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A systematic review and meta-analysis of diverting loop ileostomy versus total abdominal colectomy for the treatment of Clostridium difficile colitis

  • Systematic Reviews and Meta-analyses
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Abstract

Background

Clostridium difficile is an increasingly common source of in-patient morbidity and mortality. We aim to assess the effects of diverting loop ileostomy (DLI) versus total abdominal colectomy (TAC) for Clostridium difficile colitis (CDC), in terms of mortality and morbidity.

Methods

Systematic literature search was performed using PubMed, Embase, Cochrane, and Web of Science databases for randomized and non-randomized studies comparing DLI and TAC for fulminant CDC. Meta-analysis was carried out for mortality and postoperative complications.

Results

Five non-randomized studies qualified for inclusion in the quantitative synthesis. In total, 3683 patients were allocated to DLI (n = 733) or TAC (n = 2950). The overall mortality was equivalent (OR 0.73; 95% CI 0.45–1.20; P = 0.22). Regarding secondary outcomes, the pooled analysis revealed the following equivalent rates of postoperative events: thromboembolism (OR 0.45; 95% CI 0.14–1.43; P = 0.18), acute renal failure (OR 1.71; 95% CI 0.91–3.23; P = 0.10), surgical site infection (OR 0.95; 95% CI 0.11–8.59; P = 0.97), pneumonia (OR 0.98; 95% CI 0.36–2.66; P = 0.97), urinary tract infection (OR 0.81; 95% CI 0.26–2.52; P = 0.72), and reoperation (OR 0.95; 95% CI 0.50–1.82; P = 0.78). The ostomy reversal rate was significantly higher in DLI (OR 12.55; 95% CI 3.31–47.55; P = 0.0002).

Conclusions

The overall morbidity and mortality rates between DLI and TAC for the treatment of CDC seemed to be equivalent. Evidence from a randomized controlled trial is needed to clarify the timing and understand the impact of DLI for CDC.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Vasco de Quiroga 15, Tlalpan, 14080, Mexico City, Mexico

    Mario Trejo-Avila, Omar Vergara-Fernandez, Danilo Solórzano-Vicuña, Oscar Santes, Juan Carlos Sainz-Hernández, Paulina Moctezuma-Velázquez & Noel Salgado-Nesme

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  1. Mario Trejo-Avila
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  2. Omar Vergara-Fernandez
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  3. Danilo Solórzano-Vicuña
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Contributions

MTA: designed this work, collected and interpreted the data, drafted the manuscript, contributed to study concept, critically revised the manuscript, performed overall supervision, and contributed to the final approval of the manuscript. OVF, OS, DSV, JCSH, PMV and NSN: collected and interpreted the data, drafted the manuscript, critically revised the manuscript, and contributed to the final approval of the manuscript.

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Correspondence to Mario Trejo-Avila.

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This systematic review and meta-analysis of outcomes does not contain any studies with human participants performed by any of the authors.

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Considering the nature of this study, informed consent was not required.

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Trejo-Avila, M., Vergara-Fernandez, O., Solórzano-Vicuña, D. et al. A systematic review and meta-analysis of diverting loop ileostomy versus total abdominal colectomy for the treatment of Clostridium difficile colitis. Langenbecks Arch Surg 405, 715–723 (2020). https://doi.org/10.1007/s00423-020-01910-2

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