Early Closure of Defunctioning Loop Ileostomy: Is It Beneficial for the Patient? A Meta-analysis.
World J Surg
; 42(10): 3171-3178, 2018 10.
Article
en En
| MEDLINE
| ID: mdl-29589116
ABSTRACT
OBJECTIVE:
To perform a meta-analysis to answer the question, whether early closure (EC) of defunctioning loop ileostomy may be beneficial for patient as compared with late closure (LC) without exceeding the risk of surgical-related morbidity.DESIGN:
Medline and the Cochrane Trials Register were searched for trials published up to November 2016 comparing EC (defined as ≤14 days from the index operation in which the ileostomy was performed) versus LC for stoma closure after rectal surgery. Meta-analysis was performed using Review Manager 5.0. Inclusion criteria MAIN OUTCOMEMEASURES:
Overall morbidity rate, anastomotic leakage rate, and wound infection rate within 90 days after elective surgery.RESULTS:
Six studies were included and analyzed, yielding 570 patients (252 in EC group and 318 in LC). Meta-analysis showed no significant difference in the overall morbidity rate between the EC and LC groups (OR 0.63; 95% CI, 0.22-1.78; P = 0.38). Despite a significant higher wound infection rate of stoma site (OR 3.83; 95% CI 2.14-6.86; P < 0.00001), meta-analysis showed no significant difference in the anastomotic leakage rate between the EC and LC groups (OR 0.63; 95% CI 0.22-1.78; P = 0.38). Moreover, both stoma-related complications (OR 0.46; 95% CI 0.24-0.86; P = 0.02) and small bowel obstruction rates (OR 0.11; 95% CI 0.06-0.20; P < 0.00001) were significantly lower in the EC group than in the LC group, respectively.LIMITATIONS:
Heterogeneity of the studiesCONCLUSION:
This meta-analysis suggests that EC of a defunctioning loop ileostomy is effective and safe in careful selected patients without increasing overall postoperative complications. This promising strategy should be proposed in patients in order to reduce stoma-related complications.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Complicaciones Posoperatorias
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Anastomosis Quirúrgica
/
Estomas Quirúrgicos
/
Fuga Anastomótica
Tipo de estudio:
Etiology_studies
/
Risk_factors_studies
/
Systematic_reviews
Límite:
Female
/
Humans
/
Male
Idioma:
En
Revista:
World J Surg
Año:
2018
Tipo del documento:
Article
País de afiliación:
Francia