Facilitated early ileostomy closure after rectal cancer surgery: a case-matched study

The aim of this study was to evaluate the outcomes of an early stoma closure protocol facilitated by Seprafilm wrapping of defunctioning ileostomies compared with a similar group of patients with conventional stoma formation and closure.

Consecutive patients undergoing defunctioning ileostomy following rectal resection with pelvic anastomosis were planned for early closure and had their ileostomy wrapped in Seprafilm at the time of formation. Stoma closure was performed at 4-6 weeks if water-soluble contrast enema showed no evidence of leak, and the patient's physiological parameters had been optimized. Patients were matched for age, gender, American Society of Anaesthesiologists score, neoadjuvant treatment and procedure, with patients undergoing conventional ileostomy formation and closure. Outcomes were compared using the 2-tailed Mann-Whitney U test and Fisher's exact test.

Following resection, twenty-two patients (69 %) were suitable for early closure and underwent stoma closure at a median of 37 days (range 25-90 days). Seprafilm-wrapped ileostomies were closed earlier than the conventional ileostomies (median 55 days (range 25-250 days) versus 213 days (range 86-352 days), p < 0.001). There was no difference between the groups as regards length of hospital stay or complications following ileostomy closure. Eighteen Seprafilm stoma patients and 22 conventional stoma patients received adjuvant chemotherapy. Median time to starting chemotherapy from resection was 10 versus 8.5 weeks, respectively (p = 0.36).

An early stoma closure protocol facilitated by Seprafilm wrapping of the ileostomy is practical, does not increase morbidity and significantly reduces the time with a stoma for the patient. An early stoma closure protocol did not significantly delay in the commencement of chemotherapy.