Nutzen eines Reiters bei einer Anlage eines doppelläufigen Ileostomas - Eine retrospektive Datenanalyse über 14 Jahre

Hintergrund: In vielen chirurgischen Schulen ist es üblich ein protektives Loop-Ileostoma durch einen Reiter zu sichern. Ziel dieser Studie war es zu überprüfen, ob ein relevanter Zusammenhang zwischen der Verwendung eines Reiters und postoperativen Stomakomplikationen besteht bzw. diese verhindert...

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Bibliographic Details
Main Author: Wolf, Andrej
Contributors: Fendrich, Volker (Prof. (apl.) Dr. med.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2016
Online Access:PDF Full Text
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Traditionally, a rod is used for loop ileostomies to reduce stoma associated complications. The aim of this study was to investigate whether the use of rods in loop ileostomy leads to a relevant reduction of stoma complications or even prevent it. Material and method: Stoma associated complications were investigated in 287 patients. In these patients a loop ileostomy was generated with (2000-2007, n=129) or without a rod (2008-2014, n=158) from 2000 to 2014. All statistical analysis was performed by using X; P-Values < 0.05 were considered statistically significant. Results: Stoma dehiscence occurred significantly more often in the group with rods than in the group without rods (30,2% vs.17,7%; p=0,017). In addition, stoma prolapses could also be observed more frequently in the group with rods. However, a stoma retraction was noticed rarely in both groups (2,3% vs. 3,8%; p=0,52). Furthermore, in both groups there was no detectable significant difference in the incidence of abscess and parastomal hernia (3,1% vs. 2,5% p=1,0 und 1,55% vs. 0,63%; p=0,59). The incidence of peristomal skin complications was about 31% in both groups and included complications such as skin redness (n64, 22.29%), skin maceration (n = 6, 2.0%), pustules (n = 4, 1.39%), allergy (n = 1, 0, 34%), infection of the injection sites (n = 16, 5.57%) and pressure ulcers (n = 2, 0.69%). Regarding peristomal complications, statistically no significant difference was detected in both groups, but the complications were more likely in the group with rods (36,43% vs. 26,58%; p=0,095). Conclusion: Generating a loop ileostomy should be performed without a rod, since data indicates that the use of rods leads to more postoperative complications. A prospective cohort study is needed to confirm the recommendation.