Hand-Sewn versus Stapled Closure of Loop Ileostomy: A Meta-Analysis

Madani, Rana; Day, Nigel; Kumar, Lalit; Tilney, H. S.; Gudgeon, A. M.

doi:10.1159/000487310

Cited by 35 publications

(34 citation statements)

References 20 publications

(94 reference statements)

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“…In this context, the additional operative cost of a stapling device has been justified based on a reduction in operating time or length of stay [22][23][24]. A consistent finding from the randomised controlled trials comparing stapled and hand-sewn ileostomy closures is the significantly shorter operating time for stapled ileostomy closures, with the benefit ranging from 4 to 24 minutes [23][24][25][26]. The technique used impacts upon the magnitude of this benefit.…”

Section: Discussionmentioning

confidence: 99%

Loop ileostomy closure: a retrospective comparison of three techniques

Lord

Reeves

Gray

et al. 2019

Preprint

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Background Loop ileostomy (LI) formation is a common practice for patients undergoing low anterior resection or restorative ileo-anal pouch surgery. This can be performed using a stapled or hand-sewn technique, with or without resection. If hand-sewn, the closure can be one or two layers. Randomised controlled trials have not demonstrated one technique to be superior, and meta-analyses are limited by the heterogeneity of published studies. Our primary aim is to compare stapled ileostomy closure with single- and two-layer, hand-sewn closures.Methods This retrospective, single-centre cohort study included patients undergoing LI closure between January 1999 – April 2016. Patient demographics, anastomotic technique, operative time, and patient outcomes were collected.Results Our analysis included 244 patients (median age 67 years, 43.4% female). There were no significant differences in mean operative times (71.5, 73.1, and 88.5 minutes, for stapled, single-, and two-layer hand-sewn closures respectively, adjusted overall p=0.262), or morbidity (21.5% vs 20.4% vs 17.6%, adjusted overall p=0.934) between stapled or hand-sewn anastomoses, and no mortality. Once adjusting for age, sex, ASA, and consultant surgeon, the LOS was similar between stapled and single-layer closures (4.2 vs 5.5 days, p=0.105), but significantly different between stapled and two-layer closures (4.2 vs 8.3 days, p=0.026) (overall p=0.034). No evidence of differences in complications was found.Conclusions Stapled and single-layered hand-sewn closures are similar in length of procedure, LOS, and complication rates. A two-layer, hand-sewn technique is associated with a significant increase in stay compared to a stapled ileostomy closure.

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Section: Discussionmentioning

confidence: 99%

Loop ileostomy closure: a retrospective comparison of three techniques

Lord

Reeves

Gray

et al. 2019

Preprint

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“…A meta-analysis done by Madani et al shown that the anastomotic leak rate was 2.93% (55/1,877) in the HA group and 2.08% (25/1,202) in the SA group with p=0.52. 6 We can say that there is no superiority in terms of having less anastomotic leak between these two methods and further study with large group of patient is required to strengthen this analysis.…”

Section: Discussionmentioning

confidence: 96%

Compare outcome in patients of ileostomy and colostomy closure with surgical stapler versus ileostomy and colostomy closure with hand sewn anastomosis: a prospective study

et al. 2020

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Background: Diverting temporary stoma is created to protect the primary bowel pathology and distal anastomosis. Once that primary pathology has been overcome or distal anastomosis gets healed, closure of temporary stomas can be carried out. Invention of stapling devices for intestinal anastomosis provided another dimension than hand sewn method to the stoma closure techniques. In this study, we have compared two methods of loop stoma closure-hand sewn method versus stapler method.Methods: This is prospective comparative study in which 50 cases of loop ileostomy/colostomy were taken. 25 patients underwent ileostomy/colostomy closure by hand sewn anastomosis (group A). Another 25 patients underwent ileostomy/colostomy closure by stapler anastomosis (group B). Time taken for operation, initiation of oral intake, anastomotic leak, post-operative wound infection and total hospital stay duration were compared between these two groups to conclude about which method is superior and in the best interest of patient and surgeon.Results: Mean operation time 105.96 minutes (group A) and 72.84 minutes (group B). Mean time to start oral intake 5.36 days (group A), 3.6 days (group B). 16% patients (4/25) group A and 4% patients (1/25) group B developed anastomotic leak. 28% patients (7/25) group A and 8% patients (2/25) group B had post-operative wound infection. Mean hospital stay 10.4 days in group A and 7.84 days in group B.Conclusions: Stapler method provides significant benefits in terms of less operative time, early oral intake and less hospital stay. Overall stapler method for stoma closure is more efficient and cost effective.

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“…Regarding the surgical techniques, a recently published meta-analysis (17) compared the hand-sewn with stapled anastomotic technique for closure of the loop ileostomy and found no significant difference in the rate of anastomotic leakage between the two options, but the rate of small-bowel obstruction was higher in the handsewn group (17). Zhou, et al found that the length of hospital stay was shorter in the hand-sewn anastomoses than in the stapled anastomoses' group (10).…”

Section: Discussionmentioning

confidence: 99%