Loop ileostomy closure: a retrospective comparison of three techniques

Abstract

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.

The impact of prolonged delay to loop ileostomy closure on postoperative morbidity and hospital stay: A retrospective cohort study

“…While this is less than reported in some studies, for example a wound infection rate of 6.8% [30] and rates of prolonged ileus or small bowel obstruction of 7%–12% [30–33], our results are similar to that reported in the meta‐analysis by Chow [31]. Changes in practice over time may influence our results, although our previous work has not supported this [34] While there was a significant increase in laparoscopic and hybrid anterior resections and the introduction of ERAS, there was no association between approach and complications after loop ileostomy closure, p = 0.912. In contrast, there was an increase in delay to closing a stoma of 8.3 days over each year (3.2, 13.5), p = 0.001.…”

Feasibility Analysis and Advantages of Wedge Resection Plus Transverse Suture Applied to Closure of Loop Ileostomy

“…In the past, the commonly used surgical methods for ileostomy closure surgery included the hand suture method (end-to-end anastomosis) and stapler method (end-to-end, end-to-side, or side-to-side anastomosis), each with their own advantages and disadvantages. Although many reports have compared and analyzed the advantages of these two methods, the rst-choice surgical treatment has yet to be made clear (9)(10)(11)(12). Particularly, the stapler anastomosis method is widely welcomed owing to its simple operation, shorter operation time, and rm anastomosis (13,14); however, its application of expensive staplers leads to high anastomotic costs, which further increases the patients' total hospitalization costs and the country's medical insurance costs.…”