eP728 - Comparison of Tube Ileostomy to Brook Ileostomy in Stage 3 Rectal Cancer Surgery

Tuesday, June 4, 2024

8:24 AM – 8:29 AM ET, USA

Location: Baltimore Convention Center, Room 318-320

ePoster Presenter(s)

Mahir Gachabayov, MD

Resident
Westchester Medical Center
Westchester Medical Center
White Plains, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

WA

Wafi Attaallah, n/a

Prof.Dr.
Marmara Universtiy School of Medicine
Istanbul, Istanbul, Turkey

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Ernesto Barzola

Attending
Hospital Universitario Dr. Josep Trueta
Girona, Catalonia, Spain

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
OI

Omer Inanc, MD

Attending Surgeon
Department of General Surgery, Marmara University
Istanbul, Istanbul, Turkey

Disclosure information not submitted.
AB

Alisina Bulut, MD

Attending Surgeon
Department of General Surgery, Marmara University
Istanbul, Istanbul, Turkey

Disclosure information not submitted.
MJ

Mirkhalig Javadov, MD

Attending Surgeon
Department of General Surgery, Medicana International Atasehir Hospital
Istanbul, Istanbul, Turkey

Disclosure information not submitted.
OV

Orhan Verdiyev, MD

Attending Surgeon
Department of General Surgery, Marmara University
Istanbul, Istanbul, Turkey

Disclosure information not submitted.
RB

Ryan Bendl, D.O.

Assistant Professor
Westchester Medical Center
Valhalla, New York, United States

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Senior Author(s)

RB

Roberto C.M. Bergamaschi, MD, PhD

Chief of Colon & Rectal Surgery
Jacobi Medical Center
East Setauket, New York, United States

Disclosure information not submitted.

Purpose/Background: Patients with resectable stage 3 adenocarcinoma located in the distal rectum often require diverting ileostomy at the time of elective total mesorectal excision (TME) following neo-adjuvant chemoradiation. The aim of this study was to compare tube ileostomy to Brooke ileostomy in terms of overall complications.Methods/Interventions: This was a prospective cohort study enrolling consecutive patients with stage-III low rectal cancer undergoing elective TME with tube or Brooke ileostomy at a median 8-week interval following neo-adjuvant chemoradiation in two institutions. Tube ileostomy was defined as the insertion of a soft polyvinylchloride endotracheal tube into the afferent limb of the terminal ileum and of a flexible rubber drain passed behind the backwall to occlude the efferent limb. Brooke ileostomy was defined as the exteriorization of the terminal-ileum afferent limb through the abdominal wall (then everted and sutured to the skin) with the efferent limb acting as mucous fistula. Propensity score matching with a 1:1 ratio was employed to compare diagnosis-matched patients for age, gender and ASA score.Results/Outcomes: During five years, 110 patients underwent TME with tube ileostomy, whereas 116 patients underwent TME with Brooke ileostomy. Propensity score matching left 99 tube and 99 Brooke patients comparable for age (p = 0.112), gender (p = 1.000), and ASA score (p = 1.000). Ileostomy reversal was carried out at median postoperative day (POD) 14 (same hospital stay) vs. median 150 days (readmission), (p < 0.001). Recovery after reversal was uneventful except for one obstruction requiring reoperation after Brooke reversal. Incisional SSI rates after reversal did not differ (p = 0.772). Rates of colorectal anastomotic leaks identified at CT scan with rectal contrast were 11.1 % vs. 4.0% (p = 0.104). Re-operation was required in 3/11 tube patients, whereas the remaining 9/11 recovered without intervention at median POD 28. Four Brooke patients recovered without intervention at median 180 days. Rates of dehydration with/without kidney failure (1% vs. 22.7%; p < 0.001), emergency room visits with/without readmission (1% vs. 24.5%; p < 0.001) were significantly higher in Brooke patients.Conclusion/

Discussion: Compared to Brooke, tube ileostomy with its reversal within the same hospital stay was associated with fewer complications. The evidence regarding the impact that ileostomy technique and/or timing of reversal might have on colorectal anastomotic leaks is inconclusive at this time.