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Published in: Surgery Today 6/2019

Open Access 01-06-2019 | Original Article

Factors predictive of high-output ileostomy: a retrospective single-center comparative study

Authors: Mitsunobu Takeda, Hidekazu Takahashi, Naotsugu Haraguchi, Norikatsu Miyoshi, Taishi Hata, Hirofumi Yamamoto, Chu Matsuda, Tsunekazu Mizushima, Yuichiro Doki, Masaki Mori

Published in: Surgery Today | Issue 6/2019

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Abstract

Purpose

High-output syndrome (HOS) is a complication of ileostomy, which can affect quality of life significantly; however, its exact cause remains unknown. The aim of this study was to establish the frequency, as well as the preoperative and intraoperative factors predictive of HOS.

Methods

The subjects of this study were 164 consecutive patients who underwent colorectal cancer surgery with ileostomy construction at our institute between January, 2011 and August, 2018. Thirteen patients with postoperative complications reported as causes of HOS, including intraperitoneal abscess, paralytic ileus, and outlet obstruction, were excluded. We used a logistic regression analysis to identify the factors predictive of HOS.

Results

HOS developed in 36 of the 151 patients (23.8%). There were significantly more diabetic patients in the HOS group (P = 0.03), but other patient factors such as age, gender, body mass index, and use of daily laxatives were not significantly different between the groups. The HOS group had significantly more cases of total proctocolectomy (P = 0.04), but other surgical factors such as operative time, and blood transfusion were not significantly different between the two groups.

Conclusions

These results indicate that diabetes and total proctocolectomy are preoperative predictors of HOS, allowing for the possibility of early intervention via post-surgical treatment.
Literature
1.
go back to reference Colvin H, Mizushima T, Eguchi H, Takiguchi S, Doki Y, Mori M. Gastroenterological surgery in Japan: the past, the present and the future. Ann Gastroenterol Surg. 2017;1:5–10.CrossRefPubMedPubMedCentral Colvin H, Mizushima T, Eguchi H, Takiguchi S, Doki Y, Mori M. Gastroenterological surgery in Japan: the past, the present and the future. Ann Gastroenterol Surg. 2017;1:5–10.CrossRefPubMedPubMedCentral
2.
go back to reference Miyo M, Takemasa I, Ikeda M, Tujie M, Hasegawa J, Ohue M, et al. The influence of specific technical maneuvers utilized in the creation of diverting loop-ileostomies on stoma-related morbidity. Surg Today. 2017;47:940–50.CrossRefPubMed Miyo M, Takemasa I, Ikeda M, Tujie M, Hasegawa J, Ohue M, et al. The influence of specific technical maneuvers utilized in the creation of diverting loop-ileostomies on stoma-related morbidity. Surg Today. 2017;47:940–50.CrossRefPubMed
4.
go back to reference Nightingale J, Woodward JM. Guidelines for management of patients with a short bowel. Gut. 2006;55:1–12.CrossRef Nightingale J, Woodward JM. Guidelines for management of patients with a short bowel. Gut. 2006;55:1–12.CrossRef
5.
go back to reference Robertson I, Leung E, Hughes D, Spiers M, Donnelly L, Mackenzie I, et al. Prospective analysis of stoma-related complications. Colorectal Dis. 2005;7:279–85.CrossRefPubMed Robertson I, Leung E, Hughes D, Spiers M, Donnelly L, Mackenzie I, et al. Prospective analysis of stoma-related complications. Colorectal Dis. 2005;7:279–85.CrossRefPubMed
6.
go back to reference Caricato M, Ausania F, Ripetti V, Bartolozzi F, Campoli G, Coppola R. Retrospective analysis of long-term defunctioning stoma complications after colorectal surgery. Colorectal Dis. 2007;9:559–61.CrossRefPubMed Caricato M, Ausania F, Ripetti V, Bartolozzi F, Campoli G, Coppola R. Retrospective analysis of long-term defunctioning stoma complications after colorectal surgery. Colorectal Dis. 2007;9:559–61.CrossRefPubMed
7.
go back to reference Cottam J, Richards K, Hasted A, Blackman A. Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. Colorectal Dis. 2007;9:834–38.CrossRefPubMed Cottam J, Richards K, Hasted A, Blackman A. Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. Colorectal Dis. 2007;9:834–38.CrossRefPubMed
8.
go back to reference Baker ML, Williams RN, Nightingale JM. Causes and management of a high-output stoma. Colorectal Dis. 2011;13:191–97.CrossRefPubMed Baker ML, Williams RN, Nightingale JM. Causes and management of a high-output stoma. Colorectal Dis. 2011;13:191–97.CrossRefPubMed
9.
go back to reference Williams RN, Hemingway D, Miller AS. Enteral Clostridium difficile, an emerging cause for high output ileostomy. J Clin Pathol. 2009;62:951–53.CrossRefPubMed Williams RN, Hemingway D, Miller AS. Enteral Clostridium difficile, an emerging cause for high output ileostomy. J Clin Pathol. 2009;62:951–53.CrossRefPubMed
10.
go back to reference Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111:518–26.PubMed Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111:518–26.PubMed
11.
go back to reference Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral
12.
go back to reference Fuji T, Morita H, Sutoh T, Yajima R, Tsutsumi S, Asao T, et al. Outlet obstruction of temporary loop diverting ileostomy. Hepatogastroenterology. 2015;62:602–05. Fuji T, Morita H, Sutoh T, Yajima R, Tsutsumi S, Asao T, et al. Outlet obstruction of temporary loop diverting ileostomy. Hepatogastroenterology. 2015;62:602–05.
13.
go back to reference Saklad M. Grading of patients for surgical procedures. Anesthesiology. 1941;2:281–84.CrossRef Saklad M. Grading of patients for surgical procedures. Anesthesiology. 1941;2:281–84.CrossRef
14.
go back to reference Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients (in Japanese with English abstract). Nippon Geka Gakkai Zasshi (Jpn J Surg). 1984;85:1001–5. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients (in Japanese with English abstract). Nippon Geka Gakkai Zasshi (Jpn J Surg). 1984;85:1001–5.
15.
go back to reference Nozoe T, Kohno M, Iguchi T, Mori E, Maeda T, Matsukuma A, et al. The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma. Surg Today. 2012;42:532–5.CrossRefPubMed Nozoe T, Kohno M, Iguchi T, Mori E, Maeda T, Matsukuma A, et al. The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma. Surg Today. 2012;42:532–5.CrossRefPubMed
16.
go back to reference Hakala K, Vuoristo M, Luukkone P, Jarvienen HJ, Miettinen TA. Impaired absorption of cholesterol and bile acids in patients with an ileoanal anastomosis. Gut. 1997;41:771–7.CrossRefPubMedPubMedCentral Hakala K, Vuoristo M, Luukkone P, Jarvienen HJ, Miettinen TA. Impaired absorption of cholesterol and bile acids in patients with an ileoanal anastomosis. Gut. 1997;41:771–7.CrossRefPubMedPubMedCentral
17.
go back to reference Nissinen MJ, Gylling H, Javinen HJ, Miettinen TA. Ileal pouch-anal anastomosis, conventional ileostomy and ileorectal anastomosis modify cholesterol metabolism. Dig Dis Sci. 2004;49:1444–53.CrossRefPubMed Nissinen MJ, Gylling H, Javinen HJ, Miettinen TA. Ileal pouch-anal anastomosis, conventional ileostomy and ileorectal anastomosis modify cholesterol metabolism. Dig Dis Sci. 2004;49:1444–53.CrossRefPubMed
18.
go back to reference Ogbonnaya KI, Arem R. Diabetic diarrhea. Pathophysiology, diagnosis, and management. Arch lntern Med. 1990;150:262–7.CrossRef Ogbonnaya KI, Arem R. Diabetic diarrhea. Pathophysiology, diagnosis, and management. Arch lntern Med. 1990;150:262–7.CrossRef
19.
go back to reference Forslund K, Hildebrand F, Nielsen T, Falony G, Le Chatelier E, Sunagawa S, et al. Disentangling type 2 diabetes and metformin treatment signatures in the human gut microbiota. Nature. 2015;10:262–6.CrossRef Forslund K, Hildebrand F, Nielsen T, Falony G, Le Chatelier E, Sunagawa S, et al. Disentangling type 2 diabetes and metformin treatment signatures in the human gut microbiota. Nature. 2015;10:262–6.CrossRef
20.
go back to reference Mike M, Kano N. Laparoscopic surgery for colon cancer: a review of the fascial composition of the abdominal cavity. Surg Today. 2015;45:129–39.CrossRefPubMed Mike M, Kano N. Laparoscopic surgery for colon cancer: a review of the fascial composition of the abdominal cavity. Surg Today. 2015;45:129–39.CrossRefPubMed
21.
go back to reference Matulikova A, Hoch J. Colostomy and ileostomy and their complications. Rozhl Chir. 2001;80:517–20.PubMed Matulikova A, Hoch J. Colostomy and ileostomy and their complications. Rozhl Chir. 2001;80:517–20.PubMed
Metadata
Title
Factors predictive of high-output ileostomy: a retrospective single-center comparative study
Authors
Mitsunobu Takeda
Hidekazu Takahashi
Naotsugu Haraguchi
Norikatsu Miyoshi
Taishi Hata
Hirofumi Yamamoto
Chu Matsuda
Tsunekazu Mizushima
Yuichiro Doki
Masaki Mori
Publication date
01-06-2019
Publisher
Springer Singapore
Published in
Surgery Today / Issue 6/2019
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-018-1756-2

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