The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery

“Statistics regarding ostomy-related metrics remain elusive in the United States because of underreporting and coding limitations. The estimated number of ostomates in the United States is 750,000 to 1 million, with approximately 150,000 new ostomies created each year. Stoma creation has a relatively high rate of associated morbidity, ranging from 20% to 80%; peristomal skin complications and parastomal hernia (PSH) are the most common associated morbidities. A population-based study using the Michigan Surgical Quality Collaborative, which included 4250 patients, identified a 37% unadjusted surgical complication rate for elective cases involving an ostomy and 55% unadjusted surgical complication rate for emergency cases involving an ostomy. In this study, risk-adjusted stoma-related morbidity rates varied significantly among hospitals, indicating a potential to improve outcomes in outlying institutions.”

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Adult intussusception. Determining the appropriate surgical procedure.

“Although surgery is the recommended treatment for adult intussusception, the optimal surgery remains controversial. Although abdominal computed tomography (CT) scan has
proven useful in diagnosing intussusception, it has limited value in discriminating whether a lead point is malignant, benign, or idiopathic. Reduction at surgery may avoid excessive bowel resection, although it can theoretically increase the risk of potential intraluminal seeding or venous tumor dissemination.
The aim of this study was to determine what the appropriate surgical procedure for adult intussusception is, depending on location of the intussusception or other specific situations.”

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Colonic Interposition After Adult Oesophagectomy

“Higher rates of morbidity and mortality following colonic conduits are reported to be due to be associated with longer operating times and the additional colo-gastric and colo-colic anastomoses. Yet, colonic conduits have the advantages of being longer, acid resistant, and possess an excellent blood supply. No consensus regarding the optimum site of colonic conduit (right vs. left) or placement route (posterior mediastinal, retrosternal or subcutaneous) exists. The operation is usually carried out based on individual surgeons’ preferences and experience, and in the absence of randomised controlled trials, this situation is likely to continue. The aim of this systematic review and meta-analysis was
to determine the optimal site of colonic conduit and route of placement after adult oesophagectomy.”

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Handsewn vs. stapled anastomoses in colon and rectal surgery

“Trials comparing handsewn with stapled anastomoses in colon and rectal surgery have not found statistical differences. Despite this, authors have differed in their conclusions as to which technique is superior. To help determine whether differences in patient outcomes are present, a meta-analysis of all trials was performed.”

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