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Predictors of dehydration and acute renal failure in patients with diverting loop ileostomy creation after colorectal surgery

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World Journal of Clinical Cases 2019年第14期7卷 1805-1813页

作者： Omar Vergara-Fernández Mario Trejo-Avila Oscar Santes Danilo Solórzano-Vicu?a Noel Salgado-Nesme Department of Colorectal Surgery Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán"

BACKGROUND Despite the potential benefits of fecal diversion after low pelvic anastomosis in colorectal surgery, diverting loop ileostomy construction is related to significant rates of complications. AIM To determine potential predictors of high output related complications in patients with diverting loop ileostomy creation after colorectal surgery. METHODS Patients who underwent open and laparoscopic colorectal surgery requiring a diverting loop ileostomy from January 2010 to March 2018 were retrospectively analyzed. We included patients older than 18 years, who underwent colorectal surgery with primary low pelvic anastomosis, and with the creation of a diverting loop ileostomy, at elective or emergency settings for the treatment of benign or malignant conditions. Univariate and multivariate logistic regression analysis was used to determine the effect of the potential predictors on the rate of high output related complications. The high output related complications were dehydration and acute renal failure that required visits to the emergency department and hospitalizations. RESULTS Of the 102 patients included in the study, 23.5%(n = 24) suffered high output related complications. In this group of patients at least one visit to the emergency department (mean 1.6), and at least one readmission to the hospital was needed. The factors associated with high-output ileostomy, in the univariate analysis, were: urgent surgical intervention (OR = 2.6;P = 0.047), the development of postoperative complications (OR = 3;P = 0.024), have ulcerative colitis (OR = 4.8;P = 0.017), use of steroids (OR = 4.3;P = 0.010), mean output at discharge greater than 1000 mL/24 h (OR = 3.2;P = 0.016), and use of loperamide at discharge (OR = 2.8;P = 0.032). Multivariate logistic regression analysis identified two independent risk factors for high output related complications: ulcerative colitis [OR = 7.6 (95%CI: 1.81-31.95);P = 0.006], and ileostomy output at discharge ≥ 1000 mL/24 h [OR = 3.3 (1.18-9.37);P = 0.023]. CONCLUSION In our st

关键词： Loop ileostomy high-output ileostomy Loop ileostomy complications Dehydration Colorectal surgery

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Management of enterocutaneous fistulae:A 10 years experience

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World Journal of Gastrointestinal Surgery 2010年第7期2卷 242-246页

作者： Deepa Taggarshe Daniel Bakston Michael Jacobs Alasdair McKendrick Vijay K Mittal Department of Surgery Providence Hospital and Medical Centers16001 West Nine Mile RoadSouthf ieldMI 48075United States

AIM:To compare the outcomes of conservative vs surgical treatment of enterocutaneous fistulae(ECF) in a community teaching hospital over a decade.METHODS:All cases of ECF between 1997 and 2007 were reviewed for management strategy.RESULTS:Of the 83 patients with ECF,60(72%) were postoperative.Sixty-six patients(79.5%) were treated initially with conservative measures.Eighteen patients failed to respond to conservative treatment and required later(secondary) exploration;this group consisted of an equal number of low vs high output fistulae.Seventeen(20.5%) patients underwent initial(primary) def initivesurgery secondary to anastomotic leak and peritonitis.Surgical procedures included resection of ECF with anastomosis(24),exclusion(6) and direct-drainage(4).No signif icant difference was seen in the recurrence rate for conservative(10%) vs operative-treatment(20%).role as an initial management in both low and high output fistulae.In selective cases only,early primary exploration is recommended.

关键词： Low-output high-output Enterocutaneous fistulae

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