Abstract
Loop ileostomy (LI) formation is a common practice for patients undergoing low anterior resection or restorative ileo-anal pouch surgery. Ileostomy closure 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. Randomized 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. This retrospective, single-centre cohort study included patients undergoing LI closure between January 1999 and April 2016. Patient demographics, anastomotic technique, operative time and patient outcomes were collected. 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 min, for stapled, single- and two-layer hand-sewn closures, respectively, adjusted overall P = 0.262), or morbidity (21.5% versus 20.4% versus 17.6%, adjusted overall P = 0.934) between stapled or hand-sewn anastomoses, and no mortality. Once adjusting for age, sex, American College of Anaesthesiology grade, and consultant surgeon, the length of stay was different (overall P = 0.034), being similar between stapled and single-layer closures (4.2 versus 5.5 days, P = 0.105), but significantly different between stapled and two-layer closures (4.2 versus 8.3 days, P = 0.026). Stapled and single-layered hand-sewn closures are similar in length of procedure, length of stay and complication rates. A two-layer, hand-sewn technique is associated with a significant increase in stay compared to a stapled ileostomy closure.
Highlights
Loop ileostomy (LI) formation is a common practice for patients undergoing low anterior resection or restorative ileo-anal pouch surgery
Advocates argue that the wider anastomosis produced by this technique results in less postoperative ileus and small bowel obstruction, and that the additional cost of the stapling devices can be offset by the reduced operating time [6,7]
Institutional approval was given for interrogation of the Otago Clinical Audit (OCA) database for all loop ileostomy closures performed between January 1999 – April 2016 at Dunedin Public Hospital
Summary
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. Defunctioning loop ileostomy formation is a common practice for patients undergoing low anterior resection and restorative ileo-anal pouch surgery. Use of a covering loop ileostomy has been shown to reduce the rate of clinically significant anastomotic leaks, thereby reducing morbidity and re-operation rates [1,2] Subsequent closure of these temporary stomas is, not without potential morbidity, with complications reported in up to 33% of cases [3]. Advocates argue that the wider anastomosis produced by this technique results in less postoperative ileus and small bowel obstruction, and that the additional cost of the stapling devices can be offset by the reduced operating time [6,7]
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