Increased postoperative complications after protective ileostomy closure delay: An institutional study

AIM: To study the morbidity and complications as-sociated to ileostomy reversal in colorectal surgery pa-tients, and if these are related to the time of closure. METHODS: A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance.RESULTS: The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy cre-ation was rectal cancer(56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the pa-tients, with 1% mortality. The most frequent were ileus(13%) and wound infection(13%). Pseudomembra-nous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomyclosure(P = 0.041). Male patients had more complica-tions(P = 0.042), mainly wound infections(P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure(P = 0.003). End-to-end in-testinal anastomosis without resection was significantly associated with postoperative ileus(P = 0.037). CONCLUSION: Although closure of a protective il-eostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.

Recurrent anal fistulae:Limited surgery supported by stem cells

AIM:To study the results of stem-cell therapy under a Compassionate-use Program for patients with recurrent anal fistulae.METHODS:Under controlled circumstances,and approved by European and Spanish laws,a Compassionate-use Program allows the use of stem-cell therapy for patients with very complex anal fistulae.Candidates had previously undergone multiple surgical interventions that had failed to resolve the fistulae,and presented symptomatic recurrence.The intervention consisted of limited surgery(with closure of the internal opening),followed by local implant of stem cells in the fistula-tract wall.Autologous expanded adipose-derived stem cells were the main cell type selected for implant.The first evaluation was performed on the 8th postoperative week;outcome was classified as response or partial response.Evaluation one year after the intervention confirmed if complete healing of the fistula was achieved.RESULTS:Ten patients(8 male)with highly recurrent and complex fistulae were treated(mean age:49years,range:28-76 years).Seven cases were nonCrohn’s fistulae,and three were Crohn’s-associated fistulae.Previous surgical attempts ranged from 3to 12.Two patients presented with preoperative incontinence(Wexner scores of 12 and 13 points).After the intervention,six patients showed clinical response on the 8th postoperative week,with a complete cessation of suppuration from the fistula.Three patients presented a partial response,with an evident decrease in suppuration.A year later,six patients(60%)remained healed,with complete reepithelization of the external opening.Postoperative Wexner Scores were 0 in six cases.The two patients with previous incontinence improved their scores from12 to 8 points and from 13 to 5 points.No adverse reactions or complications related to stem-cell therapy were reported during the study period.CONCLUSION:Stem cells are safe and useful for treating anal fistulae.Healing can be achieved in severe cases,sparing fecal incontinence risk,and improving previous scoring.