Estomas de proteção das anastomoses coloanais : estudo comparativo entre ileostomias e colostomias

AUTOR(ES)
DATA DE PUBLICAÇÃO

1999

RESUMO

Ilestomy or colostomy have been utilized to protect coloanal anastomosis and have also been associated with a decreasing rate of sepses and other complications. However, the choice between ileostomy and colostomy remains controversial. The purpose ofthis study was to compare the complications rate to perform and to close the stomas used as the protection of coloanal anastomosis. Fifty six patients were retrospectively analysed between 1979 and 1995, operated on by the GíOup of Coloproctology, Division of Digestive Disease, UNICAMP, mainly for the treatment of rectal cancer. Surgeries performed were: straight coloanal anastomosis in 21 patients and colonic pouch-anal anastomosis in 35. Thirty three ileostomy and 23 colostomy were performed and meam age was 51,2 (27-80) years for the ileostomy and 55,5 (26-71) years for the colostomy. Eighteen patients (54,5%) in the group of.ileostomy were female and 12 patients (52,2%) were male in the group of colostomy. The mean time between construction and closure of the stoma was 6,9 (2-23) months for the ileostomy group and 5,0 (2-17) months for the other. AlI patients were submitted to radiographic studies previously to the closure of the stoma: to confirm integrity and permeability of the sutures. AlI patients had mechanical cleasing and profhilatic antibiotics were used. The majority of the patients had the closure of the stoma performed by direct approach but laparotomy was needed for three patients (to perform cholecistectomy in two and to repair an incisional hemia in one for the ileostomy group). Some extend of stoma resection was necessary only in the ileostomy group, in five patients, to complete the closing perform. Complication related to the constructioq Gf the stoma was observed in one patient (3,0%) in the ileostomy group, presenting ,:",ith severe dehidration and acute renal failure due to high output of the stoma. Twelve complications in 11 patients (19,7%) related to the closure ofthe stoma were observed, similarly for both groups, being six (18,2%) for the ileostomy group and five (21,7%) for the colostomy group. Three complications were general ones, with two in the colostomy group in only one patient (4,3%) ( urinary tract infection and heart failure) and one in the ileostomy group (acute atrial fibrilation). Ear1y local complications were observed only in the ileostomy group (intestinal obstruction (2 - 6,1 %) and peritonitis (1 3,0%)). Intestinal obstruction was treated by laparotomy at the nineth and tenth postoperative day, and peritonits was treated on the eighth day. Late local complications were observed in six patients (10,7%), being two patients (6,1%) for the ileostomy group (intestinal obstruction) and four patients (17,4%) in the colostomy group (intestinal obstruction (2 - 8,7%) and incisional hernia (2 - 8,7%)). The mean admissional time was 6,5 (3-24) days for the ileostomy group and 7,1 (5-7) for the colostomy. In conclusion, both the ileostomy and colostomy group had the same complication rates without statistical significance

ASSUNTO(S)

cancer enterostomia reto

ACESSO AO ARTIGO

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