Protective Loop Ileostomy Closure Techniques: Comparison of Three Different Surgical Techniques.

Area of Science:

• Colorectal surgery
• Surgical techniques
• Oncology

Background:

• Anastomotic leaks pose significant risks in colorectal cancer surgery.
• Protective loop ileostomy is crucial for preventing pelvic sepsis in low anterior rectal tumors.

Purpose of the Study:

• To compare early morbidities associated with stapled, handsewn end-to-end, and handsewn anterior-only loop ileostomy closure.
• To assess the efficacy and safety of each ileostomy closure technique.

Main Methods:

• Retrospective analysis of 198 patients undergoing loop ileostomy closure between January 2014 and December 2019.
• Patients were divided into three groups: handsewn anterior closure, side-to-side stapled anastomosis, and end-to-end handsewn anastomosis.
• Multivariate logistic regression was used to identify risk factors for complications within a 30-day postoperative period.

Main Results:

• Handsewn anterior closure demonstrated superiority over stapled anastomosis regarding postoperative ileus (p: 0.027) and wound infection (p: 0.042).
• Handsewn anterior closure also showed significant advantages over handsewn end-to-end anastomosis in reducing postoperative ileus (p: 0.013), wound infection (p: 0.037), and hospital stay (p: 0.046).
• Stapled and handsewn end-to-end techniques showed a difference in postoperative ileus risk (p: 0.043) but not in wound infection or hospital stay.

Conclusions:

• No significant difference in anastomotic leakage rates was observed between handsewn and stapled techniques.
• The rate of small-bowel obstruction was higher in the handsewn group compared to stapled techniques.
• Handsewn anterior wall closure emerged as the most effective technique among those studied for ileostomy closure.