Complications of Loop Ileostomy Closure in Patients with Rectal Tumor

Loop ileostomy closure after colorectal surgery is often associated with Postoperative ileus, with an incidence between 13–20%. The aim of this study is to evaluate the efficacy and safety of preoperative stimulation of the efferent loop with probiotics prior to ileostomy closure in patients operated on for colorectal carcinoma. For this, a prospective, randomized, double-blind, controlled study is designed. All patients who underwent surgery for colorectal carcinoma with loop ileostomy were included. Randomized and divided into two groups, 34 cases and 35 controls were included in the study. Postoperative ileus, the need for nasogastric tube insertion, the time required to begin tolerating a diet, restoration of bowel function, and duration of hospital stay were evaluated. The incidence of Postoperative ileus was similar in both groups, 9/34 patients stimulated with probiotics and 10/35 in the control group (CG) with a p = 0.192. The comparative analysis showed a direct relationship between Postoperative ileus after oncological surgery and Postoperative ileus after reconstruction surgery, independently of stimulation. Postoperative ileus after closure ileostomy is independent of stimulation of the ileostomy with probiotics through the efferent loop. There seem to be a relationship between Postoperative ileus after reconstruction and the previous existence of Postoperative ileus after colorectal cancer surgery.

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Tu1529 Stapled Loop Ileostomy Closure: Does Stapler Length Matter?

Gastroenterology ◽

10.1016/s0016-5085(13)64176-1 ◽

2013 ◽

Vol 144 (5) ◽

pp. S-1120

Author(s):

Rahul Narang ◽

Sudhir Kalaskar ◽

Hoong-Yin Chong ◽

Rama Ganga ◽

Giovanna da Silva ◽

...

Keyword(s):

Loop Ileostomy ◽

Ileostomy Closure

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EP.TH.959Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer surgery: An ongoing dilemma

British Journal of Surgery ◽

10.1093/bjs/znab309.098 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Shahin Hajibandeh ◽

Shahab Hajibandeh ◽

Pratik Bhattacharya ◽

Reza Zakaria ◽

Christopher Thompson ◽

...

Keyword(s):

Rectal Cancer ◽

Adjuvant Chemotherapy ◽

Surgical Site Infection ◽

Hospital Stay ◽

Perioperative Complications ◽

Loop Ileostomy ◽

Length Of Hospital Stay ◽

Ileostomy Closure ◽

Site Infection ◽

Cancer Resection

Abstract Aims To evaluate comparative outcomes of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection. Methods We systematic searched MEDLINE; EMBASE; CINAHL; CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. Overall perioperative complications, anastomotic leak, surgical site infection, ileus and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models. Results We identified 4 studies reporting a total of 436 patients comparing outcomes of temporary loop ileostomy closure during (n = 185) or after (n = 251) adjuvant chemotherapy following colorectal cancer resection. There was no significant difference in overall perioperative complications (OR 1.39; 95% CI 0.82-2.36, p = 0.22), anastomotic leak (OR 2.80; 95% CI 0.47-16.56, p = 0.26), surgical site infection (OR 1.97; 95% CI 0.80-4.90, p = 0.14), ileus (OR 1.22; 95% CI 0.50-2.96, p = 0.66) or length of hospital stay (MD 0.02; 95% CI -0.85-0.89, p = 0.97) between two groups. Between-study heterogeneity was low in all analyses. Conclusions The meta-analysis of best, albeit limited, available evidence suggests that temporary loop ileostomy closure during adjuvant chemotherapy following rectal cancer resection may be associated with comparable outcomes to closure of ileostomy after adjuvant chemotherapy. We encourage future research to concentrate on completeness of chemotherapy and quality of life which can determine appropriateness of either approach.

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Stringent fluid management might help to prevent postoperative ileus after loop ileostomy closure

Langenbeck s Archives of Surgery ◽

10.1007/s00423-018-1744-4 ◽

2019 ◽

Vol 404 (1) ◽

pp. 39-43 ◽

Cited By ~ 3

Author(s):

Fabian Grass ◽

Basile Pache ◽

Fabio Butti ◽

Josep Solà ◽

Dieter Hahnloser ◽

...

Keyword(s):

Postoperative Ileus ◽

Loop Ileostomy ◽

Fluid Management ◽

Ileostomy Closure

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Loop Ileostomy Closure at an Ambulatory Surgery Facility

Diseases of the Colon & Rectum ◽

10.1007/s10350-004-6587-0 ◽

2003 ◽

Vol 46 (4) ◽

pp. 486-490 ◽

Cited By ~ 45

Author(s):

Matthew F. Kalady ◽

Ryan C. Fields ◽

Stephen Klein ◽

Karen C. Nielson ◽

Christopher R. Mantyh ◽

...

Keyword(s):

Ambulatory Surgery ◽

Loop Ileostomy ◽

Ileostomy Closure

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Incidence and risk factors for incisional hernia after temporary loop ileostomy closure: choosing candidates for prophylactic mesh placement

Hernia ◽

10.1007/s10029-019-02042-3 ◽

2019 ◽

Vol 24 (1) ◽

pp. 93-98 ◽

Cited By ~ 1

Author(s):

A. G. Barranquero ◽

E. Tobaruela ◽

M. Bajawi ◽

P. Muñoz ◽

J. Die Trill ◽

...

Keyword(s):

Risk Factors ◽

Incisional Hernia ◽

Loop Ileostomy ◽

Ileostomy Closure ◽

Prophylactic Mesh ◽

Mesh Placement

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Toxic megacolon due to Salmonella acute infectious colitis requiring total colectomy following loop ileostomy closure

ANZ Journal of Surgery ◽

10.1111/ans.15973 ◽

2020 ◽

Vol 90 (12) ◽

Author(s):

Shane Belvedere ◽

Jake D. Foster ◽

Mikael L. Soucisse ◽

Satish K. Warrier ◽

Alexander G. Heriot

Keyword(s):

Toxic Megacolon ◽

Total Colectomy ◽

Loop Ileostomy ◽

Ileostomy Closure ◽

Infectious Colitis

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Cost Analysis of Early versus Delayed Loop Ileostomy Closure: A Case-Matched Study

Digestive Surgery ◽

10.1159/000375324 ◽

2015 ◽

Vol 32 (3) ◽

pp. 166-172 ◽

Cited By ~ 12

Author(s):

Jason Robertson ◽

Hannah Linkhorn ◽

Ryash Vather ◽

Rebekah Jaung ◽

Ian P. Bissett

Keyword(s):

Wound Infection ◽

Infection Rate ◽

Loop Ileostomy ◽

Hospital Readmissions ◽

Hospital Costs ◽

Cost Effective ◽

Wound Infection Rate ◽

Ileostomy Closure ◽

Total Direct Cost ◽

Optimal Timing

Background/Aims: The optimal timing for the closure of loop ileostomies remains controversial. The aim of the current study was to investigate whether early ileostomy closure (EC) (<2 weeks post-formation) results in significant healthcare savings as against late closure (LC). Methods: Patients with available cost data that underwent EC between January 2008 and December 2012 were compared against matched patients undergoing LC during the same period. Direct hospital costs for the two groups were compared. Results: There were 42 EC patients and 61 LC patients. EC patients had significantly less ileostomy-related complications (p < 0.001) and hospital readmissions (p < 0.001). Operative time (p < 0.001) and operative cost (p = 0.002) were also both significantly less in the EC group. Community nursing costs favoured the LC group (p = 0.047). The EC group had an increased post-closure wound infection rate (p = 0.02). The mean total direct cost per patient was NZD 13,724 (SD NZD 3,736) for EC and NZD 16,728 (SD NZD 8,028) for LC. Representing an average costs saving of NZD 3,004 per patient favouring EC (p = 0.012). Conclusion: Although EC increases the post-closure wound infection rate, EC reduces ileostomy complications, hospital readmissions and operative costs resulting in significant healthcare savings. In order to improve patient outcomes and make EC even more cost effective, efforts should be taken to reduce wound infections.

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