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World Journal of Surgery
Published in: World Journal of Surgery 10/2018

01-10-2018 | Scientific Review

Early Closure of Defunctioning Loop Ileostomy: Is It Beneficial for the Patient? A Meta-analysis

Authors: Benjamin Menahem, Jean Lubrano, Antoine Vallois, Arnaud Alves

Published in: World Journal of Surgery | Issue 10/2018

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Abstract

Objective

To perform a meta-analysis to answer the question, whether early closure (EC) of defunctioning loop ileostomy may be beneficial for patient as compared with late closure (LC) without exceeding the risk of surgical-related morbidity.

Design

Medline and the Cochrane Trials Register were searched for trials published up to November 2016 comparing EC (defined as ≤14 days from the index operation in which the ileostomy was performed) versus LC for stoma closure after rectal surgery. Meta-analysis was performed using Review Manager 5.0. Inclusion criteria

Main outcome measures

Overall morbidity rate, anastomotic leakage rate, and wound infection rate within 90 days after elective surgery.

Results

Six studies were included and analyzed, yielding 570 patients (252 in EC group and 318 in LC). Meta-analysis showed no significant difference in the overall morbidity rate between the EC and LC groups (OR 0.63; 95% CI, 0.22–1.78; P = 0.38). Despite a significant higher wound infection rate of stoma site (OR 3.83; 95% CI 2.14–6.86; P < 0.00001), meta-analysis showed no significant difference in the anastomotic leakage rate between the EC and LC groups (OR 0.63; 95% CI 0.22–1.78; P = 0.38). Moreover, both stoma-related complications (OR 0.46; 95% CI 0.24–0.86; P = 0.02) and small bowel obstruction rates (OR 0.11; 95% CI 0.06–0.20; P < 0.00001) were significantly lower in the EC group than in the LC group, respectively.

Limitations

Heterogeneity of the studies

Conclusion

This meta-analysis suggests that EC of a defunctioning loop ileostomy is effective and safe in careful selected patients without increasing overall postoperative complications. This promising strategy should be proposed in patients in order to reduce stoma-related complications.
Literature
1.
Tan WS, Tang CL, Shi L et al (2009) Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg 96:462–472CrossRefPubMed
2.
3.
Hanna MH, Vinci A, Pigazzi A (2015) Diverting ileostomy in colorectal surgery: when is it necessary? Langenbecks Arch Surg 400:145–152CrossRefPubMed
4.
Marusch F, Koch A, Schmidt U et al (2002) Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum 45:1164–1171CrossRefPubMed
5.
Dehni N, Schlegel RD, Cunningham C et al (1998) Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch–anal anastomosis. Br J Surg 85:1114–1117CrossRefPubMed
6.
Karanjia ND, Corder AP, Holdworth PJ et al (1991) Risk of peritonitis and fatal septicaemia and the need to defunction the low anastomosis. Br J Surg 78:196–198CrossRefPubMed
7.
Peeters KCMJ, Tollenaar RAEM, Marijnen CAM et al (2005) Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 92:211–216CrossRefPubMed
8.
O’Toole GC, Hyland JM, Grant DC et al (1999) Defunctioning loop ileostomy: a prospective audit. J Am Coll Surg 188:6–9CrossRefPubMed
9.
Gessler B, Haglind E, Angenete E (2014) A temporary loop ileostomy affects renal function. Int J Colorectal Dis 29:1131–1135CrossRefPubMed
10.
Messaris E, Sehgal R, Deiling S et al (2012) Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum 55:175–180CrossRefPubMed
11.
Beck-Kaltenbach N, Voigt K, Rumstadt B (2011) Renal impairment caused by temporary loop ileostomy. Int J Colorectal Dis 26:623–626CrossRefPubMed
12.
Herrle F, Sandra-Petrescu F, Weiss C et al (2016) Quality of life and timing of stoma closure in patients with rectal cancer undergoing low anterior resection with diverting stoma: a multicenter longitudinal observational study. Dis Colon Rectum 59:281–290CrossRefPubMed
13.
Tulchinsky H, Shacham-Shmueli E, Klausner JM et al (2014) Should a loop ileostomy closure in rectal cancer patients be done during or after adjuvant therapy. J Surg Oncol 109:266–269CrossRefPubMed
14.
Velmahos GC, Degiannis E, Wells M et al (1995) Early closure of colostomies in trauma patients—a prospective randomized trial. Surgery 118:620–815CrossRef
15.
Bakx R, Busch ORC, van Geldere D et al (2003) Feasibility of early closure of loop ileostomies. Dis Colon Rectum 46:1680–1684CrossRefPubMed
16.
Jordi-Galais P, Turrin N, Tresallet C et al (2003) Fermeture précoce des stomies du grêle. Gastroenterol Clin Biol 27:697–699PubMed
17.
Alves A, Panis Y, Lelong B et al (2008) Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy. Br J Surg 95:693–698CrossRefPubMed
18.
Robertson JP, Puckett J, Vather R et al (2015) Early closure of temporary loop ileostomy: a systematic review. Ostomy Wound Manag 61:50–57
19.
Robertson J, Linkhorn H, Vather R et al (2013) Cost analysis of early versus delayed loop ileostomy closure: a case-matched study. Dig Surg 32:166–172CrossRef
20.
21.
Danielsen AK, Park J, Jansen JE et al (2017) Early closure of a temporary ileostomy in patients with rectal cancer: a multicenter randomized controlled trial. Ann Surg 265:284–290CrossRefPubMed
22.
Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097CrossRefPubMedPubMedCentral
23.
Jadad A, Moore R, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12CrossRefPubMed
24.
Worni M, Witschi A, Gloor B et al (2011) Early closure of ileostomy is associated with less postoperative nausea and vomiting. Dig Surg 28:417–423CrossRefPubMed
25.
Perez RO, Habr-Gama A, Seid VE et al (2006) Loop ileostomy morbidity: timing of closure matters. Dis Colon Rectum 49:1539–1545CrossRefPubMed
26.
Khan N, Bangash A, Hadi A et al (2010) Is early closure warranted in the management of temporary loop ileostomy? J Postgrad Med Inst 24:295–300
27.
Tang CL, Seow-Choen F, Fook-Chong S et al (2003) Bioresorbable adhesion barrier facilitates early closure of the defunctioning ileostomy after rectal excision. Dis Colon Rectum 46:1200–1207CrossRefPubMed
28.
Memon S, Heriot AG, Atkin CE et al (2012) Facilitated early ileostomy closure after rectal cancer surgery: a case-matched study. Tech Coloproctol 16:285–290CrossRefPubMed
29.
Figueiredo MN, Mège D, Maggiori L et al (2015) When is the best time for temporary closure in laparoscopic sphincter-saving surgery for rectal cancer? A study of 259 consecutive patients. Tech Coloproctol 19:469–474CrossRefPubMed
30.
Chand M, Nash GF, Talbot RW (2008) Timely closure of loop ileostomy following anterior resection for rectal cancer. Eur J Cancer Care 17:611–615
31.
Wong KS, Remzi FH, Gorgun E et al (2005) Loop ileostomy closure after restorative proctocolectomy: outcome in 1504 patients. Dis Colon Rectum 48:243–250CrossRefPubMed
32.
Menegaux F, Jordi-Galais P, Turrin N et al (2002) Closure of small bowel stomas on postoperative day 10. Eur J Surg 168:713–715CrossRefPubMed
33.
Gentilli S, Pizzorno C, Pessione S et al (2007) Early stoma closure in colorectal resections after endoscopic monitoring anastomosis. Clinical results. Chir Ital 59:507–512PubMed
34.
Omundsen M, Hayes J, Collinson R et al (2012) Early ileostomy closure: is there a downside? ANZ J Surg 82:352–354CrossRefPubMed
35.
Krand O, Yalti T, Berber I et al (2008) Early vs delayed closure of temporary covering ileostomy: a prospective study. Hepatogastroenterology 55:142–145PubMed
36.
Hirst NA, Tiernan JP, Millner PA et al (2014) Systematic review of methods to predict and detect anastomotic leakage in colorectal surgery. Colorectal Dis 16:95–109CrossRefPubMed
37.
Li LT, Hicks SC, Davilla JA et al (2014) Circular closure is associated with the lowest rate of surgical site infection following stoma reversal: a systematic review and multiple treatment meta-analysis. Colorectal Dis 16:406–416CrossRefPubMed
38.
Hsieh MC, Kuo LT, Chi CC et al (2015) Pursestring closure versus conventional primary closure following stoma reversal to reduce surgical site infection rate: a meta-analysis of randomized controlled trials. Dis Colon Rectum 58:808–815CrossRefPubMed
39.
Habbe N, Hannes S, Liese J et al (2014) The use of purse-string closure in loop ileostomy reversal leads to lower wound infection rates—a single high-volume centre experience. Int J Colorectal Dis 29:709–714CrossRefPubMed
40.
Milanchi S, Nasseri Y, Kidner T et al (2009) Wound infection after ileostomy closure can be eliminated by circumferential subcuticular wound approximation. Dis Colon Rectum 52:469–474CrossRefPubMed
41.
Chow A, Tilney HS, Paraskeva P et al (2009) The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis 24:711–723CrossRefPubMed
42.
Shorthouse AJ, Bartram CI, Eyers AA et al (1982) The water soluble contrast enema after rectal anastomosis. Br J Surg 69:714–717CrossRefPubMed
43.
Gouya H, Oudjit A, Leconte M et al (2012) CT antegrade colonography to assess proctectomy and temporary diverting ileostomy complications before early ileostomy takedown in patients with low rectal endometriosis. AJR 198:98–105CrossRefPubMed
44.
Biagi JJ, Raphael MJ, Mackillop WJ et al (2011) Association between time to initiation of adjuvant chemotherapy and survival in colorectal cancer. A systematic review and meta-analysis. JAMA 305:2335–2342CrossRefPubMed
Metadata
Title
Early Closure of Defunctioning Loop Ileostomy: Is It Beneficial for the Patient? A Meta-analysis
Authors
Benjamin Menahem
Jean Lubrano
Antoine Vallois
Arnaud Alves
Publication date
01-10-2018
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 10/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4603-0

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