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

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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.

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Acknowledgements

The authors thank Sarah Sabboobeh, Marie Demian, Georgia Rigas, and Elektra McDermott for their administrative support and assistance.

Funding

Dr. Garfinkle is the recipient of a Fonds de Recherche du Québec - Santé/MSSS Resident Physician Health Research Career Training Program (specialized medicine)—Phase 1 award and a Canadian Institutes of Health Research (CIHR) Canada Graduate Scholarships—Master’s Program award. Dr. Filion is a recipient of Fonds de Recherche du Québec—Santé salary support awards and also holds a William Dawson Scholar award from McGill University. Dr. Boutros is a recipient of Fonds de Recherche du Québec—Santé salary support awards. Drs. Savage, Landry, Reynier, Morin, and Vasilevsky have no financial disclosures.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada

    Richard Garfinkle, Paul Savage, Marylise Boutros, Nancy Morin & Carol-Ann Vasilevsky

  2. Faculty of Medicine, McGill University, Montreal, QC, Canada

    Paul Savage

  3. Medical Libraries, McGill University Health Center, Montreal, QC, Canada

    Tara Landry

  4. Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada

    Pauline Reynier & Kristian B. Filion

  5. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada

    Kristian B. Filion

  6. Department of Medicine, McGill University, Montreal, QC, Canada

    Kristian B. Filion

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  1. Richard Garfinkle
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Drs. Richard Garfinkle, Paul Savage, Marylise Boutros, Tara Landry, Pauline Reynier, Nancy Morin, Carol-Ann Vasilevsky, and Kristian B. Filion have no conflict of interest and financial ties to disclose.

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Appendix 1—Full MEDLINE strategy of systematic review search

Appendix 1—Full MEDLINE strategy of systematic review search

  1. 1

    Ileostomy/ (6912)

  2. 2

    Ostomy/ (1385)

  3. 3

    Surgical Stomas/ (1696)

  4. 4

    1 or 2 or 3 (9620)

  5. 5

    Abdominal Wound Closure Techniques/ (596)

  6. 6

    (closure or reversal).tw,kf. (168566)

  7. 7

    5 or 6 (168748)

  8. 8

    4 and 7 (928)

  9. 9

    ((ileostom* or ostom* or stoma*) adj5 (closure or reversal)).tw,kf. (3616)

  10. 10

    8 or 9 (3802)

  11. 11

    exp Ileus/ (5496)

  12. 12

    Intestinal Obstruction/ (30689)

  13. 13

    limit 12 to yr = ”1968 - 2003” (16593)

  14. 14

    Morbidity/ (29418)

  15. 15

    Postoperative complications/ (362621)

  16. 16

    Reoperation/ (85728)

  17. 17

    (complicat* or ileus or morbidity).tw,kf. (1362026)

  18. 18

    POI.tw,kf. (1053)

  19. 19

    11 or 13 or 14 or 15 or 16 or 17 or 18 (1643244)

  20. 20

    10 and 19 (1444)

  21. 21

    Animals/ not Humans/ (4771261)

  22. 22

    (animals or animal or canine* or cat or cats or dog or dogs or feline or hamster* or mice or monkey or monkeys or mouse or murine or pig or pigs or piglet* or porcine or primate* or rabbit* or rats or rat or rodent* or sheep or veterinar*).ti,jw. (2438914)

  23. 23

    21 or 22 (5204283)

  24. 24

    20 not 23 (1430)

  25. 25

    (exp child/ or exp infant/ or adolescent/) not exp adult/ (1875013)

  26. 26

    (adolesc* or baby or babies or boy* or child* or fetus or fetal or foet* or girl* or juvenile* or kid or kids or infan* or newborn* or new-born* or neonat* or neo-nat* or paediatr* or pediatr* or preadolesc* or prepubesc* or preteen* or pubescen* or teen* or toddler* or youth*).ti,jw. (1884656)

  27. 27

    25 or 26 (2538655)

  28. 28

    24 not 27 (1245)

  29. 29

    remove duplicates from 28 (1048)

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Garfinkle, R., Savage, P., Boutros, M. et al. Incidence and predictors of postoperative ileus after loop ileostomy closure: a systematic review and meta-analysis. Surg Endosc 33, 2430–2443 (2019). https://doi.org/10.1007/s00464-019-06794-y

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