Randomized clinical trial of early <i>versus</i> delayed temporary stoma closure after proctectomy

Alvès, Arnaud; Panís, Yves; Lelong, Bernard; Dousset, B.; Benoist, Stéphane; Vicaut, Éric

doi:10.1002/bjs.6212

Cited by 153 publications

(191 citation statements)

References 18 publications

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“…Another controversy around the subject is the best timing for stoma reversal. Some groups defend very early closure, even during the first admission, such as Alves et al [23] , who perform reversal on the 8 th postoperative day if no complications of the first intervention have occurred. Nevertheless, it is widely accepted to delay closure, and different studies report mean times of 3-6 mo, with a low medical priority given to this procedure [24] .…”

Section: Discussionmentioning

confidence: 99%

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Rubio-Perez¹,

León²,

Pastor³

et al. 2014

WJGS

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AIM:To study the morbidity and complications associated to ileostomy reversal in colorectal surgery patients, and if these are related to the time of closure. METHODS:A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance. RESULTS:The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy creation was rectal cancer (56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the patients, with 1% mortality. The most frequent were ileus (13%) and wound infection (13%). Pseudomembranous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomy closure (P = 0.041). Male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003). End-to-end intestinal anastomosis without resection was significantly associated with postoperative ileus (P = 0.037). CONCLUSION:Although closure of a protective ileostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Protective ileostomy; Stomas; Stoma-related complications; Surgical infections; Colorectal surgery Core tip: Protective ileostomies are widely used by surgeons for the protection of anastomoses, but they imply a second intervention for reversal. Despite being considered a minor intervention, ileostomy reversal does not lack complications. Adjuvant treatment, complications from the first intervention, or low-priority consideration can delay the closure of the stoma. In our study, we reviewed all complications following ileostomy reversal and found they were considerably high (40%), and increased as did the time (in months) until closure (P = 0.041). In multivariate analysis, male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003).Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R. Increased postoperative complications after protective ileostomy closure delay: An institutional study. World J Gastrointest Surg 2014; 6(9): 169-174 Available from:

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Section: Discussionmentioning

confidence: 99%

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Rubio-Perez¹,

León²,

Pastor³

et al. 2014

WJGS

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“…10 Alves et al, concluded in their study that in selected patients, early stoma closure is feasible with reduced hospital stay, bowel obstruction and medical complications, but a higher wound complication rate. 14 According to two randomized trials, preoperative chemo-radiotherapy did not increase early postoperative mortality and morbidity significantly. In selected patients early stoma closure could be considered even following preoperative chemo radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Early Closure of Temporary Stoma

Alam¹,

Gondal²,

Siddique³

et al. 2016

Annals KEMU

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Introduction: A stoma is a surgical procedure in which a part of gut is taken out and connected on the anterior abdominal wall. An anastomosis is the joining together of the two intestinal ends that remain after a diseased section has been removed. The closure of the stoma though thought to be minor surgical procedure, yet it may be associated with appreciable morbidity. When the reversal of stoma is done in less than 8 weeks following primary surgery then it is considered to be early closure. Early closure of the temporary stoma might reduce both stoma -related complications and patient ailment. Wound complications are common but there are many associated morbidities due to delay in closure. So the aim of this study is to find the complications associated with early closure of temporary

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“…Perhaps, and whenever possible, earlier reversal of an ileostomy could reduce these costs24. The pH values recorded were not notably different from physiological values and there were only a few positive cultures.…”

Section: Discussionmentioning

confidence: 85%

Randomized clinical trial of intracutaneouslyversustranscutaneously sutured ileostomy to prevent stoma-related complications (ISI trial)

Sier¹,

Wisselink²,

Ubbink³

et al. 2018

British Journal of Surgery

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BackgroundIleostomy construction is a common procedure but can be associated with morbidity. The stoma is commonly secured to the skin using transcutaneous sutures. It is hypothesized that intracutaneous sutures result in a tighter adherence of the peristomal skin to the stoma plate to prevent faecal leakage. The study aimed to compare the effect of intracutaneous versus transcutaneous suturing of ileostomies on faecal leakage and quality of life.MethodsThis randomized trial was undertaken in 11 hospitals in the Netherlands. Patients scheduled to receive an ileostomy for any reason were randomized to intracutaneous or transcutaneous suturing (IC and TC groups respectively). The primary outcome was faecal leakage. Secondary outcomes were stoma‐related quality of life and costs of stoma‐related materials and reinterventions.ResultsBetween April 2011 and February 2016, 339 patients were randomized to the IC (170) or TC (169) group. Leakage rates were higher in the IC than in the TC group (52·4 versus 41·4 per cent respectively; risk difference 11·0 (95 per cent c.i. 0·3 to 21·2) per cent). Skin irritation rates were high (78·2 versus 72·2 per cent), but did not differ significantly between the groups (risk difference 6·1 (95 per cent c.i. –3·2 to 15·10) per cent). There were no significant differences in quality of life or costs between the groups.ConclusionIntracutaneous suturing of an ileostomy is associated with more peristomal leakage than transcutaneous suturing. Overall stoma‐related complications did not differ between the two techniques. Registration number: NTR2369 ( http://www.trialregister.nl).

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

Cited by 153 publications

References 18 publications

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Outcome of Early Closure of Temporary Stoma

Randomized clinical trial of intracutaneouslyversustranscutaneously sutured ileostomy to prevent stoma-related complications (ISI trial)

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