Is a sustaining rod necessary for diverting loop ileostomy?

Objective: Whether or not a protective stoma reduces the rate of anastomotic leakage after distal colorectal anastomosis is still discussed controversially. It does however facilitate clinical management once leakage has occurred. Loop ileostomies seem to be associated with a lower morbidity and a better quality of life compared to loop colostomies. Generally, diverting loop ileostomies are secured at skin level by means of a supporting device in order to prevent retraction of the ileostomy into the abdomen. However, due to the supporting rod, difficulties may occur in applying a stoma bag correctly and leakage of faeces onto the skin may occur even with correct eversion of the afferent limb. Our aim was to compare morbidity and time to self-sufficient stoma-care in patients having a loop ileostomy with rod to those without rod. Methods: A total of 60 patients necessitating loop ileostomy were analyzed. Patients received surgery in of the two involved institutions according to inhouse standard procedures. 30 patients had an ileostomy with rod (VCHK Inselspital) and a further 30 without rod (KSW Winterthur). Morbidity and time to self-sufficiency regarding stoma care was analyzed during the first 90 postoperative days. Morbidity was determined according to a scoring system ranging from 0 to 4 points for any given set of possible complications (bleeding, necrosis, skin irritation, abscess, stenosis, retraction, fistula, prolapse, parastomal hernia, incomplete diversion), where 0 = no complication and 4 = severe complication. Continuous variables were expressed as median (95% Confidence Interval). For comparisons between the groups the Mann-Whitney U test was used, between categorical variables the X2 test was applied. Results: There were no significant differences in length of hospital stay or time to self-sufficient stoma-care between the groups. Although not significant, patients with a rod ileostomy had a tendency towards more stoma-related complications as well as stoma-related reoperations. The number of patients reaching total self-sufficiency regarding stoma care was higher after rodless ileostomy. Conclusion: According to our data, rodless ileostomies seemto fare just as well as those with a supporting rod, with equal morbidity rates and more patients reaching self-sufficient stoma care. Therefore routine application of a rod for diverting loop ileostomy seems unnecessary

The story of Community preference for food security

"Préférence communautaire" is an in-built notion of the CAP since its inception with the Treaty of Rome (1957). Its’ simple objective laid down at the Stresa Conference in 1958 is to prefer community produce over imports wherever possible, while at the same time promoting agricultural exports and FDI (“vocation exportatrice de l’Europe”). Does this contrast or correlate with the notion of “food sovereignty” which originated in 1996 as a notion of small farmer self-sufficiency (Via Campesina), and which now has found its way into the official EC discourse? Recent CAP reforms indeed seem to continue banking on border protection and on the occasional export subsidy. Nonetheless, coming together with claims to mitigate climate change, “food sovereignty” à la CAP fails to acknowledge efficiency losses at home and negative spillover effects on the right to food of food exporting developing countries. This chapter asks whether new non-tariff and domestic support measures are just new wine in the old cask of fortress Europe, together with the FDI promotion instruments of the FED and others. Might the increasing dynamics and new challenges of agricultural trade and investment lead to lower market and production shares for European farms? It concludes that in the medium term the WTO Green Box has the only legal and effective tools to promote EU agriculture and food.