Stoma placement in obstructive XXXX prior to neo-adjuvant treatment and definitive surgery: A practical guideline.

@entity5 @entity1 @entity532 @entity1744
INTRODUCTION: @entity1744 in @entity5 is a common problem, requiring stoma placement to decompress the colon and permit neo-adjuvant treatment. The majority of @entity1 operated on in our hospital are referred; after stoma placement at the referring centre without overseeing final type of surgery. Stoma malpositioning and its effects on @entity5 care are described. METHODS: All @entity1 who underwent surgery for locally advanced or locally recurrent @entity5 between 2000 and 2013 in our tertiary referral centre were reviewed and included if they received a stoma before curative surgery. @entity1 with recurrent @entity5 were only included if the stomas from the primary surgery had been restored. The main outcome measures are stoma malpositioning, postoperative and @entity532 . RESULTS: A total of 726 @entity1 were included; of these, 156 @entity1 (21%) had a stoma before curative surgery. In the majority of @entity1 , acute or pending @entity1744 was the main indication for emergent stoma creation; some of the @entity1 had @entity5 -related fistulae. In 53 @entity1 (34%), the stoma required revision during definitive surgery. No significant differences were found regarding postoperative complications. CONCLUSION: One-third of the previously placed emergency stomas were considered to be located inappropriately and required revision. We were able to avoid increased complication rates in @entity1 with a malpositioned stoma, however unnecessary surgery for an inappropriately placed stoma should be avoided to decrease @entity1 inconvenience and risks. An algorithm is proposed for the placement of a suitable stoma.
