Outcomes of Early versus Standard Closure of Diverting Ileostomy after Proctectomy: Meta-analysis and Meta-regression Analysis of Randomized Controlled Trials.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
02 Oct 2023
02 Oct 2023
Historique:
medline:
3
10
2023
pubmed:
3
10
2023
entrez:
3
10
2023
Statut:
aheadofprint
Résumé
We aimed to compare outcomes of early and standard closure of diverting loop ileostomy (DLI) after proctectomy and determine risk factors for anastomotic leak (AL) and complications. Formation of DLI has been a routine practice after proctectomy to decrease the incidence and potential adverse sequela of AL. PubMed, Scopus and Web of Science were searched for randomized controlled trials (RCTs) that compared outcomes of early versus standard closure of DLI after proctectomy. Main outcome measures were postoperative complications, AL, ileus, surgical site infection (SSI), reoperation, readmission, and hospital stay following DLI closure. Eleven RCTs (932 patients; 57% male) were included. Early closure group included 474 patients and standard closure 458 patients. Early closure was associated with higher odds of AL (OR: 2.315, P=0.013) and similar odds of complications (OR: 1.103, P=0.667), ileus (OR: 1.307, P=0.438), SSI (OR:1.668, P=0.079), reoperation (OR: 1.896, P=0.062) and readmission (OR: 3.431, P=0.206). Hospital stay was similar (WMD: 1.054, P=0.237). Early closure had higher odds of AL than standard closure when early closure was done ≤2 weeks (OR: 2.12, P=0.047) but not within 3-4 weeks (OR: 2.98, P=0.107). Factors significantly associated with complications after early closure were diabetes mellitus, smoking, and closure of DLI ≤2 weeks whereas factors associated with AL were ≥ASA II classification and diabetes mellitus. Early closure of DLI after proctectomy has a higher risk of AL, particularly within two weeks of DLI formation. On the basis of this study, routine early ileostomy closure cannot be recommended.
Sections du résumé
OBJECTIVE
OBJECTIVE
We aimed to compare outcomes of early and standard closure of diverting loop ileostomy (DLI) after proctectomy and determine risk factors for anastomotic leak (AL) and complications.
SUMMARY BACKGROUND DATA
BACKGROUND
Formation of DLI has been a routine practice after proctectomy to decrease the incidence and potential adverse sequela of AL.
METHODS
METHODS
PubMed, Scopus and Web of Science were searched for randomized controlled trials (RCTs) that compared outcomes of early versus standard closure of DLI after proctectomy. Main outcome measures were postoperative complications, AL, ileus, surgical site infection (SSI), reoperation, readmission, and hospital stay following DLI closure.
RESULTS
RESULTS
Eleven RCTs (932 patients; 57% male) were included. Early closure group included 474 patients and standard closure 458 patients. Early closure was associated with higher odds of AL (OR: 2.315, P=0.013) and similar odds of complications (OR: 1.103, P=0.667), ileus (OR: 1.307, P=0.438), SSI (OR:1.668, P=0.079), reoperation (OR: 1.896, P=0.062) and readmission (OR: 3.431, P=0.206). Hospital stay was similar (WMD: 1.054, P=0.237). Early closure had higher odds of AL than standard closure when early closure was done ≤2 weeks (OR: 2.12, P=0.047) but not within 3-4 weeks (OR: 2.98, P=0.107). Factors significantly associated with complications after early closure were diabetes mellitus, smoking, and closure of DLI ≤2 weeks whereas factors associated with AL were ≥ASA II classification and diabetes mellitus.
CONCLUSIONS
CONCLUSIONS
Early closure of DLI after proctectomy has a higher risk of AL, particularly within two weeks of DLI formation. On the basis of this study, routine early ileostomy closure cannot be recommended.
Identifiants
pubmed: 37788345
doi: 10.1097/SLA.0000000000006109
pii: 00000658-990000000-00656
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest and Source of Funding: None of the authors has any relevant financial disclosures. Dr. Wexner reports receiving consulting fees from ARC/Corvus, Astellas, Baxter, Becton Dickinson, GI Supply, ICON Language Services, Intuitive Surgical, Leading BioSciences, Livsmed, Medtronic, Olympus Surgical, Stryker, Takeda and receiving royalties from Intuitive Surgical and Karl Storz Endoscopy America Inc. Dr. Emile reports receiving consulting fees from SafeHeal.