Safety of early ileostomy closure: a systematic review and meta-analysis of randomized controlled trials
| Autor: | Niclas Dohrn, Ismail Gögenur, Mads Klein, Frederik Bjerg Clausen, Emma Rosenkrantz Hölmich |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Colorectal cancer medicine.medical_treatment Anastomotic Leak law.invention 03 medical and health sciences Ileostomy 0302 clinical medicine Postoperative Complications Randomized controlled trial Quality of life law Internal medicine medicine Humans Ileostomy closure Randomized Controlled Trials as Topic business.industry Rectal Neoplasms Anastomosis Surgical Gastroenterology Hepatology medicine.disease Surgery 030220 oncology & carcinogenesis Meta-analysis Quality of Life 030211 gastroenterology & hepatology business Complication |
| Zdroj: | International journal of colorectal disease. 36(2) |
| ISSN: | 1432-1262 |
| Popis: | Patients with a defunctioning ileostomy after rectal resection experience substantial ileostomy-related morbidity and decreased quality of life. Early reversal of the defunctioning ileostomy has been proposed as a method of mitigating these problems. We aimed to evaluate the safety of early ileostomy closure within 6 weeks. Randomized controlled trials investigating the safety of early ileostomy closure were identified through a systematic search and review of the current literature. Meta-analysis of the extracted outcome data was performed, and the methodological quality of the individual studies was assessed. The search identified six eligible studies yielding a total of 528 patients, with 269 in the early closure (EC) group and 259 in the standard closure (SC) group. Major complications in the EC group was 5.2% compared with 3.6% in the SC group (RR = 1.12, 95% CI 0.33–3.79). Anastomotic leakage in the EC group was 3.3% compared with 3.5% in the SC group (RR = 0.89, 95% CI 0.29–2.75). The meta-analysis resulted in no statistically significant differences between the groups in any of the primary or secondary outcomes. This review was not able to discern a statistically significant difference in postoperative complications when comparing early and standard ileostomy closure. The current literature indicates that early ileostomy closure is not associated with higher complication rates in patients with an uncomplicated postoperative course and radiologically verified intact distal anastomosis after index surgery. |
| Databáze: | OpenAIRE |
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