Improving the time to ileostomy closure following an anterior resection for rectal cancer in the UK.
Anterior resection
ileostomy
rectal cancer
Journal
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
ISSN: 1463-1318
Titre abrégé: Colorectal Dis
Pays: England
ID NLM: 100883611
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
revised:
09
09
2021
received:
03
08
2021
accepted:
13
09
2021
pubmed:
21
9
2021
medline:
31
3
2022
entrez:
20
9
2021
Statut:
ppublish
Résumé
Delayed closure of ileostomy following an anterior resection for rectal cancer in the UK is common. The aims of this study were (i) to investigate the variation in patient pathways between hospitals, (ii) to identify the key learning points from units with the shortest time to closure and (iii) to develop guidance for a pathway to minimize delay in ileostomy closure. This was a mixed methods study. Thirty-eight colorectal units in the UK completed a short online survey. Nine colorectal units in Wales filled in an additional, expanded version of the survey. Semi-structured interviews were performed with clinicians from the six best performing units in terms of timely ileostomy closure. The optimal pathway suggested is based on the best evidence available and the Association of Coloproctology of Great Britain and Ireland guidelines. Qualitative analysis revealed that 5% of units (n = 2) have a local target time for ileostomy closure. Of all units, 90% (n = 34) would consider implementing a pathway if guidelines were developed. In-depth interviews highlighted the importance of a multidisciplinary approach, a dedicated coordinator to facilitate timely booking, and consensus on whether closure should be performed before or after adjuvant chemotherapy. There is a lack of national guidance in timing of contrast studies and ileostomy closure. Key aspects to consider are better information at consent regarding stoma closure timing, a dedicated person to track patients and the planning of contrast studies at discharge from initial surgery. With a dedicated approach closure of ileostomy within 10-12 weeks is feasible for most units.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
120-127Subventions
Organisme : Medical Research Council
ID : MR/S006745/1
Pays : United Kingdom
Informations de copyright
© 2021 Association of Coloproctology of Great Britain and Ireland.
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