All all ileostomy reversals open wounds?

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Punky44
Posts: 383
Joined: Mon Oct 01, 2018 4:29 pm

All all ileostomy reversals open wounds?

Postby Punky44 » Sun Jun 23, 2019 10:20 pm

And if so, why?

How hard is it to pack and take care of?
Caregiver to my amazing mom (68)
10/1/18 DX with rectal cancer; CEA 17 at diagnosis
T3N2M0
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
CEA 4/23: 2.1; 7/24: 1.9; 10/22: 2.6
6/28/19 Reversal and port out
10/22 — nodules on lungs—possible infection or mets—PET scheduled for 11/25

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

Big Jay
Posts: 35
Joined: Fri Jun 17, 2016 5:41 pm
Location: Baltimore, MD

Re: All all ileostomy reversals open wounds?

Postby Big Jay » Mon Jun 24, 2019 6:43 am

From what I've heard pretty much all of them are left open. I don't recall the proper medical term.

As it was explained to me: if they seal up the skin there's a danger of "stuff" being trapped inside. This could fester and cause an infection. By letting the wound heal itself from the inside out any crud gets pushed out of the hole during the process.

In regards to packing: Once the initial surgical packing was removed (a disturbingly long piece of gauze) there was never any additional packing. After that I just had to change out the bandage on a daily basis.
DX at 45yo 6/9/16, 2.4cm tumor, 9cm from Anal Verge, 6/27/16
Clinical staging IIIC, CEA 3.1 7/1/16
30x Chemorad 8/5/16 - 9/16/16
CT/MRI/Scope => CCR 11/1/16... Rolling the dice on Watch & Wait
Snake Eyes: Tiny regrowth at scar 11/1/17
LAR 1/17/18: Path = 3mm tumor, 0/12 nodes Med Onc doesn't recommend chemo.
Reversal 4/17/18

Rikimaroo
Posts: 263
Joined: Tue Dec 20, 2016 8:48 pm

Re: All all ileostomy reversals open wounds?

Postby Rikimaroo » Mon Jun 24, 2019 1:36 pm

For mine there was no packing need. You just cover it with the things they give you. It's not a problem at all. The real problem is pooping LOL...
RC T3N1M0 12/16
MSS - NRAS Mutation
Chemo Rad, CCR - W&W 5/2017
Recurrence 11/2017
CT Scan 11/2017 Liver Met 5.5cm Stable, Stage IV
Port Scheduled for 12/2017, folfox - avastin 12/2017
Blood Clot in Neck 1/2018, stop avastin, continue FolFox
LAR/Liver Resect 4/2018
Chemo Finish 8/2018
Reversal 10/18
CEA highest 500, lowest .8 throughout process, waiting for latest
Recurrence left seminal vescial/pelvic sidewall - 10/7/2019 resection surgery, perm bag, requested
FolFiri 11/6 - 5 rounds

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juliej
Posts: 3049
Joined: Thu Aug 05, 2010 12:59 pm

Re: All all ileostomy reversals open wounds?

Postby juliej » Mon Jun 24, 2019 4:29 pm

I have heard of a few people who had their wound glued or stapled shut. Personally, I'd worry about the possibility of getting an infection in it with that procedure.

It's more common to pack the wound with gauze combined with a saline solution. It's not hard to do - just squirt a little saline onto a strip of gauze and stuff it into the wound. Then the wound heals from the bottom up. It won't close up on the top until it fills in from the bottom, so there's no chance of creating a "pocket" in which fluid or bacteria can accumulate.

You'll notice that it takes a little less gauze every few days. Eventually you won't be able to get in even the tiniest piece of gauze and you can switch to a band-aid. That method also makes the smallest and flattest scar, which if you're a chick (like me) who rock climbs in low waistline compression tights (like me), is an important factor. I have a little white "moon" now where my ileostomy used to be.

Hope this helps!
Juliej
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 9/23/2019, CEA<1

Punky44
Posts: 383
Joined: Mon Oct 01, 2018 4:29 pm

Re: All all ileostomy reversals open wounds?

Postby Punky44 » Mon Jun 24, 2019 9:23 pm

Thank you all! My mom is the most squeamish person on the planet so I’m likely going to handle whatever the care instructions are, although if it does just end up being a bandage change, she might be able to do that?
Caregiver to my amazing mom (68)
10/1/18 DX with rectal cancer; CEA 17 at diagnosis
T3N2M0
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
CEA 4/23: 2.1; 7/24: 1.9; 10/22: 2.6
6/28/19 Reversal and port out
10/22 — nodules on lungs—possible infection or mets—PET scheduled for 11/25

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

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CRguy
Posts: 10021
Joined: Sun Feb 10, 2008 6:00 pm

Re: All all ileostomy reversals open wounds?

Postby CRguy » Mon Jun 24, 2019 11:56 pm

Guess I am the outlier here :shock:
I had surgical staples which were removed 10 days later by family doctor.
Had home care nurse to check things twice at home, BUTT did my own bandage changes in between
BUTT there was a closed surgery site .. NOT an open wound which required packing.
They knew I was a vet, so I could handle the "duties" !

AS a vet, I have done hundreds of GIT surgeries and with animals, we pretty much need to ...
"get in, get done and get OUT !" and the skin closures are pretty much always sutured or stapled closed.
just FYI !

Best wishes for your Mom
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
12 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

Rock_Robster
Posts: 379
Joined: Thu Oct 25, 2018 5:27 am
Location: Melbourne, Australia

Re: All all ileostomy reversals open wounds?

Postby Rock_Robster » Tue Jun 25, 2019 12:09 am

Hi Punky44, your question got me curious so I did a little digging - in the below single-centre review (n=176), wounds left open to heal were in the minority (compared to purse-string closures or staples/sutures), but had the best results on infection rates by far (0%!), which I think is consistent with others’ responses and might explain the popularity you see.

https://www.o-wm.com/article/retrospect ... l-outcomes
Last edited by Rock_Robster on Tue Jun 25, 2019 5:29 pm, edited 1 time in total.
Male 37; Melbourne, Australia
10/2018 Dx 3.5cm RC adenocarcinoma, 12cm from AV
Mod diff, EMVI+ LVI+ PNI-
3 LN; 4 liver mets, resectable
pT3pN1aM1a; Stage IVa. MSS, NRAS (G13R)
CEA: Oct-18= 12; Nov-18= 14, Mar-19= 2.4, Aug-19 <2.0
11/18 - FOLFOX x 6
3/19 - Liver resection
4-5/19 - 25 x pelvic radiation; complete met. response, TRG 3
07/19 - ULAR (robot), temp ileo, 1/27 LN
08/19 - Missed liver spot
08-11/19 - FOLFOX x 1, FOLFOXIRI x 1, FOLFIRI x 5
12/19 - Planned liver resection #2 & stoma reversal

Punky44
Posts: 383
Joined: Mon Oct 01, 2018 4:29 pm

Re: All all ileostomy reversals open wounds?

Postby Punky44 » Tue Jun 25, 2019 9:24 am

Interesting CR Guy and Rock Robster! I will keep you posted on what they end up doing.
Caregiver to my amazing mom (68)
10/1/18 DX with rectal cancer; CEA 17 at diagnosis
T3N2M0
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
CEA 4/23: 2.1; 7/24: 1.9; 10/22: 2.6
6/28/19 Reversal and port out
10/22 — nodules on lungs—possible infection or mets—PET scheduled for 11/25

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

Pyro70
Posts: 155
Joined: Mon Jan 21, 2019 4:25 pm

Re: All all ileostomy reversals open wounds?

Postby Pyro70 » Tue Jun 25, 2019 11:41 am

One option is a purse string closure that pulls the wound shut as much as possible but leaves a little opening for drainage.
Dx Jan 2017 stage IVB w/ PC age 35
FOLFOX
SEP 17 HIPEC 1, anastamosis leak
XELODA
MAR 18 HIPEC 2
JUN 18, ileo reversal and 2nd anastamosis leak

User avatar
juliej
Posts: 3049
Joined: Thu Aug 05, 2010 12:59 pm

Re: All all ileostomy reversals open wounds?

Postby juliej » Tue Jun 25, 2019 7:12 pm

CRguy wrote:They knew I was a vet, so I could handle the "duties" !

They thought...

This guy KNOWS what's what so we can go straight to staples and if there's an issue HE'LL be the first to tell us!

If I was a dog/cat/tiger/muskrat I'd want you to do my closure!

JJ
Stage IVb, liver/lung mets 8/4/2010
Xelox+Avastin 8/18/10 to 10/21/2011
LAR, liver resec, HAI pump 11/2011
Adjuvant Irinotecan + FUDR
Double lung surgery + ileo reversal 2/2012
Adjuvant FUDR + Xeloda
VATS rt. lung 12/2012 - benign granuloma!
VATS left lung 11/2013
NED 11/22/13 to 9/23/2019, CEA<1

User avatar
CRguy
Posts: 10021
Joined: Sun Feb 10, 2008 6:00 pm

Re: All all ileostomy reversals open wounds?

Postby CRguy » Tue Jun 25, 2019 8:23 pm

If I was a dog/cat/tiger/muskrat I'd want you to do my closure!
Deal JJ,

should you decide to shape shift ... :shock:
I gotchur back homie !!!
( never actually done muskrats BUTT beaver, otter and fishers back during the day I was thinking of training as a zoo/wildlife vet.... and ... LOVES me my big cats !!!! )

Cheers
CRguy
Caregiver x 4
Stage IV A rectal cancer/lung met
12 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

Punky44
Posts: 383
Joined: Mon Oct 01, 2018 4:29 pm

Re: All all ileostomy reversals open wounds?

Postby Punky44 » Sat Jun 29, 2019 12:43 am

Reversal surgery was today and all went well! And her wound is closed! Mayo said they do this as standard unless the tissues look damaged or there is a high chance of infection. So interesting!

Crossing our fingers that these next couple days go well and she can be discharged.

She had a couple spots of blood on her sheets from her backend—normal?
Caregiver to my amazing mom (68)
10/1/18 DX with rectal cancer; CEA 17 at diagnosis
T3N2M0
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
CEA 4/23: 2.1; 7/24: 1.9; 10/22: 2.6
6/28/19 Reversal and port out
10/22 — nodules on lungs—possible infection or mets—PET scheduled for 11/25

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

NHMike
Posts: 2322
Joined: Fri Jul 21, 2017 3:43 am

Re: All all ileostomy reversals open wounds?

Postby NHMike » Wed Jul 03, 2019 7:54 am

I'm glad things went well.

I changed the bandages myself and it took quite a while before I could stop doing them. The wound is still there and maybe it will always be there. I haven't had any problems with it.

I do not recall seeing blood after the reversal but I was more preoccupied with the amount of poop coming out and the inability to control it. I would just ask her surgeon or an intern or resident about it.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT


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