The application of protective stoma in the terminal ileum with self-closing intubation in colorectal surgery

Objective To investigate the feasibility and safety of the spontaneously closed protective stoma at the terminal ileum to prevent anastomotic leakage in colorectal surgery. Methods A retrospective analysis of 106 cases of colorectal surgery with protective stoma patients from May,2011 to December,2015 in Lanxi People's Hospital.They were divided into two groups:83 cases with spontaneously closed protective stoma at the terminal ileum and 23 cases with conventional loop ileostomy or loop transverse colostomy.Two groups were compared for the following indicators:postoperative complications,nutrition and infection-related indicators(TP,Alb,PA,CRP,PCT and so on),intestinal repatency time,hospitalization costs and so on. Results Two protective stoma methods all have a protective effect on colorectal anastomoses.There was no statistically significant difference in anastomotic leakage rate,the incidence of postoperative infection in 7 days in addition to nutrition indicators in 14 days.The average intestinal repatency time of the spontaneously closed protective stoma group is 19 d,while the conventional group is 125 d.The recovery of enterokinesia and defacation of the spontaneously closed protective stoma group was significantly earlier than that of the conventional group;meanwhile,parastomal hernia,intestinal obstruction and other complications of the experimental groupwere significantly less than the conventional group.Hospitalization time and costs of the experimental group were significantly lower than the conventional group. Conclusion For the patients with advanced age,malnutrition,diabetes and other complications,receiving neoadjuvant chemotherapy before operation,anus-retained operation for low rectal cancer,and the patients was unsatisfied with intraoperative anastomoses,left colorectal cancer complicated by acute obstruction,acute injury of left colon or rectum and other patients dissatisfied with intestinal tract preparation are suitable for protective stoma.Compared with conventional loop ileostomy or loop transverse colostomy,spontaneously closed protective stoma has the same effect of preventing anastomotic leakage,and can shorten hospitalization time,avoid 2nd stage operation,ease patients' pain and reduce hospitalization costs.