A systematic review and meta-analysis of diverting loop ileostomy versus total abdominal colectomy for the treatment of
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SYSTEMATIC REVIEWS AND META-ANALYSES
A systematic review and meta-analysis of diverting loop ileostomy versus total abdominal colectomy for the treatment of Clostridium difficile colitis Mario Trejo-Avila 1 & Omar Vergara-Fernandez 1 & Danilo Solórzano-Vicuña 1 & Oscar Santes 1 & Juan Carlos Sainz-Hernández 1 & Paulina Moctezuma-Velázquez 1 & Noel Salgado-Nesme 1 Received: 17 April 2020 / Accepted: 12 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Clostridium difficile is an increasingly common source of in-patient morbidity and mortality. We aim to assess the effects of diverting loop ileostomy (DLI) versus total abdominal colectomy (TAC) for Clostridium difficile colitis (CDC), in terms of mortality and morbidity. Methods Systematic literature search was performed using PubMed, Embase, Cochrane, and Web of Science databases for randomized and non-randomized studies comparing DLI and TAC for fulminant CDC. Meta-analysis was carried out for mortality and postoperative complications. Results Five non-randomized studies qualified for inclusion in the quantitative synthesis. In total, 3683 patients were allocated to DLI (n = 733) or TAC (n = 2950). The overall mortality was equivalent (OR 0.73; 95% CI 0.45–1.20; P = 0.22). Regarding secondary outcomes, the pooled analysis revealed the following equivalent rates of postoperative events: thromboembolism (OR 0.45; 95% CI 0.14–1.43; P = 0.18), acute renal failure (OR 1.71; 95% CI 0.91–3.23; P = 0.10), surgical site infection (OR 0.95; 95% CI 0.11–8.59; P = 0.97), pneumonia (OR 0.98; 95% CI 0.36–2.66; P = 0.97), urinary tract infection (OR 0.81; 95% CI 0.26– 2.52; P = 0.72), and reoperation (OR 0.95; 95% CI 0.50–1.82; P = 0.78). The ostomy reversal rate was significantly higher in DLI (OR 12.55; 95% CI 3.31–47.55; P = 0.0002). Conclusions The overall morbidity and mortality rates between DLI and TAC for the treatment of CDC seemed to be equivalent. Evidence from a randomized controlled trial is needed to clarify the timing and understand the impact of DLI for CDC. Keywords Clostridium difficile . Diverting loop ileostomy . Emergency surgery for clostridium . Fulminant colitis . Total abdominal colectomy
Introduction Clostridium difficile, currently known as Clostridioides difficile, has become one of the leading causes of healthcareassociated infections, with an incidence of up to 35.15 cases per 1000 admissions reported in the USA [1]. Clostridium difficile colitis (CDC) is currently recognized as a significant
* Mario Trejo-Avila [email protected] 1
Department of Colorectal Surgery, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Vasco de Quiroga 15, Tlalpan, 14080 Mexico City, Mexico
cause of morbidity, and the attributable mortality at 30 days is 6.9% [2]. CDC may present with a range of symptoms, from selflimited diarrhea to septic shock and toxic megacolon. Treatment guidelines have been designed to stratify patients according to the severity of the disease and to provide treatment rec
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