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Protective ileostomy creation after anterior resection of the rectum: shared decision-making or still subjective?

Balla, Andrea; Saraceno, Federica; Rullo, Marika; Morales-Conde, Salvador; Targarona Soler, Eduardo M; Di Saverio, Salomone; Guerrieri, Mario; ... Sileri, Pierpaolo; + view all (2023) Protective ileostomy creation after anterior resection of the rectum: shared decision-making or still subjective? Colorectal Disease , 25 (4) pp. 647-659. 10.1111/codi.16454. Green open access

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Abstract

AIM: The choice to perform protective ileostomy (PI) after anterior resection (AR) is mainly guided by risk factors (RFs) responsible for anastomotic leakage (AL) development. However, clear guidelines about PI creation are still lacking in the literature and this is often decided according to the surgeon's preferences, experiences, or feelings. This qualitative study aims to investigate by an open-ended question survey, the individual surgeon's decision-making process regarding PI creation after elective AR. METHOD: Fifty-four colorectal surgeons took part in an electronic survey to answer the questions and describe what usually led their decision to perform PI. A content analysis was used to code the answers. To classify answers, five dichotomous categories (In favour/Against PI, Listed/Not listed RFs, Typical/Atypical, Emotions/Non-emotions, Personal experience/No personal experience) have been developed. RESULTS: Overall, 76% of surgeons were in favour of PI creation and 88% considered listed RFs in the question to perform PI. Atypical answers were reported in 10% of cases. Emotions and personal experience influenced surgeons' decision-making process in 22% and 49% of cases, respectively. The most frequent considered RFs were the distance of the anastomosis from the anal verge (96%), neoadjuvant chemoradiotherapy (88%), positive intraoperative leak test (65%), blood loss (37%), and immunosuppression therapy (35%). CONCLUSION: The indications to perform PI following rectal cancer surgery lack standardization and evidence-based guidelines are required to inform practice. Until then, experts' opinions can be helpful to assist the decision-making process in patients who underwent AR for adenocarcinoma.

Type: Article
Title: Protective ileostomy creation after anterior resection of the rectum: shared decision-making or still subjective?
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/codi.16454
Publisher version: https://doi.org/10.1111/codi.16454
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Adenocarcinoma, Anterior resection of the rectum, Decision-making process, Defunctioning stoma, Protective ileostomy
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: https://discovery.ucl.ac.uk/id/eprint/10166806
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