Short-stay compared to long-stay admissions for loop ileostomy reversals: a systematic review and meta-analysis

Archer, Victoria; Cloutier, Zacharie; Berg, Annie; McKechnie, Tyler; Wiercioch, Wojtek; Eskicioglu, Cagla

doi:10.1007/s00384-022-04256-x

Cited by 2 publications

(1 citation statement)

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“…It showed no difference in readmissions (moderate-grade evidence) or reoperations (very low-grade evidence) and lower nonoperative complications in the short-stay group (low-grade evidence). 32 However, it only included 4 observational studies, so its conclusions were based on low-quality evidence, reiterating the relevance and purpose of our RCT.…”

Section: Discussionmentioning

confidence: 99%

Loop Ileostomy Closure as a 23-Hour Stay Procedure With Preoperative Efferent Limb Enteral Stimulation: A Randomized Controlled Trial

Charbonneau,

Morin,

Paré

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Loop ileostomy closure is a common procedure in colorectal surgery. Often seen as a simple operation associated with low complication rates, it still leads to lengthy hospitalizations. Reducing postoperative complications and ileus rates could lead to a shorter length of stay and even ambulatory surgery. OBJECTIVES: This study aimed to assess the safety and feasibility of ileostomy closure performed in a 23-hour hospitalization setting using a standardized enhanced recovery pathway. DESIGN: Randomized controlled trial. SETTINGS: Two high-volume colorectal surgery centers. PATIENTS: Healthy adults undergoing elective ileostomy closure, from July 2019 to January 2022. INTERVENTION: All patients were enrolled in a standardized enhanced recovery pathway specific to ileostomy closure including daily irrigation of efferent limb with a nutritional formula for 7 days prior to surgery. Patients were randomly allocated to either conventional hospitalization (n = 23) or a 23-hour stay (n = 24). MAIN OUTCOME MEASURES: Primary outcome was total length of stay and secondary outcomes were 30-day rates of readmission, postoperative ileus, surgical site infections, postoperative morbidity and mortality. RESULTS: A total of 47 patients were ultimately randomized. Patients in the 23-hour hospitalization arm had a shorter median length of stay (1 day vs. 2 days, p = 0.02) and similar rates of readmission (4% vs. 13%, p = 0.35), postoperative ileus (none in both arms), surgical site infection (0 vs. 4%, p = 0.49), postoperative morbidity (21% vs. 22%, p = 1.00) and mortality (none in both arms). LIMITATIONS: Due to COVID-19, access to surgical beds was greatly limited, leading to a shift toward ambulatory surgery for ileostomy closure. The study was terminated early, which affected its statistical power. CONCLUSION: Loop ileostomy closures as 23-hour stay procedures are feasible and safe. Ileus rate might be reduced by preoperative intestinal stimulation with nutritional formula through stoma’s efferent limb, although specific RCTs are needed to confirm this association

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Section: Discussionmentioning

confidence: 99%