Resumen. La ostomía de alto débito es una complicación frecuen- te en pacientes portadores de ileostomías que está poco identificada y que no suele ser. cual fue la organización nacional de ostomía en los Estados. Unidos desde hasta el . 2. CONTENIDO. COMPLICACIONES DE COLOSTOMIA. Complicaciones de Ostomias – Download as Powerpoint Presentation .ppt), PDF File .pdf), Text File .txt) or view presentation slides online.
|Published (Last):||16 July 2016|
|PDF File Size:||11.45 Mb|
|ePub File Size:||2.25 Mb|
|Price:||Free* [*Free Regsitration Required]|
Despite existing beneficial evidence, there is no established indication for performing protective ostomies. Dis Colon Rectum ;49 7: Patient characteristics The series is made up of 89 patients: Eur J Surg ; 2: Morbidity and mortality associated with diverting ileostomy closures in rectal cancer surgery.
The mean waiting time between creation of the ileostomy and closure was 8 months The mean waiting time was 9. On the one hand, the use of gastrograffin enemas in the immediate postoperative period is not recommended odtomias patients with no clinical suspicion of dehiscence, as the increase in pressure on the anastomosis may lead to a disruption, or to a bacteraemia ostomia the event of a subclinical local septic process; it should therefore not be done before the 6 th -8 th week postoperatively 11 ; moreover, false positive rates of 6.
Ann R Coll Surg Engl ;83 4: We believe that the closure of diverting ileostomies should not be considered a complication-free minor surgical procedure; for this same reason we analyse our experience in a series of patients undergoing closure of diverting loop ileostomies between There were 89 patients: J Gastrointest Surg ;12 7: Br J Surg ;95 6: The third reoperation was performed in a patient who developed an ischemia of the anastomosis; this was the only death in our series, caused by septic shock secondary to peritonitis on day 7 after the second operation.
Dis Colon Rectum ;37 Defunctioning loop ileostomy and stapled side-to-side closure has low morbidity. Clinical results of loop ileostomy closures in rectal cancer surgical patients. The use of computed complicadiones with rectal contrast demonstrates the same drawbacks as gastrograffin enema, although it has the advantage of being able to evaluate possible local septic processes Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy.
Manejo de ostomías y prevención de sus complicaciones
But it is stoma closure that carries the highest rates of morbidity and mortality 3. Delayed closure of the ileostomy is often related to the adjuvant chemotherapy that many of these patients receive, as occurs in our series, in which the mean waiting time increases in the chemotherapy group, compared to those not receiving adjuvant treatment 6.
Br J Surg ; 88 2: The study population was selected from a historical archive of patients receiving programmed surgery in the General Surgery department; this archive allows identification of the process for which the patient undergoes surgery and is ordered chronologically.
In third place, enterocutaneous fistula, with a frequency of 4. Epub Dec Minor events included two cases of phlebitis 2. The decision, therefore, to create and subsequently close an ileostomy should not be considered a minor surgical process and the surgeon should take into account which patients will really benefit ostomjas it cases of low anastomoses, presence of adverse complicacionws for healing of the anastomosis, etc.
Most of our complications were solved conservatively and the reoperation rate was just 3. During this pre-closure waiting period an imaging test is usually performed to check the integrity of the anastomosis and diagnose the presence of fistulas or stenosis, although it is not clear if it is strictly necessary in all cases.
Complicaciones de la piel periestomal | Características, causas y manejo
Complications in colorectal surgery have decreased in recent years due to the creation of specialised units 4 ; however, when they occur they associate high rates of morbidity and mortality, especially the feared anastomotic dehiscence.
Carlsen E, Bergan AB.
Preoperative and postoperative modalities in colon and rectal surgery. There are groups that favour a lower rate of complications associated with a mechanical rather than a manual anastomosis, especially bowel obstruction 16, Br J Surg ;92 9: J Gastrointest Surg ;12 5: The most common was intestinal obstruction, that happened in 29 patients Surgical technique All the patients were given antibiotic prophylaxis with ceftriaxone prior to surgery complicackones rachideal anaesthesia.
There are groups that incline towards an early stoma closure during hospital admission with a view to improving the patients’ quality of life and preventing possible stomal complications, such as Alves et al.
However, creation means subsequent closure, which must not be considered a minor procedure but an operation with possibly significant complications, including death, as has been shown in publications on the subject and in our own series. The most commonly chosen test was abdominal computed tomography with oral contrast and gastrograffin enema, performed in Digital rectal examination compares favourably with conventional water-soluble contrast enema in the assessment of anastomotic healing after low rectal excision: Diverting ileostomies are widely used in colorectal surgery to protect low rectal anastomoses, especially in techniques such as low anterior resection and restorative protocolectomy.
Data collection Data were collected retrospectively and entered into a database created for this purpose.
Ileostomías de protección: complicaciones y mortalidad asociadas a su cierre
Results Waiting time before surgery The mean waiting time between creation of the ileostomy and closure was 8 months Later there was realized closing of the abdominal wall by planes by running suture of material monofilament of slow-absorption, and closing of cellular subcutaneous by interrupted suture of monofilament. Another of the points for discussion is the type of anastomosis to perform in the ileostomy closure.
One of the controversial ostoias is the optimum time interval between the creation of the ileostomy and the time of closure. Dis Colon Rectum ;48 2: Moreover, the surgeon must take into account on the one hand the potential benefit of the ileostomy in protecting the anastomosis, and on ostomlas other hand the se involved, such as the reduced life quality of ostomy patients 2 and the morbidity and mortality associated with the future closure of the ostomy.
It was necessary in both cases to resect the anastomosis and create a new ileostomy, terminal in these cases.