Loop ileostomy closure: a retrospective comparison of three techniques

Area of Science:

• Gastroenterology and Surgical Innovation
• Colorectal Surgery Techniques

Background:

• Loop ileostomy (LI) formation is common after low anterior resection or restorative ileo-anal pouch surgery.
• Ileostomy closure techniques include stapled, single-layer hand-sewn, and two-layer hand-sewn methods.
• Previous studies lack definitive evidence on the superiority of any single closure technique.

Purpose of the Study:

• To compare the outcomes of stapled ileostomy closure versus single- and two-layer hand-sewn closures.
• To evaluate operative time, morbidity, and length of stay for different ileostomy closure techniques.

Main Methods:

• Retrospective, single-centre cohort study of 244 patients undergoing loop ileostomy closure between 1999 and 2016.
• Data collected included patient demographics, anastomotic technique, operative time, and patient outcomes.
• Statistical analysis adjusted for age, sex, American College of Anaesthesiology grade, and consultant surgeon.

Main Results:

• No significant differences in operative times or morbidity were observed between stapled and hand-sewn closure techniques.
• Length of stay was similar for stapled and single-layer hand-sewn closures (4.2 vs. 5.5 days).
• Two-layer hand-sewn closure was associated with a significantly longer length of stay compared to stapled closure (8.3 vs. 4.2 days).

Conclusions:

• Stapled and single-layer hand-sewn ileostomy closures demonstrate comparable operative times, lengths of stay, and complication rates.
• A two-layer hand-sewn technique for ileostomy closure is associated with an increased length of hospital stay compared to stapled closure.