Protective Ileostomy Closure after Rectal Cancer
With the purpose of decreasing surgical site infection and improving wound cosmesis after closing a diverting ileostomy created after low rectal cancer surgery a case report utilizing the NPseal negative pressure wound therapy device was performed. The NPseal negative pressure wound therapy device was placed over a diverting ileostomy after neoadjuvant chemoradiation and wound cosmesis and exudate production was evaluated.
A 56-year-old male presenting with painless rectal bleeding to his primary care doctor was evaluated in our study. The patient was noted to have stage two rectal cancer on flexible sigmoidoscopy. Patient was seen by their oncologist and neoadjuvant therapy with 50Gy of radiation therapy with preoperative Xeloda was recommended. After the patient was taken to the operating room and a laparoscopic Low Anterior Resection was performed. Preoperative radiation and chemotherapy to the pelvis resulted in local tissue changes to the pelvis and abdominal wall and the decision to perform a diverting loop ileostomy was made to protect the newly formed anastomosis. The patient recovered well over the next 6 months and completed 8 cycles of FOLFOX chemotherapy. After the completion of his chemotherapy ileostomy was scheduled for reversal. The ileostomy was taken down from the abdominal wall, anastomosed, and dropped back into the abdomen. The ileostomy site fascia was closed with 1.0 PDS suture and the elliptical colostomy site was closed loosely with 4.0 Monocryl without tension. The NPseal was removed from its packing and the plastic protectors over the adhesive ends were removed. The NPseal was placed directly on top of the closed colostomy site and the edges were smoothed out so there were no wrinkles allowing for air escape. The NPseal was pumped 12 times until the center tubing remained collapsed signifying a pressure of -125mmHg and the patient was taken to the PACU.
Throughout the patient’s hospital course, the NPseal negative pressure wound therapy device held suction and did not require additional pumping of the center chamber. The patient did not complain of any discomfort from the device and the device did not become overly saturated with exudate necessitating removal and replacement. On postoperative day 3 the patient was cleared for discharge and the patient was discharged home with the device in place. The patient was given instructions on how to care for the device at home. At the patients home the NPseal remained in place, holding suction until postoperative day 6 when the patient was told to remove the device from his ileostomy takedown site. On return to clinic on postoperative day 30 the ileostomy takedown site incision was clean with no wound infection and the noticeable scar was minimal. The patient was pleased with the appearance of the scar.
In summary, the patient found the NPseal negative pressure wound therapy device to be comfortable and easy to manage. This patient, when closing their ileostomy in a local wound bed exposed to chemotherapy and radiation, experienced excellent wound cosmesis, no postoperative discomfort with the dressings, and no postoperative would complications. The NPseal negative pressure wound therapy device produces a cost effective and efficacious method for improving wound cosmesis and decreasing wound exudate buildup. The small self-contained unit of the NPseal dressing allowed the patient to remain mobile, shower and dress as normal.
- NPseal negative pressure wound therapy device was easy to maintain.
- The ileostomy takedown site dressed with the NPseal negative pressure wound therapy device showed excellent wound cosmesis at post operative day 30.
- NPseal negative pressure wound therapy device was easy to manage and remove at home without the supervision of a healthcare provider.
- Patient was able to mobilize, shower and dress with the NPseal negative pressure wound therapy device in place.
Post-operative day 30 picture of ileostomy closure site