / Do we really know why colorectal anastomoses leak? / J Gastrointest Surg 17:1698~1707

Lovegrove RE / 2006 / A comparison of hand-sewn versus stapled ileal pouch anal anastomosis (IPAA) following proctocolectomy: a meta-analysis of 4183 patients / Ann Surg 244:18~26

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Xiao L / 2011 / Can transanal tube placement after anterior resection for rectal carcinoma reduce anastomotic leakage rate? A single-institution prospective randomized study / World J Surg 35:1367~1377

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