Laparoscopic versus open loop ileostomy reversal: A systematic review and meta-analysis

Area of Science:

• Colorectal Surgery
• Minimally Invasive Surgery
• Surgical Outcomes Research

Background:

• Loop ileostomies (LIs) are utilized for temporary fecal diversion to safeguard downstream colorectal anastomoses.
• The traditional method for LI reversal involves an open surgical technique.
• Laparoscopic techniques for LI reversal have emerged and are increasingly studied.

Purpose of the Study:

• To systematically review and compare the outcomes of laparoscopic versus open loop ileostomy reversal.
• To evaluate postoperative morbidity and length of stay between the two surgical approaches.

Main Methods:

• A systematic literature search was conducted across Medline, Embase, and CENTRAL databases.
• Included studies compared laparoscopic and open LI reversal, focusing on postoperative morbidity and length of stay (LOS).
• Pairwise meta-analyses and GRADE assessment were employed to evaluate the evidence quality.

Main Results:

• Four observational studies involving 213 laparoscopic and 176 open LI reversals were analyzed.
• Laparoscopic reversal was associated with significantly shorter LOS (MD -0.39, p=0.03).
• Superficial surgical site infection (sSSI) rates were lower in the laparoscopic group (OR 0.22, p=0.01), with overall morbidity comparable.

Conclusions:

• Low-quality evidence suggests laparoscopic LI reversal is feasible, potentially reducing LOS and sSSI without increasing operative time.
• Further high-quality prospective studies are needed to validate these findings.
• Laparoscopic LI reversal offers a promising alternative to open techniques.