OUTCOMES OF LOOP ILEOSTOMY CLOSURE METHODS

BACKGROUND: Preventive ileostomy closure has potential risk of severe complications with 30% rate of postoperative morbidity and 4% rate of mortality. There is no relevant data (evidence) which method of ileostomy closure is a method of choice. AIM. To identify effective and safe method of ileostomy closure. PATIENTS AND METHODS. A prospective randomized controlled single centre trial was carried out in State Scientific Centre of Coloproctology (Moscow, Russia) during the period 2015-2017. Patients with defunctioning ileostomy were randomized to closure by hand-sewn end-to-end anastomosis group, by hand-sewn side-to-side anastomosis group and by stapled side-to-side anastomosis group. RESULTS. The trial recruited 327 patients. Mortality rate was 0.3%, one post-op death occurred in hand-sewn side-to-side anastomosis group (p=1.0). Morbidity rate was 14.4% in hand-sewn end-to-end anastomosis group, 18.4% in hand-sewn side-to-side anastomosis group and 11.7% stapled side-to-side anastomosis group (p=0.5). Hand-sewn side-to-side anastomosis was associated with longest time of anastomosis creation (49.3 min p<0.05), longest total operative time (105.7 min p<0.05) and longest post-op stay (9.3 days; p<0.05). Stapled anastomosis was faster than hand-sewn (20 min vs 33.1 min and 49.3 min; p<0.001). CONCLUSION. Superiority in ileostomy closure methods was not obtained. Stapled side-to-side method makes procedure significantly faster and significantly reduces postoperative ileus rate.

loop ileostomy closure, reversal ileostomy closure, ileostomy closure, hand sewn anastomosis, stapler anastomosis

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