Early takedown of a defunctioning ileostomy, is there a downside? – a prospective analysis from Rural Bengal

Authors

  • Shouptik Basu Department of General Surgery, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India
  • Dhrubajyoti Maulik Department of General Surgery, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India
  • Jaganmoy Maji Department of General Surgery, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India

DOI:

https://doi.org/10.18203/2349-2902.isj20205899

Keywords:

Ileostomy, Defunctioning, Loop, Stoma, Reversal, Takedown

Abstract

Background: Since the pilot study in 2002, many studies have evaluated the feasibility of an Early Ileostomy takedown by 2 weeks, thus decreasing the stoma related morbidity. However, in a developing country like India, this paradigm shift is still debatable. Our study from a tertiary teaching rural hospital in Bengal evaluates the feasibility of Early takedown by 2 weeks and compares it to a more accepted concept of Ileostomy takedown by 8-10 weeks.

Methods: This prospective longitudinal comparative study conducted from February 2018 to July 2019, in our institute. Sample size was calculated to be 30 in each group. The early closure went a takedown at 2 weeks and the delayed closure underwent a takedown by 8-10 weeks. Data was analysed with Fischer’s exact or Chi square test, student’s t test. A p value of 0.05 was significant.

Results: Our set of rural patients, had more stoma related complications due to lack of stoma care (13.33% vs 3.33%, EC vs DC). Intraoperative adhesions (26 vs 12, p=0.0004) significantly increased operative time (126.1667±27.5895 vs 86.0000±34.2506, EC vs DC, p<0.001), leading to post-operative complications hence, the Length of hospital stay was more in the early subset (17.9667±6.9851 vs 11.2000±4.0548, EC vs DC, p<0.001).

Conclusions: An early takedown of a defunctioning ileostomy, may be a technically difficult procedure to perform, has more post-operative complications and is discouraged, in our opinion.

Author Biography

Shouptik Basu, Department of General Surgery, Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India

 

 

References

Hindenburg T, Rosenberg J. Closing a temporary ileostomy within two weeks. Dan Med Bull. 2010;57(6):A4157.

Bakx R, Busch OR, van GD, Bemelman WA, Slors JF, van Lanschot JJ. Feasibility of early closure of loop ileostomies: a pilot study. Dis Colon Rectum. 2003;46:1680-4

Bakx R, Busch ORC, Bemelman WA. Morbidity of temporary loop Ileostomies. Dig Surg. 2004;21:277-81.

Kodner Ira J, Read Thomas E, Loehner Donna L (2013) Intestinal Stomas. In: Maingot’s Abdominal Operations 12th edn. McGraw-Hill-Medical, New York ,pp 179-182

Alves A, Panis Y, Lelong B, Dousset B, Benoist S, Vicant E. Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy. Br J Surg, 2008; 95:693-8.

Jordi-Galais P, Turrin N, Tresallet C, Nguyen-Thanh Q, Chigot JP, Menegaux F. Early closure of temporary stoma of the small bowel. Gastroenterologie clinique et biologique. 2003;27(8-9):697-9.

Gessler B, Haglind E, Angenete E. A temporary loop ileostomy affects renal function. Int J Colorectal Dis. 2014;29:1131-5.

Menegaux F, Jordi-Galai s P, Turrin N, Chigot JP. Closure of small bowel stomas on postoperative day 10. Eur J Surg. 2002;168:713-5.

Zhen L, Wang Y, Zhang Z, Wu T, Liu R, Li T, et al. Effectiveness between early and late temporary ileostomy closure in patients with rectal cancer: A prospective study. Curr Prob Canc. 2017;41(3):231-40.

Lee KH, Kim HO, Kim JS, Kim Y. Prospective study on the safety and feasibility of early ileostomy closure 2 weeks after lower anterior resection for rectal cancer Ann Surg Treat Res. 2019;96(1):41-6.

Pedrazzani C, Secci F, Fernandes E. Early ileostomy reversal after minimally invasive surgery and ERAS program for mid and low rectal cancer. Updates Surg. 2019;71(3):485-92.

Danielsen AK, Correa-Marinez A, Angenete E, Skullmann S, Haglind E, Rosenberg J, SSORG (Scandinavian Outcomes Research Group. Early closure of temporary ileostomy—the EASY trial: protocol for a randomised controlled trial. Bio Med J. 2011;1(1).

Danielsen AK, Park J, Jansen JE. Early Closure of a Temporary Ileostomy in Patients with Rectal Cancer: A Multicenter Randomized Controlled Trial. Ann Surg. 2017;265(2):284-90.

Park J, Danielsen AK, Angenete E, Bock D, Marinez AC, Haglind E, et al. Quality of life in a randomized trial of early closure of temporary ileostomy after rectal resection for cancer (EASY trial). Br J Surg. 2018;105(3):244.

Farag S, Rehman S, Sains P, Baig MK, Sajid MS. Early vs delayed closure of loop defunctioning ileostomy in patients undergoing distal colorectal resections: an integrated systematic review and meta-analysis of published randomized controlled trials. Colorectal Dis. 2017;19(12):1050-7.

Omundsen M, Hayes J, Collinson R. Early ileostomy closure: is there a downside? ANZ J Surg 2012;82:352-4.

Lasithiotakis K, Aghahoseini A, Alexander D. Is Early Reversal of Defunctioning Ileostomy a Shorter, Easier and Less Expensive Operation? World J Surg. 2016;40(7):1737-40

Gustafsson CP, Gunnarsson U, Dahlstrand U, Lindforss U. Loop-ileostomy reversal—patient-related characteristics influencing time to closure. Int J Colorect Disea. 2018;33(5):593-600.

Markides GA, Wijetunga IU, Brown SR, Anwar S. Meta-analysis of handsewn versus stapled reversal of loop ileostomy. ANZ J Surg. 2015;85(4):217-2

Gustafsson CP, Gunnarsson U, Dahlstrand U, Lindforss U. Int J Colorectal Dis. 2018;33(5):593-600.

Yin TC, Tsai HL, Yang PF. Early closure of defunctioning stoma increases complications related to stoma closure after concurrent chemoradiotherapy and low anterior resection in patients with rectal cancer. World J Surg Oncol. 2017;15(1):80.

Downloads

Published

2020-12-28

Issue

Section

Original Research Articles