Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan;24(1):120-127.
doi: 10.1111/codi.15921. Epub 2021 Oct 9.

Improving the time to ileostomy closure following an anterior resection for rectal cancer in the UK

Irene Vogel  1 , Peter G Vaughan-Shaw  2 , Katherine Gash  2 , Kathleen L Withers  3 , Grace Carolan-Rees  3 , Michael Thornton  4 , Pawan Kumar Dhruvao Rao  5 , Jared Torkington  1   2 , Julie A Cornish  1   2
Affiliations

Improving the time to ileostomy closure following an anterior resection for rectal cancer in the UK

Irene Vogel et al. Colorectal Dis. 2022 Jan.

Abstract

Aim: Delayed closure of ileostomy following an anterior resection for rectal cancer in the UK is common. The aims of this study were (i) to investigate the variation in patient pathways between hospitals, (ii) to identify the key learning points from units with the shortest time to closure and (iii) to develop guidance for a pathway to minimize delay in ileostomy closure.

Method: This was a mixed methods study. Thirty-eight colorectal units in the UK completed a short online survey. Nine colorectal units in Wales filled in an additional, expanded version of the survey. Semi-structured interviews were performed with clinicians from the six best performing units in terms of timely ileostomy closure. The optimal pathway suggested is based on the best evidence available and the Association of Coloproctology of Great Britain and Ireland guidelines.

Results: Qualitative analysis revealed that 5% of units (n = 2) have a local target time for ileostomy closure. Of all units, 90% (n = 34) would consider implementing a pathway if guidelines were developed. In-depth interviews highlighted the importance of a multidisciplinary approach, a dedicated coordinator to facilitate timely booking, and consensus on whether closure should be performed before or after adjuvant chemotherapy.

Conclusion: There is a lack of national guidance in timing of contrast studies and ileostomy closure. Key aspects to consider are better information at consent regarding stoma closure timing, a dedicated person to track patients and the planning of contrast studies at discharge from initial surgery. With a dedicated approach closure of ileostomy within 10-12 weeks is feasible for most units.

Keywords: Anterior resection; ileostomy; rectal cancer.

PubMed Disclaimer

References

REFERENCES

    1. Hughes DL, Cornish J, Morris C, LARRIS Trial Management Group. Functional outcome following rectal surgery-predisposing factors for low anterior resection syndrome. Int J Colorectal Dis. 2017;32(5):691-7.
    1. Montedori A, Cirocchi R, Farinella E, Sciannameo F, Abraha I. Covering ileo- or colostomy in anterior resection for rectal carcinoma. Cochrane Database Syst Rev. 2010;12(5).
    1. Phatak UR, Kao LS, You YN, Rodriguez-Bigas MA, Skibber JM, Feig BW, et al. Impact of ileostomy-related complications on the multidisciplinary treatment of rectal cancer. Ann Surg Oncol. 2014;21(2):507-12.
    1. Ihnát P, Guňková P, Peteja M, Vávra P, Pelikán A, Zonča P. Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection. Surg Endosc. 2016;30(11):4809-16.
    1. Herrle F, Sandra-Petrescu F, Weiss C, Post S, Runkel N, Kienle P. Quality of life and timing of stoma closure in patients with rectal cancer undergoing low anterior resection with diverting stoma: a multicenter longitudinal observational study. Diseases Colon Rectum. 2016;59(4):281-90.

LinkOut - more resources