Ann Surg Treat Res.  2019 Jan;96(1):41-46. 10.4174/astr.2019.96.1.41.

Prospective study on the safety and feasibility of early ileostomy closure 2 weeks after lower anterior resection for rectal cancer

• Lee KH
• Kim HO
• Kim JS
• Kim JY

• KMID: 2429753
• DOI: http://doi.org/10.4174/astr.2019.96.1.41

Abstract

PURPOSE
Transient loop ileostomies in rectal cancer surgery are generally closed after 2 or more months to allow adequate time for anastomotic healing. Maintaining the ileostomy may cause medical, surgical, or psychological complications; it also reduces the quality of life, and increase treatment costs. We performed this study to evaluate the safety and feasibility of early ileostomy closure 2 weeks postoperatively.
METHODS
If a patient who underwent total mesorectal excision had 2 or more risk factors for anastomotic leakage, a loop ileostomy was created. After confirmation of intact anastomosis via sigmoidoscopy and proctography 1 week postoperatively, the patient was enrolled and ileostomy was closed 2 weeks postoperatively. The primary endpoint was the frequency of complication after ileostomy repair.
RESULTS
Thirty patients were enrolled in the study and 6 were excluded due to anastomotic leakage. Except for 1 case of wound infection (4.2%), no patient experienced any complication including newly developed leakage after the ileostomy closure. The mean duration to repair was 13.1 days (range, 8-16 days) and mean duration to the start of adjuvant treatment after radical surgery was 5.37 weeks (range, 3.0-8.1 weeks).
CONCLUSION
Transient loop ileostomy, which is confirmed to be intact endoscopically and radiologically, can be safely closed 2 weeks postoperatively without requiring a significant delay in adjuvant chemotherapy.

Keyword

Ileostomy; Feasibility studies

MeSH Terms

Anastomotic Leak
Chemotherapy, Adjuvant
Feasibility Studies
Health Care Costs
Humans
Ileostomy*
Prospective Studies*
Quality of Life
Rectal Neoplasms*
Risk Factors
Sigmoidoscopy
Wound Infection

Figure

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  Fig. 1 The flow chart. TME, total mesorectal excision.

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  Fig. 2 Findings of intact anastomosis: flexible sigmoscopy (A) and proctography (B).

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  Fig. 3 Findings of incidental leakage: flexible sigmoscopy (A) and proctography (B).

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