Risk factors for outlet obstruction after laparoscopic surgery and diverting ileostomy for rectal cancer

Surg Today. 2021 Mar;51(3):366-373. doi: 10.1007/s00595-020-02096-2. Epub 2020 Aug 4.

Abstract

Purpose: Outlet obstruction is defined as bowel obstruction at the stoma opening. The aim of this study was to evaluate the risk factors for outlet obstruction in patients with rectal cancer who underwent laparoscopic surgery and diverting ileostomy.

Methods: Among consecutive patients who underwent laparoscopic curative resection for primary rectal cancer between 2013 and 2015, 261 patients with diverting ileostomy were included in the analysis. The thickness of the abdominal wall, including the thickness of the rectus abdominis muscle, was measured using preoperative computed tomography. The clinicopathological factors were compared between the patients with and without outlet obstruction.

Results: Fourteen (5.4%) patients were diagnosed with outlet obstruction, but reoperation was not required. The rectus abdominis muscle was significantly thicker in male patients with outlet obstruction compared to those without outlet obstruction, but not in females. In a multivariate analysis, a rectus abdominis muscle thickness of 10 mm or more was determined to be an independent risk factor for outlet obstruction (odds ratio, 7.0482; p = 0.0061).

Conclusions: The thickness of the rectus abdominis muscle may be used to predict the occurrence of outlet obstruction in male patients with rectal cancer who undergo laparoscopic surgery and diverting ileostomy.

Keywords: Diverting ileostomy; Laparoscopic surgery; Outlet obstruction; Rectal cancer; Thickness of rectus abdominis.

MeSH terms

  • Abdominal Wall / diagnostic imaging
  • Abdominal Wall / pathology
  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Forecasting
  • Humans
  • Ileostomy / adverse effects*
  • Ileostomy / methods*
  • Intestinal Obstruction / diagnostic imaging
  • Intestinal Obstruction / etiology*
  • Laparoscopy / adverse effects*
  • Laparoscopy / methods*
  • Male
  • Middle Aged
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / etiology*
  • Preoperative Period
  • Rectal Neoplasms / diagnostic imaging
  • Rectal Neoplasms / pathology
  • Rectal Neoplasms / surgery*
  • Rectus Abdominis / diagnostic imaging*
  • Rectus Abdominis / pathology*
  • Risk Factors
  • Sex Characteristics
  • Tomography, X-Ray Computed