Feasibility of early closure of loop ileostomies

Bakx, Roel; Busch, Olivier R.; Geldere, Dirk van; Bemelman, Willem A.; Slors, J. F. M.; Lanschot, J. Jan B. van

doi:10.1007/bf02660775

Cited by 72 publications

(64 citation statements)

References 27 publications

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“…Stoma-related complications presented during the whole period the stoma was in place. Therefore, many of the encountered complications could have been avoided if the ileostomy had been closed earlier after its construction, for example during the same hospital admission [26]. An uncomplicated recovery after the initial operation and the absence of anastomotic leakage as radiologically tested by water-soluble contrast enema examination are of course crucial prerequisites for this early closure.…”

Section: Discussionmentioning

confidence: 99%

Morbidity of Temporary Loop Ileostomies

et al. 2004

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Background/Aims: A temporary loop ileostomy is constructed to protect a distal colonic anastomosis. Closure is usually performed not earlier than 8–12 weeks after the primary operation. During this period, stoma-related complications can occur and enhance the adverse effect on quality of life. The aim of this study was to evaluate the length of time between ileostomy construction and closure, to quantify stoma-related morbidity and to examine the potential advantages of early ileostomy closure. Methods: Sixty-nine patients with a temporary, protective loop ileostomy (constructed between January 1996 and December 2000) were retrospectively analysed. The analysis was done by reviewing the medical records and the notes of the stoma care nurse. Results: Sixty ileostomies (87%) were closed after a median period of 24 weeks (range 2–124 weeks). Stoma-related complications occurred in 29 of the 69 patients (42%), and 11 patients (18%) had complications after ileostomy closure. Conclusion: The length of time between ileostomy construction and closure was substantially longer than initially planned. Earlier ileostomy closure (preferably even during the initial admission) could reduce the frequently occurring stoma-related morbidity in these patients and thus improve quality of life.

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Section: Discussionmentioning

confidence: 99%

Morbidity of Temporary Loop Ileostomies

et al. 2004

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“…Early closure (EC) of the temporary loop ileostomy might reduce both stoma-related morbidity and patient discomfort. Two prospective non-randomized studies including 27 and 39 patients respectively 12,13 have evaluated the feasibility of EC of the temporary loop ileostomy after rectal surgery. These two pilot studies reported encouraging results, with no deaths and no need for revisional procedures.…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy

Alvès

Panís

Lelong

et al. 2008

British Journal of Surgery

153

162

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Background: Temporary faecal diversion is recommended with a low colorectal, coloanal or ileoanal anastomosis (LA). This randomized study evaluated early (EC; 8 days) versus late (LC; 2 months) closure of the temporary stoma.Methods: Patients undergoing rectal resection with LA were eligible to participate. If there was no radiological sign of anastomotic leakage after 7 days, patients were randomized to EC or LC. The primary endpoints were postoperative morbidity and mortality 90 days after the initial resection.Results: Some 186 patients were analysed. There were no deaths within 90 days and overall morbidity rates were similar in the EC and LC groups (31 versus 38 per cent respectively; P = 0·254). Overall surgical complication (both 15 per cent; P = 1·000) and reoperation (both 8 per cent; P = 1·000) rates were similar, but wound complications were more frequent after EC (19 versus 5 per cent; P = 0·007). Small bowel obstruction (3 versus 16 per cent; P = 0·002) and medical complications (5 versus 15 per cent; P = 0·021) were more common with LC. Median (range) hospital stay was reduced by EC (16 (6-59) versus 18 (9-262) days; P = 0·013). Conclusion:Early stoma closure is feasible in selected patients, with reduced hospital stay, bowel obstruction and medical complications, but a higher wound complication rate. Registration number: NCT00428636 (http://www.clinicaltrials.gov).

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“…Perez et al [10] reported a higher rate of postoperative complications in patients operated earlier than 8.5 weeks after the primary surgery and concluded that the time interval should not be shorter. Bakx et al [22], however, showed that loop ileostomy closure is possible as early as 7–21 days after its construction in selected patients. Mansfield et al [23] reported more postoperative complications in patients with a shorter interval to ileostomy closure, whereas Hallböök et al [24] did not find any differences.…”

Section: Discussionmentioning

confidence: 99%

Early Closure of Ileostomy Is Associated with Less Postoperative Nausea and Vomiting

Worni¹,

Witschi²,

Gloor³

et al. 2011

Dig Surg

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Background/Aims: Temporary loop ileostomy is increasingly used in colorectal surgery but necessitates secondary closure. We evaluated postoperative complications, particularly nausea and vomiting, in patients with early, intermediate, or late elective ileostomy closure. Methods: We included all patients undergoing ileostomy closure from 2001 to 2008. Time from ileostomy construction to closure was classified as early (EC, <12 weeks), intermediate (IC, 12–18 weeks), and late (LC, >18 weeks). Using multivariable logistic regression, we compared the frequency of postoperative complications between the groups. Results: We included 134 patients (87 males; median age 71 years, range 29–91). Carcinoma of the rectum (n = 67, 50%) was the main reason for ileostomy construction. The median time to ileostomy closure was 103 days (range 8–461). Among patients with EC, IC, and LC, postoperative nausea occurred in 50.0, 73.1, and 78.6%, respectively (p = 0.006), and postoperative vomiting in 22.5, 57.7, and 59.5%, respectively (p = 0.001). Adjusting for important covariates, the odds ratio for postoperative nausea was 2.0 (95% CI 0.76–5.1) for IC and 4.1 (95% CI 1.2–14.3) for LC compared to EC (p = 0.069). For postoperative vomiting, adjusted odds ratios were 3.8 (95% CI 1.4–10.4) for IC and 4.6 (95% CI 1.4–15.5) for LC (p = 0.012). Other complications did not differ between the groups. Conclusions: These findings suggest that early ileostomy closure might reduce postoperative nausea and vomiting.

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Feasibility of early closure of loop ileostomies

Abstract: Closure of a loop ileostomy early after the initial operation was feasible in 18 of 27 patients and was associated with low morbidity and no mortality.

Cited by 72 publications

References 27 publications

Morbidity of Temporary Loop Ileostomies

Morbidity of Temporary Loop Ileostomies

Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy

Early Closure of Ileostomy Is Associated with Less Postoperative Nausea and Vomiting

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