Early vs. standard reversal ileostomy: a systematic review and meta-analysis.

BACKGROUND: Formation of a defunctioning loop ileostomy is common after mid and low rectal resection. Historically, they were reversed between 3 and 6 months after initial resection. Recently, earlier closure (< 14 days) has been suggested by some current randomised controlled trials. The aim of this study was to investigate the effect of early stoma closure on surgical and patient outcomes. METHODS: A systematic review of the current randomised controlled trial literature comparing early and standard ileostomy closure after rectal surgery was performed. Specifically, we examined surgical outcomes including; morbidity, mortality and quality of life. RESULTS: Six studies met the predefined criteria and were included in our analysis. 275 patients underwent early stoma closure compared with 259 patients having standard closure. Overall morbidity was similar between both groups (25.5% vs. 21.6%) (OR, 1.47; 95% CI 0.75-2.87). However, there tended to be more reoperations (8.4 vs. 4.2%) (OR, 2.02, 95% CI 0.99-4.14) and small bowel obstructions/postoperative ileus (9.3% vs. 4.4%) (OR 0.44, 95% CI 0.22-0.90) in the early closure group, but no difference across the other domains. CONCLUSIONS: Early closure appears to be a feasible in highly selective cases after good perioperative counselling and shared decision-making. Further research on quality of life outcomes and long term benefits is necessary to help define which patients are suitable candidates for early closure.

Microalbuminuria in NIDDM.

OBJECTIVE: To determine an effective screening procedure for microalbuminuria. RESEARCH DESIGN AND METHODS: The prevalence of microalbuminuria in NIDDM patients whose urine was negative on routine Albustix testing was studied. Microalbuminuria was measured in overnight urine samples from 128 NIDDM patients on at least two of three occasions over a 6-mo period. Patients were tested with Micro-Bumintest or Micral-Test. RESULTS: Ten of 128 patients had albumin concentrations > or = 20 mg/L on two or more occasions, 14 patients had A-C ratios > or = 3 mg/M on two or more occasions, and 9 patients had both. CONCLUSIONS: Neither Micro-Bumintest nor Micral-Test is a useful or feasible screening procedure for microalbuminuria.