• Annals of surgery · Apr 2024

    Meta Analysis

    Outcomes of Early versus Standard Closure of Diverting Ileostomy after Proctectomy: Meta-analysis and Meta-regression Analysis of Randomized Controlled Trials.

    • Sameh Hany Emile, Nir Horesh, Zoe Garoufalia, Rachel Gefen, Emeka Ray-Offor, and Steven D Wexner.
    • Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL.
    • Ann. Surg. 2024 Apr 1; 279 (4): 613619613-619.

    ObjectiveWe aimed to compare outcomes of early and standard closure of diverting loop ileostomy (DLI) after proctectomy and determine risk factors for anastomotic leak (AL) and complications.BackgroundFormation of DLI has been a routine practice after proctectomy to decrease the incidence and potential adverse sequela of AL.MethodsPubMed, Scopus, and Web of Science were searched for randomized controlled trials (RCTs) that compared outcomes of early versus standard closure of DLI after proctectomy. Main outcome measures were postoperative complications, AL, ileus, surgical site infection, reoperation, readmission, and hospital stay following DLI closure.ResultsEleven RCTs (932 patients; 57% male) were included. Early closure group included 474 patients and standard closure 458 patients. Early closure was associated with higher odds of AL [odds ratio (OR): 2.315, P =0.013] and similar odds of complications (OR: 1.103, P =0.667), ileus (OR: 1.307, P =0.438), surgical site infection (OR: 1.668, P =0.079), reoperation (OR: 1.896, P =0.062), and readmission (OR: 3.431, P =0.206). Hospital stay was similar (weighted mean difference: 1.054, P =0.237). Early closure had higher odds of AL than standard closure when early closure was done ≤2 weeks (OR: 2.12, P =0.047) but not within 3 to 4 weeks (OR: 2.98, P =0.107). Factors significantly associated with complications after early closure were diabetes mellitus, smoking, and closure of DLI ≤2 weeks, whereas factors associated with AL were ≥ American Society of Anesthesiologists II classification and diabetes mellitus.ConclusionsEarly closure of DLI after proctectomy has a higher risk of AL, particularly within 2 weeks of DLI formation. On the basis of this study, routine early ileostomy closure cannot be recommended.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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