Patients Undergoing Ileostomy Closure Research Articles

Clostridium Difficile Infection in Rectal Cancer Patients after Diverted Loop Ileostomy Closure.

Clostridium difficile infection is a cause of increased morbidity and mortality in hospitals, particularly in patients with cancer pathology. There are several factors favouring the development of Clostridium difficile infection among cancer patients, including age, exposure to antibiotic and proton pump inhibitors therapy, and chemotherapy. This study was conducted to observe the prevalence of Clostridium difficile infection after the reversal of ileostomy loop for rectal cancer surgery, which were initially operated either open or laparoscopic. A retrospective study was performed on patients who were operated in a single surgical team for rectal cancer who benefited of a diverted loop ileostomy over a 4-year period. Results: 23 patients were documented with Clostridium difficile infection out of a total of 63. All 23 patients underwent ileostomy closure later than 3 months after primary surgery, and postoperatively received antibiotic therapy associated with proton pump inhibitors in the first 24 hours. Conclusions: Closure of ileostomy later than 3 months after primary surgery, combined with chemotherapy, antibiotic therapy and proton pump inhibitors, increases the risk of developing Clostridium difficile infection.

Effect of Perioperative Intravenous Lidocaine on Postoperative Recovery in Patients Undergoing Ileostomy Closure: Study Protocol for a Randomized Controlled Trial.

IntroductionOpioids have been widely used clinically as the first choice for pain management. Ileostomy closure usually leads to temporary intestinal paralysis, which manifests as abdominal distension and pain, delayed defecation, nausea, and vomiting. Intraoperative and postoperative use of opioids inhibit gastrointestinal function and aggravate intestinal paralysis, and are notoriously addictive. Thus, reducing perioperative opioid use is important for patients undergoing ileostomy closure to restore the continuity and integrity of the intestine. Intravenous lidocaine has been shown to have anti-inflammatory properties and analgesic effects. We consider minimizing the use of opioids for such patients, and perioperative intravenous injection of lidocaine may be beneficial to the recovery of intestinal function in patients with ileostomy closure.Methods and AnalysisThis is a randomized double-blind placebo-controlled trial to investigate the effectiveness and safety of intravenous lidocaine in patients undergoing ileostomy closure. The time of first postoperative anal venting, postoperative opioids use, postoperative recovery, intraoperative adverse effects and postoperative complications will be collected and analyzed.

A method of ileostomy closure associated with a low anastomotic leak rate: does operative time matter?

Background: Anastomotic leaks (AL) are serious post-operative complications associated with a high morbidity following routine ileostomy closure. Studies comparing standard methods of closure show no difference in outcome. The benefit of longer operative time has not been investigated.Methods: Baseline characteristics and surgery outcomes for all patients who had an ileostomy closure from 1994-2015 at a single centre by a single surgeon were extracted from medical records. An electronic literature search of EMBASE, PubMed was performed to identify systematic reviews of Randomised controlled trials (RCT) reporting pooled leak rates and operative time for stapled vs hand sutured anastomosis. A meta-analysis using data from 4 eligible RCT was used to compare outcomes between the new versus standard techniques.Results: A total of 415 patients underwent ileostomy closure during the study period with no leaks (0%, 95%CI 0-0.9); compared with 10 leaks reported in 649 patients (1.5%, 95%CI 7-28) from four trials. This risk difference of 1.55% corresponds to a Number needed to treat (NNT) of 66. Two individual trials reported leak rates of 2-3% which were statistically significantly different to the case series leak rate (p<0.05). Mean operative time was 170 minutes (95%CI 163-177) (p<0.05) using the modified functional end-end anastomosis and stapled: 67 minutes (95%CI 59-74) and hand-sutured: 80 minutes (95%CI 70-90).Conclusions: The increased operative time performing our modified stapled functional end-end anastomosis is associated with a very low leak rate compared with stapled or hand-sutured anastomosis.

Clinical Outcomes of Ileostomy Closure before Adjuvant Chemotherapy after Rectal Cancer Surgery: An Observational Study from a Chinese Center.

Background The optimal timing of temporary ileostomy closure with respect to the time of adjuvant chemotherapy following sphincter-saving surgery for rectal cancer remains unclear. The aim of this study is to investigate the clinical and oncological outcomes of ileostomy closure before, during, and after adjuvant chemotherapy following curative rectal cancer resection. Methods Patients diagnosed with rectal adenocarcinoma who underwent low anterior resection and temporary loop ileostomy during May 2015 and September 2019 were retrospectively evaluated. Patients undergoing ileostomy closure before adjuvant chemotherapy (Group I) were compared to patients undergoing closure during (Group II) and after (Group III) adjuvant chemotherapy. Results A total of 225 patients were evaluated for eligibility, and 132 were finally selected and divided into 3 groups (24 in Group I, 53 in Group II, and 55 in Group III). No significant differences were observed in operative time, postoperative hospital stay, postoperative complications, total adjuvant chemotherapy cycles, and low anterior resection syndrome scores among the three groups. There was no significant difference in disease-free survival (p = 0.834) and overall survival (p = 0.462) between the three groups. Conclusion Temporary ileostomy closure before adjuvant chemotherapy following curative rectal cancer resection can achieve a clinical and oncological safety level equal to stoma closure during or after chemotherapy in selected patients.

Extended duration of faecal diversion is associated with increased ileus upon loop ileostomy reversal.

The timing of ileostomy reversal has been the subject of controversy, with researchers investigating the safety of early versus late stoma closure. Anecdotally, a longer duration of faecal diversion is associated with a greater incidence of postoperative ileus. We sought to investigate the association between duration of diversion and postoperative ileus. We conducted an institutional retrospective cohort study on 173 patients undergoing ileostomy closure between 2012 and 2018. Our primary outcome was ileus; secondary outcomes included postoperative complications and descriptive factors. We investigated the association between duration of diversion and ileus using several analyses to ensure that time was treated appropriately as a continuous, nonlinear variable. In all, 20.2% of patients had an ileus. Multivariate analysis did not identify a significant association between any independent predictors and ileus, although there was a trend towards increased risk of ileus with increasing duration of diversion. When treated as a categorical variable, a duration of diversion >328days independently increased the odds of ileus (OR=3.25, P=0.033). Duration of diversion was associated with days to first flatus and to first diet (P=0.025 and P=0.004, respectively). When patients received nasogastric intubation, the mean duration of intubation was 3.2days. Greater duration of diversion was associated with a trend towards increased risk of ileus; this risk tripled when diversion lasted more than 328days.

Factors impacting time to ileostomy closure after anterior resection: the UK closure of ileostomy timing cohort study (CLOSE-IT).

Delay to closure of ileostomy following anterior resection for rectal cancer may impair postoperative bowel function and quality of life. We analysed time to ileostomy closure across the UK and investigated factors delaying closure. For the retrospective cohort we assessed time to closure and incidence of non-closure for patients who underwent anterior resection with defunctioning ileostomy during 2015. Multivariate linear/Cox regression analyses were performed. For the prospective cohort we captured patients undergoing ileostomy closure during a 3-month period in 2018 to validate retrospective findings. The retrospective cohort involved 788 patients of whom 669 (84.9%) had bowel continuity restored, median time to closure 259days. Recognized factors associated with delay and risk of non-closure included anastomotic leak (hazard ratio [HR] 3.65, 2.61-5.08), chemotherapy (HR 2.62, 2.17-3.15) and cancer progression (HR 2.05, 1.62-2.58). Crucially, specific aspects of the surgical pathway were associated with time to closure; for example, waiting list entry prior to outpatient clinic review/imaging was associated with an estimated 133-day shorter interval to closure (P<0.001). In the prospective cohort 288 patients underwent closure, at a median of 271days. Chemotherapy use and cancer progression were associated with delay to closure while listing for surgery prior to clinic and imaging was associated with an estimated shorter interval to closure of 168days (P=0.008). Delays to closure of ileostomy are common in the UK. Listing patients for surgery only after follow-up outpatient appointment, imaging or chemotherapy delays closure. Findings will inform consensus guidelines towards an optimum treatment pathway to reduce delay and improve post-closure quality of life.

Evaluation of Pelvic Anastomosis by Endoscopic and Contrast Studies Prior to Ileostomy Closure: Are Both Necessary? A Single Institution Review.

Contrast enema is the gold standard technique for evaluating a pelvic anastomosis (PA) prior to ileostomy closure. With the increasing use of flexible endoscopic modalities, the need for contrast studies may be unnecessary. The objective of this study is to compare flexible endoscopy and contrast studies for anastomotic inspection prior to defunctioning stoma reversal. Patients with a protected PA undergoing ileostomy closure between July 2014 and June 2019 at our institution were retrospectively identified. Demographics and clinical outcomes in patients undergoing preoperative evaluation with endoscopic and/or contrast studies were analyzed. We identified 207 patients undergoing ileostomy closure. According to surgeon's preference, 91 patients underwent only flexible endoscopy (FE) and 100 patients underwent both endoscopic and contrast evaluation (FE + CE) prior to reversal. There was no significant difference in pelvic anastomotic leak (2.2% vs. 1%), anastomotic stricture (1.1% vs. 6%), pelvic abscess (2.2% vs. 3.0%), or postoperative anastomotic complications (4.4% vs. 9%) between groups FE and FE + CE (P > .05). Flexible endoscopy alone appears to be an acceptable technique for anastomotic evaluation prior to ileostomy closure. Further studies are needed to determine the effectiveness of different diagnostic modalities for pelvic anastomotic inspection.

Stoma closure and reinforcement (SCAR): A study protocol for a pilot trial

A quality metric for centers performing rectal cancer surgery is a high percentage of sphincter sparing procedures. These procedures often involve temporary bowel diversion to minimize the complications of an anastomotic leak. The most common strategy is a diverting loop ileostomy which is then closed after completion of adjuvant therapy or the patient recovers from surgery. Loop ileostomy is not without complications and the closure is complicated by a one in three chance of incisional hernia development. Strategies to prevent this problem have been designed using a variety of techniques with and without mesh placement. This proposed pilot study will test the safety and efficacy of a novel stoma closure technique involving permanent mesh in the retro rectus position during ileostomy closure. The study will prospectively follow 20 patients undergoing ileostomy closure using this technique and evaluate for safety of the procedure, quality of life, and feasibility for a larger randomized controlled trial. Patients will be followed post procedurally and evaluated for 30-day complications, as well as followed up with routine cancer surveillance computed tomography every 6 months in which the presence of stoma site incisional hernias will be evaluated. The results of this pilot study will inform the design of a multiple center, blinded randomized controlled trial to evaluate the utility of permanent mesh placement to decrease the incidence of prior stoma site incisional hernias.

Same-day discharge of Gynecologic Oncology patients following ileostomy closure is feasible and safe

ObjectiveGynecologic Oncology patients are traditionally admitted for 2–3 days following ileostomy closure. Our aim was to assess feasibility and safety of same-day discharge (SDD), by comparing 30-day clinical outcomes after SDD and standard admission. MethodsRetrospective study of patients who underwent ileostomy closure at two academic tertiary centres in Toronto, Canada, between January 2010 and October 2017. ResultsIn total 117 patients underwent ileostomy closure: 23 had SDD and 94 were admitted for a median of 3 days. There were no significant differences between groups in terms of age, body mass index, comorbidities, primary malignancy, tumor stage, indication for ileostomy, previous radiation therapy, chemotherapy, interval between ileostomy formation and closure, and intraoperative complications. Median operative time was shorter (47 versus 60 min, p = 0.0001) and there was a longer median interval between last chemotherapy cycle to ileostomy closure (145 versus 106 days, p = 0.01) in the SDD group.SDD was not associated with an increased risk of adverse events (13% versus 24.5%, p= 0.24), as assessed by a composite outcome which included small bowel obstruction, anastomotic leak, surgical site infection, clostridium difficile infection, sepsis, and thromboembolic events, when compared to standard admission. Moreover, SDD did not lead to more emergency room visits (17.4% versus 16%, p = 0.87) or readmissions within 30 days of surgery (17.4% versus 8.5%, p= 0.21). ConclusionsSDD is a safe alternative to routine hospitalization that has the potential to improve healthcare resource utilization, without increasing readmissions or emergency room visits. Careful patient selection is warranted.

Comparison of Postoperative Analgesia in Patients Undergoing Ileostomy Closure with and Without Dual Transversus Abdominis Plane (TAP) Block – Prospective Randomized Controlled Trial

Comparison of Postoperative Analgesia in Patients Undergoing Ileostomy Closure with and Without Dual Transversus Abdominis Plane (TAP) Block – Prospective Randomized Controlled Trial

Comparison of Postoperative Analgesia in Patients Undergoing Ileostomy Closure with and Without Dual Transversus Abdominis Plane (TAP) Block: A Randomized Controlled Trial.

Background and AimsMultimodal analgesia comprising opioid, paracetamol, and non-steroidal anti-inflammatory drugs is used for managing postoperative surgical pain after ileostomy closure (IC). We investigated the efficacy of unilateral dual transversus abdominis plane (TAP) block to reduce morphine consumption in the first 24 hours along with a reduction in visual analogue score for pain and in postoperative nausea/vomiting.MethodsThis was a single-center, investigator-initiated, prospective, parallel-group, placebo-controlled randomized study involving patients undergoing IC under general anesthesia. We recruited 55 patients in two groups: 28 in a TAP group and 27 in a placebo group. The TAP group patients received 30 mL of 0.375% bupivacaine: 15 mL by a posterior TAP approach and 15 mL by a subcostal approach using ultrasonography. Patients in the placebo group received 30 mL normal saline (placebo) using the same approaches. Blocks were administered at the end of surgery before extubation. To monitor for the primary outcome—24-hour morphine consumption for both groups—patients were transferred to a high-dependency unit. The secondary outcome was to compare postoperative nausea/vomiting in both groups.ResultsThe demographic data, gender distribution, ASA physical status, duration of surgery, and time of first morphine dose was comparable in both groups. The 24-hour morphine consumption was 3.29±2.78 mg and 9.23±2.94 mg for the TAP and placebo groups, respectively, which was statistically significant (P=0.001).ConclusionDual TAP block reduces opioid consumption in the first 24 hours after an IC and can facilitate early recovery with less adverse effects seen than with opioids and NSAIDs.

Protocol for a multicentre, dual prospective and retrospective cohort study investigating timing of ileostomy closure after anterior resection for rectal cancer: The CLOSurE of Ileostomy Timing (CLOSE-IT) study

IntroductionA defunctioning ileostomy is often formed during rectal cancer surgery to reduce the potentially fatal sequelae of anastomotic leak. Once the ileostomy is closed and bowel continuity restored, many patients...

Morbidity associated with closure of ileostomy after a three-stage ileal pouch-anal anastomosis.

The aim of the study was to compare the perioperative outcomes of patients undergoing ileostomy closure after a three-stage ileal pouch-anal anastomosis to a control group of patients who had elective colorectal resections and stoma, and to analyse the differences based on the technique of closure. The cases were retrospectively compared for demographic characteristics and postoperative outcomes. Chi-square, Fisher's exact and Wilcoxon rank sum tests were used as appropriate. Between 2011 and 2016, 338 patients having their stoma reversed after three-stage IPAA were compared to 158 patients in the control group. A younger age (43.2 vs 60.6years, p < 0.0001), a lower body mass index (22 vs 24.4kg/m2, p < 0.0001), a higher rate of hand-sewn anastomosis (84.3 vs 15.7%, p < 0.0001), a lower rate of intraoperative complications (0 vs 1.2%, p = 0.038), a shorter operative time (91.5 vs 99.4min, p = 0.0046) and length of hospital stay (6.6 vs 7.6days, p = 0.045) were seen in the IPAA group. The 30-day rate of wound infection, anastomotic leak (0.6 vs 0.6%), small bowel obstruction (SBO, 8 vs 11.4%) and reoperation (1.8 vs 1.3%) was similar. Among IPAA patients, the hand-sewn anastomosis was correlated with a higher chance of developing SBO (9.1 vs 1.9%, p = 0.03). Closure of ileostomy after three-stage IPAA is associated with low rate of serious complications, despite the higher number of previous abdominal surgeries. This supports the construction of routine ileostomy during IPAA to reduce the risk of pelvic sepsis.

Study protocol evaluating the use of bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicenter randomized controlled trial.

Postoperative ileus is the most commonly observed morbidity following ileostomy closure. Studies have demonstrated that the defunctionalized bowel of a loop ileostomy undergoes a series of functional and structural changes, such as atrophy of the intestinal villi and muscular layers, which may contribute to ileus. A single-centre study in Spain demonstrated that preoperative bowel stimulation via the distal limb of the loop ileostomy decreased postoperative ileus, length of stay and time to gastrointestinal function. A multicentre randomized controlled trial involving patients from Canadian institutions was designed to evaluate the effect of preoperative bowel stimulation before ileostomy closure on postoperative ileus. Stimulation will include canalizing the distal limb of the ileostomy loop with an 18Fr Foley catheter and infusing it with a solution of 500ml of normal saline mixed with 30g of a thickening agent (Nestle© Thicken-Up© ). This will be performed 10 times over the 3weeks before ileostomy closure in an outpatient clinic setting by a trained Enterostomal Therapy nurse. Surgeons and the treating surgical team will be blinded to their patient's group allocation. Data regarding patient demographics, and operative and postoperative variables, will be collected prospectively. Primary outcome will be postoperative ileus, defined as an intolerance to oral food in the absence of clinical or radiological signs of obstruction, that either requires nasogastric tube insertion or is associated with two of the following on or after post-operative day 3: nausea/vomiting; abdominal distension; and the absence of flatus. Secondary outcomes will include length of stay, time to tolerating a regular diet, time to first passage of flatus or stool and overall morbidity. A cost analysis will be performed to compare the costs of conventional care with conventional care plus preoperative stimulation. This manuscript discusses the potential benefits of preoperative bowel stimulation in improving postoperative outcomes and outlines our protocol for the first multicenter study to evaluate preoperative bowel stimulation before ileostomy closure. The results of this study could have considerable implications for the care of patients undergoing ileostomy closure.

Does the timing of loop ileostomy closure affect outcome: A case-matched study

IntroductionThe optimal timing for the closure of loop ileostomies remains controversial. The aim of this study is to determine whether ileostomy closure (<3 months post formation) affects stoma-related morbidity compared to late closure (≥3 months post formation). MethodsAll patients who had loop ileostomy and ileostomy closure between 2012 and 2015 were identified from an IRB-approved, prospectively maintained institutional database.The patients who underwent ileostomy closure (<3 months) were compared against matched patients undergoing ileostomy closure (≥3 months). The outcomes for the two groups were compared. ResultsA total of 358 patients were analyzed. Mean age was 46 ± 17 years. There were 179 patients in each group [ileostomy closure (<3 months) and ileostomy closure (≥3 months)]. Both groups were matched. Groups were comparable in preoperative characteristics and demographics. All of the peri-operative variables were comparable. No difference was observed in estimated blood loss (EBL), operative time (OT) and length of stay (LOS) (all p > 0.05). Postoperative outcomes including wound infection, post-operative bleeding, intra-abdominal abscess, ileus, small bowel obstruction (SBO), anastomotic leak, reoperation, surgery related readmission, postoperative transfusion were also similar among the groups (p > 0.05). ConclusionsIleostomy closure (<3 months) is practical and safe. It does not increase morbidity and significantly reduces the time patient has a stoma. This may be advantageous in regards to having a reduced possibility of stoma related complications.

Using Modified Frailty Index to Predict Safe Discharge Within 48 Hours of Ileostomy Closure.

Enhanced recovery pathways allow for safe discharge and optimal outcomes within 48 hours after ileostomy closure. Unfortunately, some patients undergoing ileostomy closure have prolonged hospital stays. We have shown previously that the Modified Frailty Index can help predict patients who will fail early discharge after laparoscopic colorectal surgery. The purpose of this study was to use the Modified Frailty Index to identify patients who were safe for early discharge after ileostomy closure. This was a retrospective review. The study was conducted at a tertiary referral center. Patients who underwent ileostomy closure (2006-2015) were stratified into early (≤48 hours) and late discharge groups. The Modified Frailty Index, morbidity, and readmission rates were measured. A total of 272 patients undergoing ileostomy closure were evaluated. Overall length of stay was 3.64 days (±3.23 days), with 114 patients (42%) discharged within 48 hours. Sex, age, and ASA scores were similar between early and later discharge groups (p > 0.2). Univariate logistic regression demonstrated that a Modified Frailty Index score of 0 was associated with early discharge (p = 0.03), whereas a Modified Frailty Index score ≤1 and ≤2 were not. There was no significant association between the Modified Frailty Index and complication or readmission rates. Postoperative complications occurred in 39 patients (14.3%), and 1 patient died secondary to an anastomotic leak. Fifteen patients (5.5%) were readmitted within 30 days. Readmission rate within 30 days was 3.2%, with a Modified Frailty Index score of 0, 6.1% for a Modified Frailty Index score of <1, and 5.9% for a Modified Frailty Index score of <2, for which there was not an association based on univariate logistic regression (Modified Frailty Index = 0, p = 0.13; <1, p = 0.55; <2, p = 0.53). The study was limited by nature of being a retrospective review. Patients undergoing ileostomy closure with a Modified Frailty Index score of 0 are associated with higher rates of discharge within 48 hours of ileostomy closure surgery than those with a higher Modified Frailty Index, without higher readmission rates. This information can be helpful to better manage patient and resource use expectations for the duration of inpatient recovery.

Ileostomy closure by colorectal surgeons results in less major morbidity: results from an institutional change in practice and awareness.

PurposePrevious institutional analysis of ileostomy closure revealed substantial morbidity. This subsequent study aimed at determining if a change in clinical practice resulted in reduced complication rates.MethodsBetween June 2004 and January 2014, all consecutive adult patients undergoing ileostomy closure were retrospectively identified. Postoperative outcome after change in clinical practice consisting of routine participation of a colorectal surgeon, stapled side-to-side anastomosis and increased clinical awareness (cohort B) was compared with our previously published historical control group (cohort A). The primary outcome was major morbidity, defined as Clavien-Dindo grade three or higher. Independent risk factors of major morbidity were identified using multivariable analysis.ResultsIn total, 165 patients underwent ileostomy closure in cohort A, and 144 patients in cohort B. At baseline, more primary diverting ileostomies were present in cohort A (94 vs. 82 %; p = 0.001) with a similar rate of loop and end-ileostomy between the two cohorts (p = 0.331). A significant increase in colorectal surgeon participation (89 vs. 53 %; p < 0.001) and stapled side-to-side anastomosis was observed (63 vs. 16 %; p < 0.001). The major morbidity rate was 11 % in cohort A, which significantly reduced to 4 % in cohort B (p = 0.03). Surgery being performed or supervised by a colorectal surgeon (odds ratio [OR] 0.28, 95 % CI 0.11–0.67) and loop-ileostomy compared to end-ileostomy (OR 0.18, 95 % CI 0.07–0.52) were independently associated with lower major morbidity.ConclusionIleostomy closure appears to be more complex surgery then generally considered, especially end-ileostomy closure. Postoperative outcome could be significantly improved by a change in surgical practice.Electronic supplementary materialThe online version of this article (doi:10.1007/s00384-015-2478-1) contains supplementary material, which is available to authorized users.

Complications associated with closure of defunctioning loop ileostomy in low anterior resection of rectal cancer

To analyze the complications of ileostomy closure and related risk factors. Patients undergoing ileostomy closure in the Department of Colorectal Surgery, Peking University Cancer Hospital from September 2006 to March 2013 were included in this study. Clinical features of these patients were reviewed, the complications rate was calculated, and univariate and multivariate analyses with regard to the risk factors of surgical site infection(SSI) were also conducted. A total of 245 consecutive patients were enrolled in the study. Thirty-nine complications were observed in thirty-three patients, the overall complication rate was 13.5%. Complication after primary closure of defunctioning ileostomy included surgical site infection (n=21, 8.6%), ileus (n=8, 3.3%), preoperatively undiagnosed anastomotic leakage or rectovaginal fistula (n=5, 2.0%), pulmonary infection (n=2, 0.8%), and anal sphincter dysfunction (n=2, 0.8%). No patient died in the perioperative period, and 5 patients (2.0%) underwent reoperation for ileus (n=3), anastomotic leakage (n=1) and rectovaginal fistula (n=1). Multivariate analysis showed that postoperative complications [OR=10.576, 95%CI:2.898-38.597, P=0.000] and total operation time>90 min[OR=4.862, 95% CI:1.758-13.451, P=0.002] were independent risk factors of SSI, and the presence of subcutaneous vacuum drainage [OR=0.063, 95%CI:0.007-0.540, P=0.012] was protective factor of SSI. Surgical site infection is the most common complication after primary closure of defunctioning ileostomy. Subcutaneous vacuum drainage is effective for reducing SSI in patients undergoing primary closure of ileostomy, and it is especially recommended for patients with operation time>90 min.

Subcutaneous vacuum drains reduce surgical site infection after primary closure of defunctioning ileostomy.

Surgical site infection (SSI) is the most common complication after primary closure of defunctioning ileostomy. We use a subcutaneous vacuum drain (SVD) in our institution to prevent infection. This study aimed to analyze the risk factors of SSI and to assess the utility of an SVD for preventing SSI in patients undergoing primary closure of ileostomy. Patients undergoing ileostomy closure in the Department of Colorectal Surgery, Peking University Cancer Hospital, from September 2006 to March 2013, were included in this study. The clinical features of these patients with or without a subcutaneous drain were reviewed, and the complication rate of SSI was analyzed. The primary endpoints were the incidence and risk factors of SSI, and the secondary endpoints were the rate of overall complications and their management. A total of 245 consecutive patients were enrolled in the study. The overall incidence of SSI was 8.6%. Eighty-five (34.7%) patients received placement of an SVD. The use of SVDs was associated with a significantly lower incidence of SSI compared with primary closure (PC) without an SVD (1.2 vs. 12.5%, p = 0.001). Multivariate analyses showed that the presence of an SVD (odds ratio (OR) 0.063, p = 0.012), total operation time >90 min (OR 4.862, p = 0.002), and postoperative complications (OR 10.576, p < 0.001) were independent risk factors of SSI. This study shows that an SVD is effective for reducing SSI in patients undergoing PC of ileostomy. Further randomized trials are required to confirm our findings and to compare SVDs with purse-string sutures.

Systematic review and meta-analysis of published randomized controlled trials comparing purse-string vs conventional linear closure of the wound following ileostomy (stoma) closure.

Objective: The objective of this article is to systematically analyse the randomized, controlled trials comparing the effectiveness of purse-string closure (PSC) of an ileostomy wound with conventional linear closure (CLC).Methods: Randomized, controlled trials comparing the effectiveness of purse-string closure vs conventional linear closure (CLC) of ileostomy wound in patients undergoing ileostomy closure were analysed using RevMan®, and the combined outcomes were expressed as risk ratio (RR) and standardized mean difference (SMD).Results: Three randomized, controlled trials, recruiting 206 patients, were retrieved from medical electronic databases. There were 105 patients in the PSC group and 101 patients in the CLC group. There was no heterogeneity among included trials. Duration of operation (SMD: −0.18; 95% CI: −0.45, 0.09; z = 1.28; P < 0.20) and length of hospital stay (SMD: 0.01; 95% CI: −0.26, 0.28; z = 0.07; P < 0.95) was statistically similar following both approaches of ileostomy wound closure. The risk of surgical site infection (OR, 0.10; 95% CI: 0.03, 0.33; z = 3.78; P < 0.0001) was significantly reduced when ileostomy wound was closed using PSC technique.Conclusion: PSC technique for ileostomy wound is associated with a reduced risk of surgical site infection apparently without influencing the duration of operation and length of hospital stay.