Comparison of stapled versus handsewn loop ileostomy closure: a meta-analysis

The purpose of this study was to compare the rates of small bowel obstruction, anastomotic complications, and wound infections between stapled and handsewn closures of loop ileostomies. A literature search in Embase, PubMed, and Cochrane Database for Clinical Trials using search terms "closure," "loop ileostomy," and "stapled" was performed. All abstracts were reviewed to identify relevant articles, and their references were hand searched for additional studies. Six articles were identified for inclusion. Three independent reviewers extracted the following data: rates of small bowel obstruction, anastomotic complications, wound infection; length of hospital stay; and operative time. Data analysis was performed using Stata statistical software. Comparing stapled versus hand-sewn closures, there were no statistically significant differences in bowel obstruction (relative risk [RR] 0.69, 95% confidence interval [CI] 0.44 to 1.09), wound infection (RR 0.91, 95% CI 0.53 to 1.97), or anastomotic complication rates (RR 1.01, 95% CI 0.99 to 1.03). Two studies showed shorter operative times favoring stapled anastomoses. No difference was seen in length of stay. Current literature suggests no statistically significant differences between stapled and hand-sewn loop ileostomy closures, but there may be a trend favoring stapled closures with regard to lower small bowel obstruction rates and shorter operative time.