Early Closure of Defunctioning Loop Ileostomy: Is It Beneficial for the Patient? A Meta-analysis

To perform a meta-analysis to answer the question, whether early closure (EC) of defunctioning loop ileostomy may be beneficial for patient as compared with late closure (LC) without exceeding the risk of surgical-related morbidity.

Medline and the Cochrane Trials Register were searched for trials published up to November 2016 comparing EC (defined as ≤14 days from the index operation in which the ileostomy was performed) versus LC for stoma closure after rectal surgery. Meta-analysis was performed using Review Manager 5.0. Inclusion criteria MAIN OUTCOME MEASURES: Overall morbidity rate, anastomotic leakage rate, and wound infection rate within 90 days after elective surgery.

Six studies were included and analyzed, yielding 570 patients (252 in EC group and 318 in LC). Meta-analysis showed no significant difference in the overall morbidity rate between the EC and LC groups (OR 0.63; 95% CI, 0.22-1.78; P = 0.38). Despite a significant higher wound infection rate of stoma site (OR 3.83; 95% CI 2.14-6.86; P < 0.00001), meta-analysis showed no significant difference in the anastomotic leakage rate between the EC and LC groups (OR 0.63; 95% CI 0.22-1.78; P = 0.38). Moreover, both stoma-related complications (OR 0.46; 95% CI 0.24-0.86; P = 0.02) and small bowel obstruction rates (OR 0.11; 95% CI 0.06-0.20; P < 0.00001) were significantly lower in the EC group than in the LC group, respectively.

Heterogeneity of the studies CONCLUSION: This meta-analysis suggests that EC of a defunctioning loop ileostomy is effective and safe in careful selected patients without increasing overall postoperative complications. This promising strategy should be proposed in patients in order to reduce stoma-related complications.