Primary anastomosis versus diverting stoma as a management of intestinal vascular gangrene: a randomized controlled study

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Abstract

Context
When intestinal gangrene is evident or suspected, surgical laparotomy is mandatory where the affected segment is resected with a safety margin of 5–10 cm, and the remaining part is either anastomosed or diverted on anterior abdominal wall as stoma. Stomas protect against the risks of anastomotic leakage and permit close examination of the bowel by inspection and/or endoscopy; however, it affects the quality of life.
Aims
To evaluate the perioperative outcomes of patients of mesenteric vascular occlusion in relation to the method of surgical intervention with either primary anastomosis or diverting ileostomy.
Settings and design
The study was a prospective, randomized comparative study. It involved all eligible patients fulfilling the inclusion criteria of the study. It was conducted at Mansoura Emergency Hospital in the period from November 2016 till November 2019.
Patients and methods
A total of 100 patients were recruited into the current study and divided into two groups after resection of gangrenous part: stoma group and anastomosis group.
Statistical analysis
Data were fed to the PC and analyzed using SPSS, version 26.0.
Results
Overall, 100 cases had a mean age of 53.0±7.6 years, with the range of 38.0–77.0 years. It included 66 (66%) males and 34 (34%) females. The leakage rate was significantly higher in the anastomotic group (18 cases), whereas it was experienced only in two (4%) cases in the other group (<0.001). Consequently, postoperative mortality was higher in the same group (nine cases) (=0.025).
Conclusions
The diverting stoma appeared to be a safer procedure to perform in mesenteric vascular occlusion with respect to morbidity and mortality rates but needs a strict nutritional, psychological, and special home care to enhance quality of life.

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