Post-operative complications in patients undergoing early closure compared to delayed closure of ileostomy: A meta-analysis.
- Author:
Raleigh Lean P. Rojas
;
Manuel Rafael R. Azares
- Publication Type:Meta-Analysis
- Keywords:
early closure;
late closure;
reversal;
defunctioning stoma;
colon surgery;
bowel surgery
- MeSH:
Ileostomy
- From:
Philippine Journal of Surgical Specialties
2019;74(1):24-32
- CountryPhilippines
- Language:English
-
Abstract:
BACKGROUND: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.
METHODS: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.
RESULTS: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).
CONCLUSION: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.
- Full text:Post-operative complications in patientS.pdf
