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Early Closure of Defunctioning Loop Ileostomy: Is It Beneficial for the Patient? A Meta-analysis

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Abstract

Objective

To perform a meta-analysis to answer the question, whether early closure (EC) of defunctioning loop ileostomy may be beneficial for patient as compared with late closure (LC) without exceeding the risk of surgical-related morbidity.

Design

Medline and the Cochrane Trials Register were searched for trials published up to November 2016 comparing EC (defined as ≤14 days from the index operation in which the ileostomy was performed) versus LC for stoma closure after rectal surgery. Meta-analysis was performed using Review Manager 5.0. Inclusion criteria

Main outcome measures

Overall morbidity rate, anastomotic leakage rate, and wound infection rate within 90 days after elective surgery.

Results

Six studies were included and analyzed, yielding 570 patients (252 in EC group and 318 in LC). Meta-analysis showed no significant difference in the overall morbidity rate between the EC and LC groups (OR 0.63; 95% CI, 0.22–1.78; P = 0.38). Despite a significant higher wound infection rate of stoma site (OR 3.83; 95% CI 2.14–6.86; P < 0.00001), meta-analysis showed no significant difference in the anastomotic leakage rate between the EC and LC groups (OR 0.63; 95% CI 0.22–1.78; P = 0.38). Moreover, both stoma-related complications (OR 0.46; 95% CI 0.24–0.86; P = 0.02) and small bowel obstruction rates (OR 0.11; 95% CI 0.06–0.20; P < 0.00001) were significantly lower in the EC group than in the LC group, respectively.

Limitations

Heterogeneity of the studies

Conclusion

This meta-analysis suggests that EC of a defunctioning loop ileostomy is effective and safe in careful selected patients without increasing overall postoperative complications. This promising strategy should be proposed in patients in order to reduce stoma-related complications.

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Acknowledgments

We thank Hugh McGonigle, from Edanz Group (www.edanzediting.com/ac), for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France

    Benjamin Menahem, Jean Lubrano, Antoine Vallois & Arnaud Alves

  2. UMR INSERM U1086 Cancers et prevention, Centre François Baclesse, avenue du Général Harris, 14045, Caen Cedex, France

    Benjamin Menahem & Jean Lubrano

  3. UFR de Médecine, 2 rue des Rochambelles, 14033, Caen Cedex, France

    Benjamin Menahem, Jean Lubrano, Antoine Vallois & Arnaud Alves

Authors
  1. Benjamin Menahem
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  2. Jean Lubrano
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  4. Arnaud Alves
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Contributions

Conception and design: BM, AA. Acquisition of data: BM, JL, AV. Analysis and interpretation of data: BM, AA. Drafting the article: BM, AA. Final approval: JL, AA.

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Correspondence to Benjamin Menahem.

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Menahem, B., Lubrano, J., Vallois, A. et al. Early Closure of Defunctioning Loop Ileostomy: Is It Beneficial for the Patient? A Meta-analysis. World J Surg 42, 3171–3178 (2018). https://doi.org/10.1007/s00268-018-4603-0

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