Department of Surgery P, University Hospital of Aarhus, Aarhus C, Denmark.
Colorectal Dis. 2012 Aug;14(8):e499-505. doi: 10.1111/j.1463-1318.2012.02991.x.
To evaluate complications after stoma closure.
Using a retrospective review of 997 medical records, data were collected from all patients undergoing stoma closure at the Department of Surgery P, Aarhus University Hospital, Denmark, from 1996 to 2010. Patient data after Hartmann reversal and loop-ileostomy closure were compared. Data regarding the grade of the operating surgeon and assistant were extracted.
Out of 997 patients, 700 (70.6%) had a loop-ileostomy closure and 172 (17.4%) had a Hartmann reversal. Postoperative mortality was 0.5%. Seven patients required re-operation (0.7%). Morbidity was registered in 31.9% of the patients, with 131 (13.1%) having early complications and 187 (18.8%) having late complications. Wound infection was the most frequent early complication, which occurred in 31 patients (3.1%). Only 10 patients (1%) had an anastomotic leak. Incisional hernia was the most frequent late complication, occurring in 92 patients (9.3%). A consultant attended 90% of the operations. Junior surgeons never performed stoma closure without supervision. Body mass index was significantly associated with the development of incisional hernia. Hartmann reversal was associated with higher rates of complications compared with loop-ileostomy closure. In patients with Hartmann reversal, stapled anastomosis was associated with stricture in 12 out of 95 cases (12.6%), whereas hand-sewn anastomosis was not associated with stricture (0 out of 64 patients; 0%; P < 0.05).
Stoma closure is associated with low rates of leakage. A favourable case mix and high degree of consultant attendance may explain the good results.
评估造口关闭后的并发症。
使用回顾性研究，收集了 1996 年至 2010 年期间在丹麦奥胡斯大学医院 P 外科部门接受造口关闭手术的 997 名患者的病历数据。比较了 Hartmann 反转术和回肠造口关闭术患者的数据。提取了手术医生和助手的手术级别数据。
997 例患者中，700 例（70.6%）行回肠造口关闭术，172 例（17.4%）行 Hartmann 反转术。术后死亡率为 0.5%。7 例患者需要再次手术（0.7%）。31.9%的患者发生了并发症，131 例（13.1%）发生了早期并发症，187 例（18.8%）发生了晚期并发症。伤口感染是最常见的早期并发症，发生在 31 例患者（3.1%）中。仅有 10 例患者（1%）发生吻合口漏。切口疝是最常见的晚期并发症，发生在 92 例患者（9.3%）中。90%的手术都有顾问参加。初级外科医生在没有监督的情况下从不进行造口关闭手术。体重指数与切口疝的发生显著相关。与回肠造口关闭术相比，Hartmann 反转术与更高的并发症发生率相关。在 Hartmann 反转术患者中，吻合器吻合术导致 95 例中的 12 例（12.6%）出现狭窄，而手工吻合术则没有狭窄（64 例中无一例狭窄，0%；P<0.05）。
造口关闭术与低漏率相关。良好的病例组合和高顾问参与度可能解释了良好的结果。
