Revising our concepts about stoma covering a low rectal anastomosis

Introduction: There has been conclusive evidence that defunctioning stoma with either transverse colostomy or ileostomy mitigates the serious consequences of anastomotic leakage. However,whether transverse colostomy or ileostomy is preferred for defunctioning a rectal anastomosis remains controversial. The present study was designed to identify the best defunctioning stoma for colorectal anastomosis. Objective: To improve the quality of life in patients with rectal resection and anastomosis and reduce the morbidity before and after closure of the stoma. Patients and Methods The present study included 48 patients with elective colorectal resection who were randomly arranged into 2 equal groups, with 24 patients each. Group I consisted of patients who underwent ileostomy, and group II consisted of patients who underwent colostomy as a defunctioning stoma for a low rectal anastomosis. All surviving patients were readmitted to have their stoma closed and were followed-up for 6 months after closure of their stomas. All data regarding local and general complications of construction and closure of the stoma of the two groups were recorded and blotted against each other to clarify the most safe and tolerable procedure. Results: We found that all nutritional deficiencies, dehydration, electrolytes imbalance, peristomal dermatitis, and frequent change of appliances are statistically more common in the ileostomy group, while stomal retraction and wound infection after closure of the stoma were statistically more common in the colostomy group. There were no statistically significant differences regarding the total hospital stay and mortality between the two groups. Conclusion and Recommendation: Ileostomy has much higher morbidities than colostomy and it also has a potential risk of mortality; therefore, we recommend colostomy as the ideal method for defunctioning a distal colorectal anastomosis. (AU)

Post-operative complications in patients undergoing early closure compared to delayed closure of ileostomy: A meta-analysis

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.