Safety of early ileostomy closure: a systematic review and meta-analysis of randomized controlled trials
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REVIEW
Safety of early ileostomy closure: a systematic review and meta-analysis of randomized controlled trials Frederik Bjerg Clausen 1
&
Niclas Dohrn 2
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Emma Rosenkrantz Hölmich 1
&
Mads Klein 2
&
Ismail Gögenur 1
Accepted: 17 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Patients with a defunctioning ileostomy after rectal resection experience substantial ileostomy-related morbidity and decreased quality of life. Early reversal of the defunctioning ileostomy has been proposed as a method of mitigating these problems. We aimed to evaluate the safety of early ileostomy closure within 6 weeks. Method Randomized controlled trials investigating the safety of early ileostomy closure were identified through a systematic search and review of the current literature. Meta-analysis of the extracted outcome data was performed, and the methodological quality of the individual studies was assessed. Results The search identified six eligible studies yielding a total of 528 patients, with 269 in the early closure (EC) group and 259 in the standard closure (SC) group. Major complications in the EC group was 5.2% compared with 3.6% in the SC group (RR = 1.12, 95% CI 0.33–3.79). Anastomotic leakage in the EC group was 3.3% compared with 3.5% in the SC group (RR = 0.89, 95% CI 0.29–2.75). The meta-analysis resulted in no statistically significant differences between the groups in any of the primary or secondary outcomes. Conclusion This review was not able to discern a statistically significant difference in postoperative complications when comparing early and standard ileostomy closure. The current literature indicates that early ileostomy closure is not associated with higher complication rates in patients with an uncomplicated postoperative course and radiologically verified intact distal anastomosis after index surgery. Keywords Ileostomy closure . Rectal resection . Colorectal cancer . Loop ileostomy
Introduction Anastomotic leakage remains a serious and common complication after rectal resection [1–3]. In order to reduce the severity of complications associated with anastomotic leakage, a temporary defunctioning ileostomy is often performed at index surgery. The defunctioning ileostomy diverts the fecal content away from the healing low anastomosis, thereby reducing the risk of fecal contamination of the abdominal cavity in the event of an anastomotic insufficiency. Closure of the defunctioning ileostomy has classically been performed 8–12 weeks after primary surgery. The ileostomy itself is however associated with substantial morbidity
[4] and decreased quality of life for the patient [1–3]. Ileostomyrelated morbidity reported in RCTs range from 2.9 to 62.2% with a median rate of 14.3% [4]. This increases with the time to ileostomy closure [5], and it has therefore been suggested that early closure (EC) of the ileostomy could reduce these detrimental effects, while still preserving the protective effect [6]. The safety of EC has, however, not yet been established.
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