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Sun Z, Cao L, Chen Y, Song T, Guo Z, Zhu W, Li Y. The impact of delayed closure of ileostomy on postoperative complications in patients with Crohn's disease: a case-matched study. Updates Surg 2024; 76:1339-1345. [PMID: 38238543 DOI: 10.1007/s13304-023-01722-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/29/2023] [Indexed: 08/24/2024]
Abstract
Ileostomy creation is a common procedure to mitigate postoperative complications in Crohn's disease (CD) patients. However, the optimal timing for ileostomy closure remains controversial. This study aims to investigate whether delayed ileostomy closure (> 6 months post formation) affects postoperative complications compared to early closure (≤ 6 months post formation). Consecutive CD patients who underwent ileostomy reversal at a tertiary care center between January 1, 2013, and December 1, 2021, were included. The study compared patients who underwent early ileostomy closure to matched patients undergoing delayed ileostomy closure. The 90-day postoperative complications were compared between the two groups. The study included 352 eligible patients for ileostomy reversion. Our data showed that patients undergoing delayed ileostomy closure had higher incidence of ileostomy-related infectious complications (12% vs. 4%, p = 0.008), a longer postoperative hospital stay (10 days with an IQR of 7-12 days versus 8 days with an IQR of 7-11 days, p = 0.024), and increased rate of ileus (28% versus 15%, p = 0.003). There were 256 patients included after 1:1 propensity score matching. The results revealed no significant differences in postoperative hospital stay, infectious or non-infectious complications except for a statistically significant increase in the incidence of ileus in the delayed closure group (p = 0.01). Patients undergoing delayed ileostomy closure has similar outcomes to early closure in terms of postoperative complications, except for a higher incidence of ileus.
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Affiliation(s)
- Zhenya Sun
- Department of General Surgery, Affiliated Hospital of Medical School, Jinling Hospital, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Lei Cao
- Department of General Surgery, Affiliated Hospital of Medical School, Jinling Hospital, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Yusheng Chen
- Department of General Surgery, Affiliated Hospital of Medical School, Jinling Hospital, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Tianrun Song
- Department of General Surgery, Jinling Clinical School of Medicine (Eastern Theater General Hospital), Nanjing Medical University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Zhen Guo
- Department of General Surgery, Affiliated Hospital of Medical School, Jinling Hospital, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China
| | - Weiming Zhu
- Department of General Surgery, Affiliated Hospital of Medical School, Jinling Hospital, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China.
| | - Yi Li
- Department of General Surgery, Affiliated Hospital of Medical School, Jinling Hospital, Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210002, China.
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Blanco N, Oliva I, Tejedor P, Pastor E, Alvarellos A, Pastor C, Baixauli J, Arredondo J. ILEOSTIM trial: a study protocol to evaluate the effectiveness of efferent loop stimulation before ileostomy reversal. Tech Coloproctol 2023; 27:1251-1256. [PMID: 37106220 PMCID: PMC10638139 DOI: 10.1007/s10151-023-02807-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE A protective loop ileostomy is the most useful method to reduce sequelae in the event of an anastomotic leakage (AL) after rectal cancer surgery. However, it requires an additional stoma reversal surgery with its own potential complications. Postoperative ileus (POI) remains the most common complication after ileostomy reversal, which leads to an increase in morbidity, length of hospital stay (LOS) and overall healthcare costs. Several retrospective studies carried out in this field have concluded that there are insufficient evidence-based recommendations about the routine application of preoperative bowel stimulation in clinical practice. Here we discuss whether stimulation of the efferent limb before ileostomy reversal might reduce POI and improve postoperative outcomes. METHODS This is a multicentre randomised controlled trial to determine whether mechanical stimulation of the efferent limb during the 2 weeks before the ileostomy reversal would help to reduce the development of POI after surgery. This study was registered on Clinicaltrials.gov (NCT05302557). Stimulation will consist of infusing a solution of 500 ml of saline chloride solution mixed with a thickening agent (Resource©, Nestlé Health Science; 6.4 g sachet) into the distal limb of the ileostomy loop. This will be performed within the 2 weeks before ileostomy reversal, in an outpatient clinic under the supervision of a trained stoma nurse. CONCLUSION The results of this study could provide some insights into the preoperative management of these patients.
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Affiliation(s)
- N Blanco
- Department of General Surgery, Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Navarra, Spain
| | - I Oliva
- Department of General Surgery, University Hospital of León, León, Spain
| | - P Tejedor
- Department of General Surgery, University Hospital Gregorio Marañón, Madrid, Spain
| | - E Pastor
- Department of General Surgery, University Hospital of León, León, Spain
| | - A Alvarellos
- Department of General Surgery, Clínica Universidad de Navarra, Madrid, Spain
| | - C Pastor
- Department of General Surgery, Clínica Universidad de Navarra, Madrid, Spain
| | - J Baixauli
- Department of General Surgery, Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Navarra, Spain
| | - J Arredondo
- Department of General Surgery, Clínica Universidad de Navarra, Av. Pío XII 36, 31008, Pamplona, Navarra, Spain.
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von Savigny C, Juratli MA, Koch C, Gruber-Rouh T, Bechstein WO, Schreckenbach T. Short-term outcome of diverting loop ileostomy reversals performed by residents: a retrospective cohort prognostic factor study. Int J Colorectal Dis 2023; 38:108. [PMID: 37084093 PMCID: PMC10121496 DOI: 10.1007/s00384-023-04390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/22/2023]
Abstract
AIM The reversal of diverting loop ileostomy (DLI) is one of surgical trainees' first procedures. Complications of DLI reversal can cause life-threatening complications and increase patient morbidity. This study compared DLI reversals performed by surgical trainees with those by attending surgeons. METHOD This retrospective cohort study was performed at a single primary care center on 300 patients undergoing DLI reversal. The primary outcome was morbidity, according to the Clavien-Dindo classification (CDC), with special attention paid to the surgeon's level of training. The secondary endpoint was postoperative intestinal motility dysfunction. RESULTS Surgical trainees had significantly longer operation times (p < 0.001) than attending surgeons. Univariate analyses revealed no influence on the level of training for postoperative morbidity. First bowel movement later than 3 days after surgery was a significant risk factor for CDC [Formula: see text] 3 (OR, 4.348; 96% CI, 1670-11.321; p = 0.003). Independent risk factors for surgical site infections (SSIs) were an elevated BMI (OR, 1.162; 95% CI, 1.043-1.1294; p = 0.007) and a delayed bowel movement (OR, 3.973; 95% CI, 1.300-12.138; p = 0.015). For postoperative intestinal motility dysfunction, an independent risk factor was a primary malignant disease (OR, 1.980; 95% CI, 1.120-3.500; p = 0.019), and side-to-side stapled anastomosis was a protective factor (OR, 0.337; 95% CI 0.155-0.733; p = 0.006). CONCLUSION Even though surgical trainees needed significantly more time to perform the surgery, the level of surgical training was not a risk factor for increased postoperative morbidity. Instead, delayed first bowel movement was predictive of SSI.
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Affiliation(s)
- Clara von Savigny
- Department of General, Visceral, Transplantation, and Thoracic Surgery, Goethe University Frankfurt/Main, Frankfurt University Hospital and Clinics, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Mazen A Juratli
- Department of General, Visceral and Transplant Surgery, Muenster University Hospital, Muenster, Germany
| | - Christine Koch
- Department of Internal Medicine, Goethe University Frankfurt/Main, Frankfurt University Hospital and Clinics, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Tatjana Gruber-Rouh
- Institute of Diagnostical and Interventional Radiology, Goethe University Frankfurt/Main, Frankfurt University Hospital and Clinics, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Wolf O Bechstein
- Department of General, Visceral, Transplantation, and Thoracic Surgery, Goethe University Frankfurt/Main, Frankfurt University Hospital and Clinics, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Teresa Schreckenbach
- Department of General, Visceral, Transplantation, and Thoracic Surgery, Goethe University Frankfurt/Main, Frankfurt University Hospital and Clinics, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany.
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Fernández-Gálvez A, Rivera S, Durán Ventura MDC, de la Osa RMR. Nutritional and Educational Intervention to Recover a Healthy Eating Pattern Reducing Clinical Ileostomy-Related Complications. Nutrients 2022; 14:nu14163431. [PMID: 36014936 PMCID: PMC9416208 DOI: 10.3390/nu14163431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/01/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to evaluate a diet intervention implemented by our hospital in order to determinate its capacity to improve the eating pattern of patients with an ileostomy, facilitating the implementation new eating-related behaviors, reducing doubt and dissatisfaction and other complications. The study was conducted with a quasi-experimental design in a tertiary level hospital. The elaboration and implementation of a nutritional intervention consisting of a Mediterranean-diet-based set of menus duly modified that was reinforced by specific counseling at the reintroduction of oral diet, hospital discharge and first follow-up appointment. Descriptive, bivariate and multivariate analyses were performed. The protocol was approved by the competent Ethics Committee. The patients of the intervention group considered that the diet facilitated eating five or more meals a day and diminished doubt and concerns related to eating pattern. Most patients (86%) had a favorable experience regarding weight recovery and a significant reduction of all-cause readmissions and readmission with dehydration (p = 0.015 and p < 0.001, respectively). The intervention helped an effective self-management of eating pattern by patients who had a physical improvement related to hydration status, which, together with an improvement in weight regain, decreased the probability of readmissions.
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Affiliation(s)
- Antonio Fernández-Gálvez
- General and Digestive Surgery Department, University Hospital Virgen del Rocio, 410013 Seville, Spain
| | - Sebastián Rivera
- General and Digestive Surgery Department, University Hospital Virgen del Rocio, 410013 Seville, Spain
| | | | - Rubén Morilla Romero de la Osa
- Department Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 410013 Seville, Spain
- Institute of Biomedicine of Seville, University Hospital Virgen del Rocio, CSIC, University of Seville, 410013 Seville, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-635-991-295
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Ocaña J, García-Pérez JC, Labalde-Martínez M, Rodríguez-Velasco G, Moreno I, Vivas A, Clemente-Esteban I, Ballestero A, Abadía P, Ferrero E, Fernández-Cebrián JM, Die J. Can physiological stimulation prior to ileostomy closure reduce postoperative ileus? A prospective multicenter pilot study. Tech Coloproctol 2022; 26:645-653. [PMID: 35596903 DOI: 10.1007/s10151-022-02620-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/04/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to assess the impact of ileostomy closure following preoperative physiological stimulation (PPS) on postoperative ileus (POI) in patients with loop ileostomy after low anterior resection for rectal cancer. METHODS Patients who underwent ileostomy closure between January 2017 and February 2020 in two tertiary referral centers were prospectively included. PPS stimulation was compared to standard treatment. Stimulation was carried out daily during the 15 days prior to ileostomy closure by the patient's self-instillation of 200 ml of fecal contents from the ileostomy bag via the efferent loop, using a rectal catheter. Standard treatment (ST) consisted of observation. Outcomes measures were POI, morbidity, stimulation feasibility, and predictors to ileus. RESULTS A total of 58 patients were included [42 males and 16 females, median age 67 (43-85) years]. PPS was used in 24 patients, who completed the entire stimulation process, and ST in 34 patients. No differences in preoperative factors were found between the two groups. POI was significantly lower in the PPS group (4.2%) vs the ST group (32.4%); p < 0.01, OR: 0.05 (CI 95% 0.01-0.65). The PPS group had a shorter time to restoration of bowel function (1 day vs 3 days) p = 0.02 and a shorter time to tolerance of liquids (1 day vs 2 days), p = 0.04. Age (p = 0.01), open approach at index surgery, p = 0.03, adjuvant capecitabine (p = 0.01). and previous abdominal surgeries (p = 0.02) were associated with POI in the multivariate analysis. C-reactive-protein values on the 3rd (p = 0.02) and 5th (p < 0.01) postoperative day were also associated with POI. CONCLUSIONS PPS for patients who underwent ileostomy closure after low anterior resection for rectal cancer is feasible and might reduce POI.
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Affiliation(s)
- J Ocaña
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain.
| | - J C García-Pérez
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - M Labalde-Martínez
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - G Rodríguez-Velasco
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - I Moreno
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - A Vivas
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | | | - A Ballestero
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - P Abadía
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - E Ferrero
- Division of Coloproctology, Department of General and Digestive Surgery, 12 de Octubre University Hospital, Madrid, Spain
| | - J M Fernández-Cebrián
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
| | - J Die
- Division of Coloproctology, Department of General and Digestive Surgery, Ramon y Cajal University Hospital, Ctra. Colmenar Viejo, Km 9.100, 28034, Madrid, Spain
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Celayir MF, Tanal M, Besler E, Koksal H. Protective Loop Ileostomy Closure Techniques: Comparison of Three Different Surgical Techniques. Cureus 2020; 12:e10977. [PMID: 33094038 PMCID: PMC7571599 DOI: 10.7759/cureus.10977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective Anastomotic leaks can be very dangerous in colorectal cancers. Protective loop ileostomy is life-saving in low anterior rectal tumors to prevent pelvic sepsis. The aim of this study is to compare early morbidities for stapled, handsewn closure (end to end) or handsewn closure (anterior wall only) of loop ileostomy, and to further assess efficacy and safety for each technique. Methods Patients who underwent loop ileostomy closure from January 2014 and December 2019 retrospectively were analyzed. Multivariate logistic regression was used to determine the effect of the potential risk factors on the rate of each complication. The patients were divided into three groups based on the anastomoses. The first group included patients who had handsewn anterior closure; the second group included patients who had side-to-side anastomosis using linear stapler, and the third group included patients who had end-to-end handsewn anastomosis. The primary endpoint of the study was the postoperative 30 days. IBM Statistical Package for the Social Sciences (SPSS), version 22.0 (SPSS Inc., Chicago, IL) was used for statistical analysis. Results A total of 198 patients underwent reversal. There was a statistical difference between the handsewn anterior wall and stapler anastomosis in terms of postoperative ileus and wound infection. The handsewn group was superior to anastomosis with stapler (p: 0.027 and p: 0.042, respectively). A statistical difference was found between handsewn anterior wall closure and handsewn end-to-end anastomosis in terms of postoperative ileus, wound infection, and postoperative hospital stay (p: 0.013, p: 0.037, and p: 0.046, respectively). When stapled anastomosis and handsewn end-to-end anastomosis techniques were compared, a statistical difference was found in terms of postoperative ileus risk (p: 0.043), but no significant difference was found in terms of postoperative wound infection and hospital stay. Conclusions There was no significant difference in the rate of anastomotic leakage between the handsewn and stapled techniques. The rate of small-bowel obstruction was higher in the handsewn group. As a result, in this study, it was revealed that the handsewn anterior wall closure technique is the best among all ileostomy closure techniques.
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Affiliation(s)
- Mustafa F Celayir
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, TUR
| | - Mert Tanal
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, TUR
| | - Evren Besler
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, TUR
| | - Hakan Koksal
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, TUR
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Chan DKH, Ng J, Koh FHX, Lim T, Yeo D, Tan KY, Tan KK. Journey for patients following ileostomy creation is not straightforward. Int J Colorectal Dis 2019; 34:2075-2080. [PMID: 31707557 DOI: 10.1007/s00384-019-03428-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND An ileostomy is usually created to avert systemic sepsis in a patient with a tenuous anastomosis. However, what is often not reported are the numerous issues facing these patients subsequently, ranging from readmissions, non-reversal of the stoma, and complications from the closure. This study was performed to identify these issues among patients following creation of an ileostomy. METHODS We conducted a retrospective analysis of consecutive patients who had an ileostomy created from January 2011 to December 2016 at two institutions. Statistical analysis was performed to identify risk factors associated with readmissions and ileostomy non-reversal. RESULTS In total, 193 patients had an ileostomy created during the study period. Twenty-six (13.5%) patients developed stoma-related complications requiring readmission. The most common cause of readmission (9.3%) was due to dehydration and acute kidney injury secondary to high stoma output. One hundred thirty (67.4%) patients had their ileostomy reversed. On multivariate analysis, only stomas created during an ultra-low anterior resection were associated with reversal (OR 2.88 [95% CI, 1.24-6.68]; p = 0.014). Among the patients who underwent ileostomy reversal, seven (3.6%) patients developed complications from their ileostomy reversal. Four patients (2.1%) suffered from an anastomotic leak which required repeat surgical intervention with one mortality from the ensuing sepsis. CONCLUSION Almost half of the patients who had an Ileostomy had an undesirable outcome, including readmissions, non-reversal, and post-operative complications following closure. Patients need to be properly counselled about the risks involved prior to the index operation.
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Affiliation(s)
- Dedrick Kok Hong Chan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, System, 1E Kent Ridge Road, Singapore, 119228, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Rd, Singapore, Singapore
| | - Jingyu Ng
- Division of Colorectal Surgery, Ng Teng Fong General Hospital, National University Health System, 1E Kent Ridge Rd, Singapore, Singapore
| | - Frederick Hong-Xiang Koh
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Tianzhi Lim
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Danson Yeo
- Department of Surgery, Khoo Teck Puat Hospital, 1E Kent Ridge Rd, Singapore, Singapore
| | - Kok-Yang Tan
- Department of Surgery, Khoo Teck Puat Hospital, 1E Kent Ridge Rd, Singapore, Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, System, 1E Kent Ridge Road, Singapore, 119228, Singapore. .,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Rd, Singapore, Singapore.
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Garfinkle R, Savage P, Boutros M, Landry T, Reynier P, Morin N, Vasilevsky CA, Filion KB. Incidence and predictors of postoperative ileus after loop ileostomy closure: a systematic review and meta-analysis. Surg Endosc 2019; 33:2430-2443. [PMID: 31020433 DOI: 10.1007/s00464-019-06794-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/09/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Postoperative ileus (POI) is regarded as the most clinically significant morbidity following loop ileostomy closure; however, its incidence remains poorly understood. Our objective was therefore to determine the pooled incidence of POI after loop ileostomy closure and identify risk factors associated with its development. METHODS We systematically searched MEDLINE (via Ovid and PubMed), Embase, the Cochrane Library, Biosis Previews, and Scopus to identify studies reporting the incidence of POI in patients who underwent loop ileostomy closure. Two independent reviewers extracted data and appraised study quality. Cumulative incidence proportions were pooled across studies using a random-effects meta-analytic model. RESULTS Sixty-seven studies, including 9528 patients, met our inclusion criteria. The pooled estimate of POI was 8.0% (95% CI 6.9-9.3%; I2 = 74%). The estimated incidence varied by POI definition: studies with a robust definition of POI (n = 8) demonstrated the highest estimate of POI (12.4%, 95% CI 9.2-16.5%; I2 = 79%) while studies that did not report an explicit POI definition (n = 38) demonstrated the lowest estimate (6.7%, 95% CI 5.3-8.3%; I2 = 61%). Small bowel anastomosis technique (hand-sewn) and interval time from ileostomy creation to closure (longer time) were the factors most commonly associated with POI after loop ileostomy closure. However, most comparative studies were not powered to examine risk factors for POI. CONCLUSIONS POI is an important complication after loop ileostomy closure, and its incidence is dependent on its definition. More research aimed at studying this complication is required to better understand risk factors for POI after loop ileostomy closure.
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Affiliation(s)
- Richard Garfinkle
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Paul Savage
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada.,Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Marylise Boutros
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Tara Landry
- Medical Libraries, McGill University Health Center, Montreal, QC, Canada
| | - Pauline Reynier
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Nancy Morin
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Carol-Ann Vasilevsky
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Kristian B Filion
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. .,Department of Medicine, McGill University, Montreal, QC, Canada.
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