Rectal cancer pain sitting
For the first weeks after the surgery, the patient slowly goes back to a regular diet by progressively adding foods with fibre back into diet.
Colon and Rectal Cancer: How much of a problem is it really?
A healthy balanced diet and a good fluid intake are recommended at discharge. The patient remains under observation rectal cancer pain sitting hospital until bowel function returns, usually the length of postoperative hospital stay being days. A total of 33 patients underwent temporary loop ileostomy following low rectal resections in open surgery in the last 4 years.
All the cases were treated by a single surgeon. Four patients There was no case of peristomal abscess, bleeding, prolapse, retraction of the loop or intestinal rectal cancer pain sitting obstruction after the stoma was formed. Five patients Closure was performed after 6 weeks on average for the colorectal anastomoses and 10 weeks for the coloanal ones. The ileostomy reversal takes approximately minutes. First bowel movement was observed after an average time of 3 days after ileostomy reversal and patients went home at that moment.
At the time of the ileostomy reversal, due to rectal cancer pain sitting adhesions, in 2 cases 6. In these two cases the stoma was reversed later 16 weeks in order to protect a leak of the coloanal anastomosis without pelvic sepsis. After the ileosto- my closure we recorded a case 3.
This complication was managed conservatively with spontaneous closure of the fistula in the context of maintaining natural bowel movements. A long term complication was the stoma site incisional hernia upon which we came across in 4 cases No mortality was attributed to either formation rectal cancer pain sitting closure of the temporary loop ileostomy.
In low rectal surgery for cancer, protective temporary loop ileostomy represents a feasible method made with the purpose of diminishing the morbidity rectal cancer pain sitting to anastomotic leakage.
The authors consider that the protection of the low anastomosis is attenuating the consequences rectal cancer pain sitting the anastomosis leak, therefore decreasing the number of potential reinterventions 4,5,7.
It is associated with a decrease in the quality of life, local and general complications and a higher mortality, given the fact that rectal cancer pain sitting most of the cases we are dealing with older patients with a malignant condition. The advantages of ileostomy as compared to the colostomy are: it is technically easier to form and to close it, it is less fowl-smelling, the complications are less frequent prolapse, retraction, incisional hernia etc.
Bowel movements are reinstated faster and the length of hospital-stay is shorter than in the case of colostomy 2,7,8,9. On the other hand output fluid losses and mechanical obstruction are more frequent 2,3,8,9. Our technique decreases the duration of the surgery both to create and to close the stoma, tissue damages being minimal. At the same time, if an anastomotic fistula occurs, the rectal cancer pain sitting ileostomy can be changed into a terminal one.
By keeping the afferent and the efferent limb in continuity during the bowel diversion, there is no incongruence between the two at the time of ileostomy reversal. We do not create a mesentery defect by transfixing it therefore there is no risk to damage the loop vascularization.
At the time of the ileostomy reversal, usually it is enough to excise only the fibrous margins followed by a minimal enterorrhaphy transversally done, to prevent the stenosis.
Self-treatment with ointments and other drugs does not heal!
The use of the supporting rod can cause discomfort for the patient, harden the stoma bag attachment and erode the small bowel loop. In most cases the supporting rod is removed after days, when the stoma is healed, but the retraction can occur even after this period 3. Rectal cancer pain sitting studies have shown that by not fixing the stoma at the rectus sheath or by not supporting it, the frequency of the rectal cancer pain sitting retraction wouldnt necessarily increase 3,5,10, If a loop ileostomy is properly constructed, the retraction is rare and the use of a bridge is unnecessary Mucosal eversion is recommended to prevent faecal leakage into the abdominal wall and subsequently wound infection 5.
We have not noted a higher frequency of this complication in the non-eversion cases, rectal cancer pain sitting the adhesions between the serosa of the loop and the skin were rapidly built and the serosa-skin junction becomes watertight 3,5.
The ileostomy reversal is performed through a direct approach avoiding dose helmintox median laparotomy which should be more traumatic. The enterorrhaphy is minimal and the small bowel resection is avoided, therefore the postoperative morbidity decreases. The closure technique doesnt imply any mechanical suturing devices reducing the total cost of the procedure.
The reversal of the loop ileostomy can be performed under local or spinal anaesthesia with less systemic drugs-effects than general rectal cancer pain sitting.
Early closure at weeks as rectal cancer pain sitting have also done results into fewer postoperative complications 2,10, Performing the reversal at a later time, we can face solid adhesions between rectal cancer pain sitting loop and the abdominal wall which make the dissection to be more difficult. Consequently we can come across the need for a small bowel resection. In this case, the indication of the resection is given by the difficulty of its freeing, secondary to solid adhesions, and not by the lack of vascularization.
Our technique is well tolerated by the patient, safe and rapid, and can represent a suitable solution to temporary protect the anastomosis in low rectal resections. References References 1. Virtual ileostomy following TME and primary sphincter-saving reconstruction for rectal cancer. Nicolau AE. Temporary loop-ileostomy for distal anastomosis protection in colorectal resections.
Chirurgia Bucur. Romanian 3. Techniques and complications of ileostomy takedown. Am J Surg. Postoperative manage- ment after loop ileostomy closure: are we keeping patients in hospital too long?. Ann R Coll Surg Engl. Loop ileostomy: modification of technique.
Surg-J R Coll Surg. Surgery for toxic megacolon. Mastery of Surgery fifth edition.
Covering ileo- or colostomy in anterior resection for rectal carcinoma. Cochrane Database Syst Rev. Comparison of outcomes following ileostomy rectal cancer pain sitting colostomy for defunctioning colorectal anastomoses.
World J Surg. Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis. Early vs.
Ileostomy rod - is it a bridge too far? Colorectal Dis. Temporary Loop Ileostomy alternative technique poster. Interese conexe.