Abstract
Introduction A Loop ileostomy is one of the most common techniques used in colorectal surgery to establish a reversible faecal diversion and bypass the large bowels, in order to protect either a downstream colorectal anastomosis or a coloanal anastomosis. However, it is a procedure that can cause a plethora of complications including long term ones such as the psychological effects. Currently, there is no consensus regarding the optimal time to perform closure of a loop ileostomy. Some studies suggested the early reversal of ileostomy procedure as a solution to reduce these complications. This study aims to review the available literature in order to ascertain the benefits behind early closure of loop ileostomy. Methods The literature was searched for all studies that included a comparison between the outcomes of early and late closure of loop ileostomy in terms of morbidity, mortality, or quality of life, where available. Early closure of loop ileostomy is defined as closure less than three months and late as more than three months, in accordance with conventional literature. The resultant articles were filtered using our inclusion and exclusion criteria. Finally, the remaining articles were assessed for quality and their results were compared to one another in order to draw our conclusions. Results and Discussion. The results were slightly inclined toward early closure of loop ileostomy. However, there were limitations of the studies reviewed, including the heterogenicity of studies, selection bias, lack of clear definition of measured outcomes, and small sample size. Taking that into consideration, the results of early closure of loop ileostomies in the selected patients were promising and require further investigation.
Highlights
A Loop ileostomy is one of the most common techniques used in colorectal surgery to establish a reversible faecal diversion and bypass the large bowels, in order to protect either a downstream colorectal anastomosis or a coloanal anastomosis
Among the studies our search yielded, only two were multicentre randomized controlled studies including one that solely focused on comparing the outcomes of early and late closure of loop ileostomy with regard to the quality of life. e first randomized controlled study primarily compared the number of complications in early and late closure groups using computer-generated randomization by Danielsen et al [14]
It included a total of 112 patients divided into early closure group and late closure group. e study’s primary endpoint was to compare both groups by examining the mean number of complications after total mesorectal excision (TME) for low rectal cancer
Summary
A Loop ileostomy is one of the most common techniques used in colorectal surgery to establish a reversible faecal diversion and bypass the large bowels, in order to protect either a downstream colorectal anastomosis or a coloanal anastomosis. Some studies suggested the early reversal of ileostomy procedure as a solution to reduce these complications. Is study aims to review the available literature in order to ascertain the benefits behind early closure of loop ileostomy. E literature was searched for all studies that included a comparison between the outcomes of early and late closure of loop ileostomy in terms of morbidity, mortality, or quality of life, where available. E results were slightly inclined toward early closure of loop ileostomy. The results of early closure of loop ileostomies in the selected patients were promising and require further investigation. Complications that arise from stoma formation can be divided into early and late. To better understand how these complications may arise, it is essential to discuss the steps involved in the procedures of a loop ileostomy’s formation. (iii) While protecting the rest of the abdominal contents, the skin disc is resected and monopolar diathermy is used to deepen the incision to the anterior rectus sheath with the help of blunt retractors.
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