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Efficacy of transanal drainage tube in preventing anastomotic leakage after surgery for rectal cancer: A meta-analysis

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World Journal of Gastrointestinal Surgery 2023年第6期15卷 1202-1210页

作者： Shiki Fujino Masayoshi Yasui Masayuki Ohue Norikatsu Miyoshi Innovative Oncology Research and Regenerative Medicine Osaka International Cancer InstituteOsaka 541-8567Japan Department of Surgery Osaka International Cancer InstituteOsaka 541-8567Japan

BACKGROUND Anastomotic leakage(AL)following rectal cancer surgery is an important cause of mortality and *** transanal drainage tubes(TDTs)are expected to reduce the rate of AL,their preventive effects are *** To reveal the effect of TDT in patients with symptomatic AL after rectal cancer *** A systematic literature search was performed using the PubMed,Embase,and Cochrane Library *** included randomized controlled trials(RCTs)and prospective cohort studies(PCSs)in which patients were assigned to two groups depending on the use or non-use of TDT and in which AL was *** results of the studies were synthesized using the Mantel-Haenszel randomeffects model,and a two-tailed P value>0.05 was considered statistically *** Three RCTs and two PCSs were included in this *** AL was examined in all 1417 patients(712 with TDT),and TDTs did not reduce the symptomatic AL *** a subgroup analysis of 955 patients without a diverting stoma,TDT reduced the symptomatic AL rate(odds ratio=0.50,95%confidence interval:0.29–0.86,P=0.012).CONCLUSION TDT may not reduce AL overall among patients undergoing rectal cancer ***,patients without a diverting stoma may benefit from TDT placement.

关键词： Meta-analysis Drainage Transanal Anastomotic leakage surgical stomas Rectal cancer

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Risk factors for postoperative stoma outlet obstruction in ulcerativecolitis

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World Journal of Gastrointestinal Surgery 2020年第12期12卷 507-519页

作者： Tomoaki Kitahara Yu Sato Takashi Oshiro Rie Matsunaga Makoto Nagashima Shinichi Okazumi Department of Surgery Toho University Sakura Medical CenterSakura 285-8741ChibaJapan

BACKGROUND Current medical treatments can achieve remission of ulcerative colitis (UC).Surgery is required when potent drug treatment is ineffective or when coloncancer or high-grade dysplasia develops. The standard procedure is restorativeproctocolectomy (RPC) with ileal pouch-anal anastomosis, commonly performedas two- or three-stage RPC with diverting ileostomy. Postoperative stoma outletobstruction (SOO) is frequent, but the causes are not well *** To identify the risk factors for SOO after stoma surgery in patients with *** We retrospectively reviewed the files of 148 consecutive UC patients whounderwent surgery with stoma construction. SOO was defined as small bowelobstruction symptoms and intestinal dilatation just below the penetrating part ofthe stoma on computed tomography. Patients were divided into two groups:Those who developed SOO within 30 d after surgery and those who did *** characteristics, intraoperative parameters, the stoma site, and rectusabdominis muscle thickness were collected. Moreover, we identified the patientswho repeatedly developed SOO. Univariate and multivariate analyses wereperformed to identify risk factors for SOO and recurring *** Eighty-nine patients who underwent two-stage RPC were included betweenJanuary 2008 and March 2020. Postoperatively, SOO occurred in 25 (16.9%)patients after a median time of 9 d (range 2-26). Compared to patients withoutSOO, patients with SOO had a significantly higher rate of malignant tumors ordysplasia (36.0% vs 17.1%, P = 0.032), lower total glucocorticoid dose one monthbefore surgery (0 mg vs 0 mg, P = 0.026), higher preoperative total protein level(6.8 g/dL vs 6.3 g/dL, P = 0.048), higher rate of loop ileostomy (88.0% vs 55.3%, P= 0.002), and higher maximum stoma drainage volume (2300 mL vs 1690 mL, P =0.004). Loop ileostomy (OR = 6.361;95%CI 1.322–30.611;P = 0.021) and maximumstoma drainage volume (OR = 1.000;95%CI 1.000–1.001;P = 0.015) wereconfirmed as independent r

关键词： Ileal pouch anal anastomosis Ileostomy Loop ileostomy Proctocolectomy and restorative surgical stomas Total proctocolectomy Ulcerative colitis

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