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Safety of early ileostomy closure: a systematic review and meta-analysis of randomized controlled trials

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Abstract

Purpose

Patients with a defunctioning ileostomy after rectal resection experience substantial ileostomy-related morbidity and decreased quality of life. Early reversal of the defunctioning ileostomy has been proposed as a method of mitigating these problems. We aimed to evaluate the safety of early ileostomy closure within 6 weeks.

Method

Randomized controlled trials investigating the safety of early ileostomy closure were identified through a systematic search and review of the current literature. Meta-analysis of the extracted outcome data was performed, and the methodological quality of the individual studies was assessed.

Results

The search identified six eligible studies yielding a total of 528 patients, with 269 in the early closure (EC) group and 259 in the standard closure (SC) group. Major complications in the EC group was 5.2% compared with 3.6% in the SC group (RR = 1.12, 95% CI 0.33–3.79). Anastomotic leakage in the EC group was 3.3% compared with 3.5% in the SC group (RR = 0.89, 95% CI 0.29–2.75). The meta-analysis resulted in no statistically significant differences between the groups in any of the primary or secondary outcomes.

Conclusion

This review was not able to discern a statistically significant difference in postoperative complications when comparing early and standard ileostomy closure. The current literature indicates that early ileostomy closure is not associated with higher complication rates in patients with an uncomplicated postoperative course and radiologically verified intact distal anastomosis after index surgery.

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Data availability

Only published data has been included in the study and is available via the original articles.

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Authors and Affiliations

Authors

Contributions

Frederik Bjerg Clausen initiated the review, designed the search strategy, performed the literature review, assessed the methodological quality of the included studies, performed data analysis, and drafted the manuscript. Niclas Dohrn performed literature review and assessed the methodological quality of the included studies. All authors contributed to the design of the study and continually reviewed the work. All authors critically revised the article before submission.

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Correspondence to Frederik Bjerg Clausen.

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Clausen, F.B., Dohrn, N., Hölmich, E.R. et al. Safety of early ileostomy closure: a systematic review and meta-analysis of randomized controlled trials. Int J Colorectal Dis 36, 203–212 (2021). https://doi.org/10.1007/s00384-020-03761-1

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