Author(s): Raleigh Lean P. Rojas, MD and Manuel Rafael R. Azares, MD
The objective of this study was to evaluate the postoperative outcomes of early ileostomy closure compared to delayed closure in adult patients that have undergone bowel surgery. Specific outcomes measured included wound infection, ileus, postoperative obstruction, anastomotic failure, total number of complications and mortality.
Online search was made through Medline, Cochrane, EBSCHost, and ClinicalKey databases up to June 2018 for randomized controlled trials comparing early (<4 weeks) and delayed (>4 weeks) closure of ileostomy. Review Manager 5.3 was utilized for data analysis. The odds ratio was determined for each of the outcomes.
Eight RCT’s met the inclusion criteria, yielding 1126 patients (506 in early closure and 620 in delayed closure group). Statistical analysis showed no advantage of delayed closure over early closure of ileostomy in terms of post-operative complications (OR 1.13, 95% CI, 0.84-1.54, p=0.45), rate of anastomotic leakage (OR 0.96;95% CI, 0.55-1.66, p=0.54) and over-all mortality (OR 2.00;95% CI, 0.18-22.29, p=0.57). Early closure patients were found to be less likely to have post-operative ileus or obstruction when compared to delayed closure (OR 0.36;95% CI, 0.14-0.90, p=0.03). However, early closure was more likely to cause postoperative wound infection compared to delayed closure (OR 2.32;95% CI, 1.48-3.63, p=0.0002).
Early closure of ileostomy is beneficial in terms of development of less post-operative ileus. Delayed closure of ileostomy is advantageous in terms of less wound infections.
Key words: early closure, late closure, reversal, defunctioning stoma, ileostomy, colon surgery, bowel surgery