Abstract
Background
Loop ileostomy is widely employed as a defunctioning procedure for left-sided colonic anastomoses. Closure of the stoma carries a risk of morbidity and even mortality. The aim of this prospective trial was to evaluate the ability of stapled stoma closure to decrease the rates of perioperative morbidity.
Methods
One hundred and nineteen patients (mean age 56.2 ± 5.4 years) underwent two-stage operations for rectal carcinoma with protective loop ileostomy between 2005 and 2008. All patients were randomly divided into two groups: 56 patients had conventional ileostomy takedown, while in the other 63, a functional end-to-end anastomosis was created using a linear stapler. Groups were comparable in terms of age, gender, body mass index, and other parameters.
Results
Mean time of stoma closure using functional end-to-end anastomosis was 68 ± 7, when compared to 92 ± 11 min (P = 0.01) for conventional stoma closure. The overall morbidity rate after ileostomy closure using a stapler was 3.2%: one patient (1.6%) developed a wound infection and self-limited bleeding from the anastomotic line, while another patient (1.6%) had an ileal obstruction caused by adhesions and required additional intervention. Conventional ileostomy closure resulted in a 14.3% morbidity rate: six patients (10.7%) had prolonged ileus, 2 (3.6%) had small bowel obstruction, and 2 (3.6%) had wound infections (P = 0.04).
Conclusion
Functional end-to-end anastomosis reduces operating time and morbidity compared to conventional ileostomy takedown.
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References
Kaiser AM, Israelit S, Klaristenfeld D et al (2008) Morbidity of ostomy takedown. J Gastrointest Surg 12:437–441
Riesener KP, Lehnen W, Höfer M, Kasperk R, Braun JC, Schumpelick V (1997) Morbidity of ileostomy and colostomy closure: impact of surgical technique and perioperative treatment. World J Surg 21:103–108
Kestenberg A, Becker JM (1985) Anew technique of loop ileostomy closure after endorectal ileoanal anastomosis. Surgery 98:109–111
Hasegawa H, Radley S, Morton DG, Keighley MR (2000) Stapled versus sutured closure of loop ileostomy: a randomized controlled trial. Ann Surg 231:202–204
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 83:246–249
Bain IM, Patel R, Keighley MR (1996) Comparison of sutured and stapled closure of loop ileostomy after restorative proctocolectomy. Ann R Coll Surg Engl 78:555–556
Hull TL, Kobe I, Fazio VW (1996) Comparison of handsewn with stapled loop ileostomy closures. Dis Colon Rectum 39:1086–1089
Leung TT, MacLean AR, Buie WD, Dixon E (2008) Comparison of stapled versus handsewn loop ileostomy closure: a meta-analysis. J Gastrointest Surg 12:939–944
O’Toole GC, Hyland JM, Grant DC, Barry MK (1999) Defunctioning loop ileostomy: a prospective audit. J Am Coll Surg 188:6–9
Mann LJ, Stewart PJ, Goodwin RJ, Chapuis PH, Bokey EL (1991) Complications following closure of loop ileostomy. Aust N Z J Surg 61:493–496
Kraemer M, Seow-Choen F, Ho YH, Eu KW (2000) A comparison of sutured and stapled closure of diverting loop ileostomies. Tech Coloproctol 4:89–92
García-Botello SA, García-Armengol J, García-Granero E et al (2004) A prospective audit of the complications of loop ileostomy construction and takedown. Dig Surg 21:440–446
Chow A, Tilney HS, Paraskeva P, Jeyarajah S, Zacharakis E, Purkayastha S (2009) The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6, 107 cases. Int J Colorectal Dis 24:711–723
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Shelygin, Y.A., Chernyshov, S.V. & Rybakov, E.G. Stapled ileostomy closure results in reduction of postoperative morbidity. Tech Coloproctol 14, 19–23 (2010). https://doi.org/10.1007/s10151-009-0550-y
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DOI: https://doi.org/10.1007/s10151-009-0550-y