Early and Late Closure of Loop Ileostomies: A Retrospective Comparative Outcomes Analysis

Abdalla, Sala; Scarpinata, Rosaria

doi:10.25270/owm.2018.12.3035

Cited by 15 publications

(18 citation statements)

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“…Even though the severity of post-closure complications was relatively low and did not differ between groups in the categories of moderate and severe negative outcomes, mild complications were found significantly more frequent in patients with a late closure of a protective loop-ileostomy. Our data are in line with reports from Abdalla and Scarpinata ( 19 ) as well as Hughes et al ( 20 ), who accounted for the negative impact of a delayed closure more than 6 months after index surgery on the rate of post-closure complications in a small cohort, whereas Zhen et al ( 21 ) could not substantiate the inferiority of a late closure operation. The authors observed a comparable number of adverse outcomes for patients with a closure beyond 6 months from primary surgery, but this study group actually received more adjuvant chemotherapy cycles and might, thus, even have a better prognosis than patients with an early closure.…”

Section: Discussionsupporting

confidence: 93%

Timing of Closure of a Protective Loop-Ileostomy Can Be Crucial for Restoration of a Functional Digestion

et al. 2022

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IntroductionProtective loop-ileostomy is one of the most common interventions in abdominal surgery to provide an alternative intestinal outlet until sufficient healing of a distal anastomosis has occurred. However, closure of a loop-ileostomy is also associated with complications. Thus, knowledge of the optimal time interval between primary and secondary surgery is crucial.MethodsData from 409 patients were retrospectively analyzed regarding complications and risk factors in closure-associated morbidity and mortality. A modified Clavien-Dindo classification of surgical complications was used to evaluate the severity of complications.ResultsA total of 96 (23.5%) patients suffered from postoperative complications after the closure of the loop-ileostomy. Early closure within 150 days from enterostomy (n = 229) was associated with less complications (p < 0.001**). Looking at the severity of complications, there were significantly more (p = 0.014*) mild postoperative complications in the late closure group (>150 days). Dysfunctional digestive problems—either (sub-) ileus (p = 0.004*), diarrhea or stool incontinence (p = 0.003*)—were the most frequent complications associated with late closure. Finally, we could validate in a multivariate analysis that “time to closure” (p = 0.002*) is independently associated with the development of complications after closure of a protective loop-ileostomy.ConclusionLate closure (>150 days) of a loop-ileostomy is an independent risk factor in post-closure complications in a multivariate analysis. Nevertheless, circumstances of disease and therapy need to be considered when scheduling the closure procedure.

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Section: Discussionsupporting

confidence: 93%

Timing of Closure of a Protective Loop-Ileostomy Can Be Crucial for Restoration of a Functional Digestion

et al. 2022

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“…Our findings in fact corroborate and extend the findings of these trials. The upper quartile in our study (>328 days) translates to ~11 months of diversion, which is comparable to the retrospective study done by Abdalla and Scarpinata which compared early (DOD <6 months) vs. late (DOD >6 months) ileostomy closure with a mean DOD of 12.8 months in the late closure group [8]. This study found no differences between the early and late groups; however, this may reflect the effect of patients whose closure occurred between the 6-and 11-month mark, since this DOD is not sufficient to result in ileus, according to our analysis.…”

Section: Ta B L E 2 Outcome Comparisonsupporting

confidence: 86%

Extended duration of faecal diversion is associated with increased ileus upon loop ileostomy reversal

et al. 2021

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Faecal diversion by loop ileostomy is frequently indicated in patients undergoing surgery for the treatment of colorectal cancer, diverticulitis, inflammatory bowel disease and other gastrointestinal diseases [1]. There is a diversity of opinion regarding the optimal duration of diversion (DOD) with practice ranging from days to many months. A study of 134 patients undergoing low-anterior resection plus loop ileostomy for rectal cancer found that more than 80% of patients waited over 4 months for stoma closure [2].Other studies have found that up to 25% of their patients with loop ileostomies never underwent stoma closure, and those that do may wait between 5 and 9 months for reversal [3][4][5]. Additionally, patient quality of life is negatively impacted by the presence of an ileostomy, specifically with respect to body image, anxiety and sexual interest [4]. To help answer the question of optimal

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“…In this study (Fig. 1) the time from index operation to the reversal of the ileostomy (median 11.99 months; IQR: 8.2–14.7) was longer compared to published studies 10–13 . To better understand waiting times to reversal, we therefore divided the reversal pathway into 4: ‘Not ready’, ‘Investigation’, ‘Management and decision to reverse’ and ‘Wait‐listed’.…”

Section: Discussionmentioning

confidence: 82%

Investigations and time trends in loop ileostomy reversals following anterior resections: a single Australian institution seven‐years' experience

Taylor

Besson

Faragher

et al. 2020

ANZ Journal of Surgery

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Background Currently no consensus exists regarding what pre‐reversal investigations are required to assess integrity of the rectal anastomosis. The objective of this study was to compare pre‐reversal assessments of anastomotic integrity and to evaluate trends that might have influenced timings for reversal. Methods From a prospectively maintained database, patients with colorectal cancer resections between March 2012 and October 2019 were identified. Patient characteristics, pre‐reversal contrast enema and flexible sigmoidoscopy findings were recorded, and management of complications were recorded. Time‐to‐ileostomy reversal and time series for trends were analysed. Results There were 154 patients included. Pre‐reversal contrast enema or sigmoidoscopy detected a possible stricture or leak at the rectal anastomotic site in 11% (15/132) and 15% (18/112), respectively. When both modalities were used there was concordance of 86.1% and a positive likelihood ratio of 5.73. Of 125 (81.2%) ileostomies reversed, the median time‐to‐reversal was 11.99 months; time series analysis over the 7‐year period showed no significant trend for average patient‐days from booking to reversal (P = 0.60). Cox regression modelling did not identify any influential risk factors for the times taken to reversal. Conclusion This study supports the use of both contrast enema and flexible sigmoidoscopy in the assessment of rectal anastomosis integrity. Most patients with complications can have their ileostomies reversed. Patients who have adjuvant chemotherapy have a prolonged time to reversal.

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Early and Late Closure of Loop Ileostomies: A Retrospective Comparative Outcomes Analysis

Cited by 15 publications

References 0 publications

Timing of Closure of a Protective Loop-Ileostomy Can Be Crucial for Restoration of a Functional Digestion

Timing of Closure of a Protective Loop-Ileostomy Can Be Crucial for Restoration of a Functional Digestion

Extended duration of faecal diversion is associated with increased ileus upon loop ileostomy reversal

Investigations and time trends in loop ileostomy reversals following anterior resections: a single Australian institution seven‐years' experience

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