Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 8/2019

01-08-2019 | Ileus | Review Article

Incidence and predictors of postoperative ileus after loop ileostomy closure: a systematic review and meta-analysis

Authors: Richard Garfinkle, Paul Savage, Marylise Boutros, Tara Landry, Pauline Reynier, Nancy Morin, Carol-Ann Vasilevsky, Kristian B. Filion

Published in: Surgical Endoscopy | Issue 8/2019

Login to get access

Abstract

Introduction

Postoperative ileus (POI) is regarded as the most clinically significant morbidity following loop ileostomy closure; however, its incidence remains poorly understood. Our objective was therefore to determine the pooled incidence of POI after loop ileostomy closure and identify risk factors associated with its development.

Methods

We systematically searched MEDLINE (via Ovid and PubMed), Embase, the Cochrane Library, Biosis Previews, and Scopus to identify studies reporting the incidence of POI in patients who underwent loop ileostomy closure. Two independent reviewers extracted data and appraised study quality. Cumulative incidence proportions were pooled across studies using a random-effects meta-analytic model.

Results

Sixty-seven studies, including 9528 patients, met our inclusion criteria. The pooled estimate of POI was 8.0% (95% CI 6.9–9.3%; I2 = 74%). The estimated incidence varied by POI definition: studies with a robust definition of POI (n = 8) demonstrated the highest estimate of POI (12.4%, 95% CI 9.2–16.5%; I2 = 79%) while studies that did not report an explicit POI definition (n = 38) demonstrated the lowest estimate (6.7%, 95% CI 5.3–8.3%; I2 = 61%). Small bowel anastomosis technique (hand-sewn) and interval time from ileostomy creation to closure (longer time) were the factors most commonly associated with POI after loop ileostomy closure. However, most comparative studies were not powered to examine risk factors for POI.

Conclusions

POI is an important complication after loop ileostomy closure, and its incidence is dependent on its definition. More research aimed at studying this complication is required to better understand risk factors for POI after loop ileostomy closure.
Appendix
Available only for authorised users
Literature
1.
Pisarka M, Gajewska N, Malczak P et al (2018) Defunctioning ileostomy reduces leakage rate in rectal cancer surgery—systematic review and meta-analysis. Oncotarget 9:20816–208125
2.
Huser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, Friess H (2008) Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 248:52–60CrossRef
3.
Luglio G, Pendlimari R, Holubar SD, Cima RR, Nelson H (2011) Loop ileostomy reversal after colon and rectal surgery: a single institutional 5-year experience in 944 patients. Arch Surg 146:1191–1196CrossRef
4.
Löffler T, Rossion I, Bruckner T, HASTA Trial Group et al (2012) Hand suture versus stapling for closure of loop ileostomy (HASTA Trial): results of a multicenter randomized trial (DRKs00000040). Ann Surg 256:828–835CrossRefPubMed
5.
6.
Tevis SE, Carchman EH, Foley EF, Harms BA, Heise CP, Kennedy GD (2015) Postopertiave ileus—more than just prolonged length of stay? J Gastrointest Surg 19:1684–1690CrossRef
7.
Slieker J, Hubner M, Addor V, Duvoisin C, Demartines N, Hahnloser D (2018) Application of an enhanced recovery pathway for ileostomy closure: a case-control trial with surprising results. Tech Coloproctol 22:295–300CrossRefPubMed
8.
Keller DS, Swendseid B, Khan S, Delaney CP (2014) Readmissions after ileostomy closure: cause to revisit a standardized enhanced recovery pathway? Am J Surg 208:650–655CrossRefPubMed
9.
Berger NG, Chou R, Toy ES, Ludwig KA, Ridolfi TJ, Peterson CY (2017) Loop ileostomy closure as an overnight procedure: institutional comparison with the National Surgical Quality Improvement Project Dataset. Dis Colon Rectum 60:852–859CrossRefPubMed
10.
Kalady MF, Fields RC, Klein S, Nielsen KC, Mantyh CR, Ludwig KA (2003) Loop ileostomy closure at an ambulatory facility: a safe and cost-effective alternative to routine hospitalization. Dis Colon Rectum 46:486–490CrossRefPubMed
11.
Bhalla A, Peacock O, Tierney GM et al (2015) Day-case closure of ileostomy: feasible, safe and efficient. Colorectal Dis 17:820–823CrossRefPubMed
12.
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341CrossRefPubMed
13.
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73:712–716CrossRefPubMed
14.
Higgins JP, Altman DG, Gotzsche PC, et al (2011) Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:5928CrossRef
15.
Vather R, Trivedi S, Bissett I (2013) Defining postoperative ileus: results of a systematic review and global survey. J Gastrointest Surg 17:962–972CrossRef
16.
Amin SN, Memon MA, Armitage NC, Scholefield JH (2001) Defunctioning loop ileostomy and stapled side-to-side closure has low morbidity. Ann R Coll Surg Engl 83:246–249PubMedPubMedCentral
17.
Swain BT, Ellis CN Jr (2002) Laparoscopy-assisted loop ileostomy: an acceptable option for temporary fecal diversion after anorectal surgery. Dis Colon Rectum 45:705–707CrossRefPubMed
18.
Hallbook O, Matthiessen P, Leinskold T, Nystrom PO, Sjodahl R (2002) Safety of the temporary loop ileostomy. Colorectal Dis 4:361–364CrossRefPubMed
19.
Kairaluoma M, Rissanen H, Kultti V, Mecklin JP, Kellokumpu I (2002) Outcome of temporary stomas. A prospective study of temporary intestinal stomas constructed between 1989 and 1996. Dig Surg 19:45–51CrossRefPubMed
20.
Garcia-Botello SA, Garcia-Armengol J, Garcia-Granero E, Espi A, Juan C, Lopez-Mozos F, Lledo S (2004) A propsective audit of the complications of loop ileostomy construction and takedown. Dig Surg 21:440–446CrossRefPubMed
21.
Bell C, Asolati M, Hamilton E, Fleming J, Nwariaku F, Sarosi G, Anthony T (2005) A comparison of complications associated with colostomy reversal versus ileostomy reversal. Am J Surg 190:717–720CrossRef
22.
Gastinger I, Marusch F, Steinart R, Wolff S, Koeckerling F, Lippert H, Working Group “Colon/Rectum Carcinoma” (2005) Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 92:1137–1142CrossRefPubMed
23.
Haase O, Raue W, Bohm B, Neuss H, Scharfenberg M, Schwenk W (2005) Subcutaneous gentamycin impant to reduce would infections after loop-ileostomy closure: a randomized, double-blind, placebo-controlled trial. Dis Colon Rectum 48:2025–2031CrossRef
24.
Perez RO, Habr-Gama A, Seid VE et al (2006) Loop ileostomy morbidity: timing of closure matters. Dis Colon Rectum 49:1539–1545CrossRefPubMed
25.
Salum M, Wexner SD, Nogueras JJ et al (2006) Does sodium hyaluronate- and carboxymethylcellulose-based bioresorbable membrane (Seprafilm) decrease operative time for loop ileostomy closure? Tech Coloproctol 10:187–190CrossRef
26.
Thalheimer A, Bueter M, Kortuem M, Thiede A, Meyer D (2006) Morbidity of temporary loop ileostomy in patients with colorectal cancer. Dis Colon Rectum 49:1011–1017CrossRef
27.
Flikier-Zelkowicz B, Codina-Cazador A, Farres-Coll R, Olivet-Pujol F, Martin-Grillo A, Pujadas-de Palol M (2008) Morbidity and mortality associated with diverting ileostomy closures in rectal cancer patients. Cir Esp 84:16–19CrossRefPubMed
28.
Joh YG, Lindsetmo RO, Stulberg J, Obias V, Champagne B, Delaney CP (2008) Standardized postoperative pathway: accelerating recovery after ileostomy closure. Dis Colon Rectum 51:1786–1789CrossRefPubMed
29.
Kaiser AM, Israelit S, Klaristenfeld D, Selvindoss P, Vukasin P, Ault G, Beart RW (2008) Morbidity of ostomy takedown. J Gastrointest Surg 12:437–441CrossRef
30.
Mansfield SD, Jensen C, Phair AS, Kelly OT, Kelly SB (2008) Complications of loop ileostomy closure: a retrospective cohort analysis of 123 patients. World J Surg 32:2101–2106CrossRefPubMed
31.
Tjandra JJ, Chan MK (2008) A sprayable hydrogel ahesion barrier facilitates closure of defunctioning loop ileostomy: a randmomized trial. Dis Colon Rectum 51:956–960CrossRefPubMed
32.
Akiyoshi T, Fujimoto Y, Konishi T, Kuroyanagi H, Ueno M, Oya M, Yamaguchi T (2010) Complications of loop ileostomy closure in patients with rectal tumor. World J Surg 34:1937–1942CrossRef
33.
Baraza W, Wild J, Barber W, Brown S (2010) Postoperative management after loop ileostomy closure: are we keeping patients in hospital too long? Ann R Coll Surg Engl 92:51–55CrossRefPubMedPubMedCentral
34.
Courtier R, Pares D, Silva CA et al (2010) Clinical results of loop ileostomy closures in rectal cancer surgical patients. Effect of chemotherapy in the waiting period. Cir Esp 88:308–313CrossRefPubMed
35.
Horisberger K, Beldi G, Candinas D (2010) Loop ileostomy closure: comparison of cost effectiveness between suture and stapler. World J Surg 34:2867–2871CrossRefPubMed
36.
Ihedioha U, Muhtaseb S, Kalmar K, Donnelly L, Muir V, Macdonald A (2010) Closure of loop ileostomies: is early discharge safe and feasible. Scott Med J 55:27–29CrossRefPubMed
37.
Shelygin YA, Chernyshov SV, Rybakov EG (2010) Stapled ileostomy closure results in reduction in postoperative morbidity. Tech Coloproctol 14:19–23CrossRefPubMed
38.
D’Haeninck A, Wolthuis AM, Penninckx F, D’Hondt M, D’Hoore A (2011) Morbidity after closure of a defunctioning loop ileostomy. Acta Chir Belg 111:136–141CrossRefPubMed
39.
Mennigen R, Senninger N, Bruwer M, Rijcken E (2011) Impact of defunctioning loop ileostomy on outcome after restorative proctcolectomy for ulcerative colitis. Int J Colorectal Dis 26:627–633CrossRef
40.
Peacock O, Law CI, Collins PW, Speake WJ, Lund JN, Tierney GM (2011) Closure of loop ileostomy: potentially a daycase procedure? Tech Coloproctol 15:431–437CrossRefPubMed
41.
Worni M, Witschi A, Gloor B, Candinas D, Laffer UT, Kuehni CE (2011) Early closure of ileostomy is associated with less postoperative nausea and vomiting. Dig Surg 28:417–423CrossRef
42.
Chun LJ, Haigh PI, Tam MS, Abbas MA (2012) Defunctioning loop ileostomy for pelvic anastomoses: predictors of morbidity and nonclosure. Dis Colon Rectum 55:167–174CrossRef
43.
Cipe G, Erkek B, Kuzu A, Gecim E (2012) Morbidity and mortality after the closure of a protective loop ileostomy: analysis of possible predictors. Hepatogastroenterology 59:2168–2172PubMed
44.
El-Hussuna A, Lauritsen M, Bulow S (2012) Relatively high incidence of complications after loop ileostomy reversal. Dan Med J 59:A4517PubMed
45.
Gustavsson K, Gunnarsson U, Jestin P (2012) Postoperative complications after closure of a diverting ileostoma—differences according to closure technique. Int J Colorectal Dis 27:55–58CrossRefPubMed
46.
Memon S, Heriot AG, Atkin CE, Lynch AC (2012) Facilitated early ileostomy closure after rectal cancer surgery: a case-matched study. Tech Coloproctol 16:285–290CrossRefPubMed
47.
Omundsen M, Hayes J, Collinson R, Merrie A, Parry B, Bissett I (2012) Early ileostomy closure: is there a downside? ANZ J Surg 82:352–354CrossRefPubMed
48.
Dusch N, Goranova D, Herrle F, Niedergethmann M, Kienle P (2013) Randomized controlled trial: comparison of two surgical techniques for closing the wound following ileostomy closure: purse string vs. direct suture. Colorectal Dis 15:1033–1040CrossRefPubMed
49.
Hiranyakas A, Rather A, da Silva G, Weiss EG, Wexner SD (2013) Loop ileostomy closure after laparoscopic versus open surgery: is there a difference? Surg Endosc 27:90–94CrossRefPubMed
50.
Klink CD, Wunschmann M, Binnebosel M et al (2013) Influence of skin closure technique on surgical site infection after loop ileostomy reversal: retrospectvie cohort study. Int J Surg 11:1123–1125CrossRefPubMed
51.
Marcet JE, Nfonsam VN, Larach S (2013) An extended paln relief trial using the infiltration of a long-acting Multivesicular liPosome foRmulation Of bupiVacaine, EXPAREL (IMPROVE): a phase IV health economic trial in adult patients undergoing ileostomy reversal. J Pain Res 18:549–555CrossRef
52.
Peacock O, Bhalla A, Simpson JA et al (2013) Twenty-three hour stay loop ileostomy closures: a pilot study. Tech Coloproctol 17:45–49CrossRefPubMed
53.
Royds J, O’Riordan JM, Mansour FM, Eguare E, Neary P (2013) Randomized clinical trial of the benefit of laparoscopy with closure of loop ileostomy. Br J Surg 100:1295–1301CrossRefPubMed
54.
Abrisqueta J, Abellan I, Lujan J, Hernandez Q, Parrilla P (2014) Stimulation of the efferent limb before ileostomy closure: a randomized clinical trial. Dis Colon Rectum 57:1391–1396CrossRefPubMed
55.
Perez-Dominguez L, Garcia Martinez MT, Caceres Alvarado N, Toscano Novella A, Higuero Grosso AP, Casal Nnuez JE (2014) Morbidity and mortality of temporary diverting ileostomies in rectal cancer surgery. Cir Esp 92:604–608CrossRefPubMed
56.
Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R (2014) Increased postoperative complications after protective ileostomy closure delay: an institutional study. World J Gastrointest Surg 27:169–174CrossRef
57.
Saito Y, Takakura Y, Hinoi T, Egi H, Tashiro H, Ohdan H (2014) Body mass index as a predictor of postoperative complications in loop ileostomy closure after rectal resection in Japanese patients. Hiroshima J Med Sci 63:33–38PubMed
58.
Vallribera Valls F, Villanueva Figueredo B, Jimenez Gomez LM, Espin Bassany E, Sanchez Martinez JL, Marti Gallostra M, Armengol Carrasco M (2014) Ileostomy closure in a colorectal surgery unit. Comparative analysis of different techniques. Cir Esp 92:182–187CrossRefPubMed
59.
Bracey E, Chave H, Agombar A, Sleight S, Dukes S, Bryan S, Branagan G (2015) Ileostomy closure in an enhanced recovery setting. Colorectal Dis 17:917–921CrossRefPubMed
60.
Figueiredo MN, Mege D, Maggiori L, Ferron M, Panis Y (2015) When is the best time for temporary stoma closure in laparosopic sphincter-saving surgery for rectal cancer? A study of 259 patients. Tech Coloproctol 19:469–474CrossRefPubMed
61.
Markides GA, Wijetunga I, McMahon M, Gupta P, Subramanian A, Anwar S (2015) Reversal of loop ileostomy under an enhanced recovery programme—is the stapled anastomosis technique still better than the handsewn technique? Int J Surg 23:41–45CrossRefPubMed
62.
Robertson J, Linkhorn H, Vather R, Jaung R, Bissett IP (2015) Cost analysis of early versus delayed loop ileostomy closure: a case-matched study. Dig Surg 32:166–172CrossRefPubMed
63.
Young MT, Hwang GS, Menon G et al (2015) Laparoscopic versus open loop ileostomy reversal: is there an advantage to a minimally invasive approach? World J Surg 39:2805–2811CrossRefPubMed
64.
Ihnat P, Gunkova P, Peteja M, Vavra P, Pelikan A, Zonca P (2016) Diverting ileostomy in laparoscopic rectal cancer surgery: high price of protection. Surg Endosc 30:4809–4816CrossRefPubMed
65.
Lasithiotakis K, Aghahoseini A, Alexander D (2016) Is early reversal of defunctioning ileostomy a shortier, easier and less expensive operation? World J Surg 40:1737–1740CrossRefPubMed
66.
Mahla V, Khan S, Ahmad R, Jenaw RK (2016) Early feeding after loop ileostomy reversal: a prospective study. Formosan J Surg 49:178–182CrossRef
67.
Man VC, Choi HK, Law WL, Foo DC (2016) Morbidities after closure of ileostomy: analysis of risk factors. Int J Colorectal Dis 31:51–57CrossRefPubMed
68.
Zhou P, Hrabe J, Byrn J (2016) A retrospective, single-institution review of loop ileostomy reversal outcomes. Ostomy Wound Manage 62:22–33PubMed
69.
Bertoni DM, Hammond KL, Beck DE, Hicks TC, Whitlow CB, Vargas HD, Margolin DA (2017) Use of sodium hyaluronate/carboxymethylcellulose bioresorbable membrane in loop ileostomy construction facilitates stoma closure. Ochsner J 17:146–149PubMedPubMedCentral
70.
Lam D, Lauritz B, Chandra R, Mushaya C, Sansom W, Sammour T, Keck J (2017) Midline stoma via the umbilicus versus traditional diverting loop ileostomy: a retrospective comparative study. Indian J Surg 80:545–548CrossRef
71.
Li W, Ozuner G (2017) Does the timing of loop ileostomy closure affect outcome: a case-matched study. Int J Surg 43:52–55CrossRef
72.
Luglio G, Terracciano F, Giglio MC et al (2017) Ileostomy reversal with handsewn techniques. Short-term outcomes in a teaching hospital. Int J Colorectal Dis 32:113–118CrossRefPubMed
73.
Zhen L, Wang Y, Zhang Z et al (2017) Effectiveness between early and late temporary ileostomy closure in patients with rectal cancer: a prospective study. Curr Probl Cancer 41:231–240CrossRef
74.
Zhou MW, Wang ZH, Chen ZY, Xiang JB, Gu XD (2017) Advantages of early preventive ileostomy closure after total mesorectal excision surgery for rectal cancer: an institutional retrospective study of 123 consecutive patients. Dig Surg 34:305–311CrossRefPubMed
75.
Lob S, Luetkens K, Krajinovic K, Wiegering A, Germer CT, Seyfried F (2018) Impact of surgical proficiency levels on postoperative morbidity: a single centre analysis of 558 ileostomy reversals. Int J Colorectal Dis 33:601–608CrossRefPubMed
76.
Park J, Gessler B, Block M, Angenete E (2018) Complications and morbidity associated with loop ileostomies in patients with ulcerative colitis. Scand J Surg 107:38–42CrossRef
77.
Wolthuis AM, Bislenghi G, Fieuws A, de Buck van Overstraeten A, Boeckxstaens G, D’Hoore A (2016) Incidence of prolonged postoperative ileus after colorectal surgery: a systematic review and meta-analysis. Colorectal Dis 18:1–9CrossRef
78.
Hedrick TL, McEvoy MD, Mythen MMG et al (2018) Perioperative Quality Initiative 2 Workgroup. American Society of Enhanced Recovery and Perioperative Quality Initiative joint consensus statement on postoperative gastrointestinal dysfunction within an enhanced recovery pathway for elective colorectal surgery. Anesth Analg 126:1896–1907CrossRefPubMed
79.
Saha AK, Tapping CR, Foley GT et al (2009) Morbidity and mortality after closure of loop ileostomy. Colorectal Dis 11:866–871CrossRefPubMed
80.
Hasegawa H, Radley S, Morton DG, Keighley MR (2000) Stapled versus sutured closure of loop ileostomy: a radnomized controlled trial. Ann Surg 231:202–204CrossRefPubMedPubMedCentral
81.
Gong J, Guo Z, Li Y, Gu L, Zhu W, Li J, Li N (2013) Stapled vs. hand suture closure of loop ileostomy: a meta-analysis. Colorectal Dis 15:e561–e568CrossRefPubMed
82.
Markides GA, Wijetunga IU, Brown SR, Anwar S (2015) Meta-analysis of handsewn versus stapled reversal of loop ileostomy. ANZ J Surg 85:217–224CrossRefPubMed
83.
84.
Moghadamyeghaneh Z, Hwang GS, Hanna MH et al (2016) Risk factors for prolonged ileus following colon surgery. Surg Endosc 30:603–609CrossRef
85.
Garfinkle R (2018) Ileostomy closure for colectomy-specific PUFs [online]. Email to Clifford Ko (cko@facs.org) September 7
Metadata
Title
Incidence and predictors of postoperative ileus after loop ileostomy closure: a systematic review and meta-analysis
Authors
Richard Garfinkle
Paul Savage
Marylise Boutros
Tara Landry
Pauline Reynier
Nancy Morin
Carol-Ann Vasilevsky
Kristian B. Filion
Publication date
01-08-2019
Publisher
Springer US
Keywords
Ileus
Ileostomy
Published in
Surgical Endoscopy / Issue 8/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-019-06794-y

Other articles of this Issue 8/2019

Surgical Endoscopy 8/2019 Go to the issue

OriginalPaper

Competency assessment for gastric endoscopic submucosal dissection using an endoscopic part-task training box

2018 SAGES Oral

Long-term outcomes following endoscopic stenting in the management of leaks after foregut and bariatric surgery

OriginalPaper

New onset alcohol use disorder following bariatric surgery

OriginalPaper

Impact of vagus nerve integrity testing on surgical management in patients with previous operations with potential risk of vagal injury

OriginalPaper

Occult contralateral inguinal hernias: what is their true incidence and should they be repaired?

2018 SAGES Oral Dynamic

Step-by-step guide to safe removal of pre-peritoneal inguinal mesh