Meta-Analysis:
Meta-analysis of early versus late closure of a temporary ileostomy after proctectomy
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Abstract
Xiaozhun Huang1,*, Chunling Wang2,*, Zhangkan Huang1, Houhong Zhou1, Han Li1, Fengxiang Shi3, Longde Du4, Xianni Ke5, Biao Zheng1, Shuisheng Zhang6 and Xu Che6
1Department of Abdominal Surgery, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
2Department of Hepatology, Huizhou Municipal Central Hospital, Huizhou 516000, China
3Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
4Department of Thoracic Surgery, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
5Department of Medical Oncology, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
6Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
*These authors have contributed equally to this work
Correspondence to:
Xu Che, email: [email protected]
Shuisheng Zhang, email: [email protected]
Keywords: temporary ileostomy; early closure; late closure; complication; hospital stay
Received: November 08, 2017 Accepted: January 03, 2018 Published: January 08, 2018
ABSTRACT
Background: A temporary ileostomy is frequently constructed to reduce the risk of symptomatic anastomotic leakage. An ostomy is a heavy burden on both patient and society, and early closure is therefore desirable to counteract increased morbidity. The optimal time for stoma closure has been investigated in some studies, although it remains controversial.
Methods: We conducted a literature search of PubMed, Wiley, Web of Science, and the Cochrane Library to identify studies published till 2017 that focused on perioperative complications and details related to early(<4 weeks) and late(>4weeks) closure of temporary ileostomies after proctectomy.
Results: Six studies (three randomized controlled trials, two prospective non-randomized trials, and one retrospective trial) satisfied our inclusion criteria, and the outcomes of 767 patients (356 early closures and 411 late closures) were analyzed. There was a significantly lower prevalence of skin irritation (p=0.0002) in the early group, but no worse morbidity outcomes were observed between the early and late closure groups. Hospital stay length after an ileostomy closure was not prolonged following early closure, suggesting that the increased wound infection risk did not significantly delay discharge. Also, the overall hospital stay length, when time since admission for the original operation was included in the late closure group, showed no significantly longer duration in the early closure group (p = 0.02).
Conclusions: We found that early closure of a temporary ileostomy after proctectomy was feasible in selected patients, with some advantages and disadvantages that need to be weighed by the patient and surgeon.
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