Twenty-three-hour stay loop ileostomy closures: a pilot study

Abstract

A specific 23-h discharge protocol for loop ileostomy closures is feasible and safe. Improved primary care and out-of-hours hospital support would have prevented both minor wound complications requiring readmission. The anastomotic leak presented at postoperative day 8 and would have occurred in the community even if a standard protocol was used. Additional patient information and support via stoma care have been introduced to build on our experience, and 23-h stay has been introduced as standard care.

Day‐case closure of ileostomy: feasible, safe and efficient

“…Our readmission rates compare favourably with those for enhanced recovery for elective colorectal surgery and our previous publications regarding 23-h closure of loop ileostomy [5,6]. Since April 2013 23-h closure of ileostomy has been standard practice in our institution for 84% of patients who meet the inclusion criteria.…”

“…The median interval between primary surgery and closure of loop ileostomy was 8 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) months. All patients were discharged on the day of surgery.…”

“…Our unit implemented a protocol for 23‐h stay for closure of ileostomy and found no increase in postoperative complications or any detriment to patient safety . We modified the protocol to conduct a pilot study exploring the potential for closure of loop ileostomy performed as a day‐case procedure.…”

Reply to Bhalla et al.

“…We acknowledge their contribution to the literature, particularly in relation to reducing the length of stay following ileostomy closure. We understood from their article on 23‐h stay ileostomy closure, however, published in 2013 , that the patients were specifically selected for inclusion in the 23‐h stay and a new protocol was drawn up for those patients included in the study. This differs from our publication of consecutive unselected patients undergoing ileostomy closure within an established enhanced recovery programme.…”

Response to: Ileostomy closure in an enhanced recovery setting

“…We feel that we should draw to the attention of the authors that there is more evidence than ‘the only published studies of ileostomy closure within an enhanced recovery programme are from a single institution in the USA (Case Medical, Cleveland)’ . Our own study, published in 2013, successfully implemented an enhanced recovery programme for 23‐h ileostomy reversal . Subsequently over 100 patients have been discharged within 23 h of ileostomy reversal.…”