Stapled versus sutured closure of loop ileostomy: a randomized controlled trial

Area of Science:

• Colorectal Surgery
• Surgical Techniques
• Patient Outcomes

Background:

• Defunctioning loop ileostomy is a common procedure in colorectal surgery.
• Ileostomy closure can lead to complications, notably bowel obstruction.
• Previous nonrandomized studies indicated no significant difference in complications between sutured and stapled closure.

Purpose of the Study:

• To compare the outcomes of conventional sutured loop ileostomy closure versus stapled ileostomy closure.
• To evaluate complication rates, specifically bowel obstruction, following different ileostomy closure techniques.

Main Methods:

• A randomized controlled trial involving 141 patients who underwent loop ileostomy between 1993 and 1998.
• Patients were randomized to either stapled (71 patients) or sutured (70 patients) loop ileostomy closure.
• Data collected included postoperative complications, readmissions, reoperations, and hospital stay.

Main Results:

• Postoperative bowel obstruction occurred in 14% of patients with sutured closure versus 3% with stapled closure (p<0.05).
• No significant difference in bowel obstruction was observed in the subgroup of patients with ileal pouch (2/30 stapled vs. 7/29 sutured).
• Other complications, readmissions, and reoperations did not differ significantly between the stapled and sutured groups. Stapled closure was marginally faster (4 minutes).

Conclusions:

• Stapled loop ileostomy closure is associated with a lower incidence of postoperative bowel obstruction.
• There were no statistically significant differences in mean hospital stay, readmission rates, or reoperation rates between stapled and sutured ileostomy closure.
• Stapled closure may offer a benefit in reducing bowel obstruction after loop ileostomy.