The feasibility and safety of early ileostomy reversal: a systematic review and meta‐analysis
Background Recent evidence supports the safety of early reversal of a temporary stoma, within 14 days of construction. The aim of this systematic review and meta‐analysis was to evaluate the post‐operative morbidity and overall feasibility of early stoma reversal. Methods Medline and Cochrane databa...
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| Veröffentlicht in: | ANZ journal of surgery 2020-09, Vol.90 (9), p.1580-1587 |
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| creator | Ng, Zi Qin Levitt, Michael Platell, Cameron |
| description | Background
Recent evidence supports the safety of early reversal of a temporary stoma, within 14 days of construction. The aim of this systematic review and meta‐analysis was to evaluate the post‐operative morbidity and overall feasibility of early stoma reversal.
Methods
Medline and Cochrane databases were searched for studies up to June 2019 that investigated the outcomes of early stoma reversal (EC, defined as closure ≤14 days from the index operation) versus late stoma reversal (LC, ≥8 weeks from the index operation). Meta‐analysis was performed on the respective rates of post‐operative morbidity, anastomotic leak, wound infection, bleeding, sepsis, small bowel obstruction and ileus.
Results
Nine studies were included (667 patients analysed). Meta‐analysis showed no significant difference in the post‐operative morbidity rate, anastomotic leak rate, rates of small bowel obstruction, bleeding and ileus between EC and LC. However, the wound infection rate was significantly higher after EC than LC; relative difference 0.10 (95% confidence interval 0.00–0.19, P = 0.047). The stoma‐related complication rate was significantly higher after LC than EC; relative difference −0.28 (95% confidence interval ‐0.45 to −0.11, P = 0.001).
Conclusion
The concept of early stoma reversal is appealing, and this meta‐analysis confirms the safety of early stoma closure with an associated reduction in stoma‐related complications despite higher wound infection rates. However, the results need to be interpreted with caution due to the heterogeneity of the studies included, especially in respect of the definition of complications that were used. Further well‐designed prospective studies are required prior to confident adoption of early stoma closure into clinical practice.
The overall morbidity rate was 20.6% (58/281) after early stoma closure as compared to 32% (111/347) after late stoma closure with relative difference ‐0.05 (95% confidence interval −0.22 to 0.11, P = 0.531). |
| doi_str_mv | 10.1111/ans.16079 |
| format | Article |
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Recent evidence supports the safety of early reversal of a temporary stoma, within 14 days of construction. The aim of this systematic review and meta‐analysis was to evaluate the post‐operative morbidity and overall feasibility of early stoma reversal.
Methods
Medline and Cochrane databases were searched for studies up to June 2019 that investigated the outcomes of early stoma reversal (EC, defined as closure ≤14 days from the index operation) versus late stoma reversal (LC, ≥8 weeks from the index operation). Meta‐analysis was performed on the respective rates of post‐operative morbidity, anastomotic leak, wound infection, bleeding, sepsis, small bowel obstruction and ileus.
Results
Nine studies were included (667 patients analysed). Meta‐analysis showed no significant difference in the post‐operative morbidity rate, anastomotic leak rate, rates of small bowel obstruction, bleeding and ileus between EC and LC. However, the wound infection rate was significantly higher after EC than LC; relative difference 0.10 (95% confidence interval 0.00–0.19, P = 0.047). The stoma‐related complication rate was significantly higher after LC than EC; relative difference −0.28 (95% confidence interval ‐0.45 to −0.11, P = 0.001).
Conclusion
The concept of early stoma reversal is appealing, and this meta‐analysis confirms the safety of early stoma closure with an associated reduction in stoma‐related complications despite higher wound infection rates. However, the results need to be interpreted with caution due to the heterogeneity of the studies included, especially in respect of the definition of complications that were used. Further well‐designed prospective studies are required prior to confident adoption of early stoma closure into clinical practice.
The overall morbidity rate was 20.6% (58/281) after early stoma closure as compared to 32% (111/347) after late stoma closure with relative difference ‐0.05 (95% confidence interval −0.22 to 0.11, P = 0.531).</description><identifier>ISSN: 1445-1433</identifier><identifier>EISSN: 1445-2197</identifier><identifier>DOI: 10.1111/ans.16079</identifier><identifier>PMID: 32597018</identifier><language>eng</language><publisher>Melbourne: John Wiley & Sons Australia, Ltd</publisher><subject>Anastomotic Leak ; Bleeding ; closure ; complication ; Complications ; Confidence intervals ; early ; Feasibility ; Feasibility Studies ; Heterogeneity ; Humans ; Ileostomy ; Ileostomy - adverse effects ; Infections ; Intestinal obstruction ; Meta-analysis ; Morbidity ; Ostomy ; Postoperative Complications - epidemiology ; Prospective Studies ; reversal ; Safety ; Sepsis ; Small intestine ; stoma ; Surgical Stomas - adverse effects ; Systematic review ; Wound infection</subject><ispartof>ANZ journal of surgery, 2020-09, Vol.90 (9), p.1580-1587</ispartof><rights>2020 Royal Australasian College of Surgeons</rights><rights>2020 Royal Australasian College of Surgeons.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3539-b7ccf9564b13a3a65e8cf3d3479af9740afc52ce77c293bc63670ee61fb363ac3</citedby><cites>FETCH-LOGICAL-c3539-b7ccf9564b13a3a65e8cf3d3479af9740afc52ce77c293bc63670ee61fb363ac3</cites><orcidid>0000-0002-6272-4640</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fans.16079$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fans.16079$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,778,782,1414,27911,27912,45561,45562</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32597018$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ng, Zi Qin</creatorcontrib><creatorcontrib>Levitt, Michael</creatorcontrib><creatorcontrib>Platell, Cameron</creatorcontrib><title>The feasibility and safety of early ileostomy reversal: a systematic review and meta‐analysis</title><title>ANZ journal of surgery</title><addtitle>ANZ J Surg</addtitle><description>Background
Recent evidence supports the safety of early reversal of a temporary stoma, within 14 days of construction. The aim of this systematic review and meta‐analysis was to evaluate the post‐operative morbidity and overall feasibility of early stoma reversal.
Methods
Medline and Cochrane databases were searched for studies up to June 2019 that investigated the outcomes of early stoma reversal (EC, defined as closure ≤14 days from the index operation) versus late stoma reversal (LC, ≥8 weeks from the index operation). Meta‐analysis was performed on the respective rates of post‐operative morbidity, anastomotic leak, wound infection, bleeding, sepsis, small bowel obstruction and ileus.
Results
Nine studies were included (667 patients analysed). Meta‐analysis showed no significant difference in the post‐operative morbidity rate, anastomotic leak rate, rates of small bowel obstruction, bleeding and ileus between EC and LC. However, the wound infection rate was significantly higher after EC than LC; relative difference 0.10 (95% confidence interval 0.00–0.19, P = 0.047). The stoma‐related complication rate was significantly higher after LC than EC; relative difference −0.28 (95% confidence interval ‐0.45 to −0.11, P = 0.001).
Conclusion
The concept of early stoma reversal is appealing, and this meta‐analysis confirms the safety of early stoma closure with an associated reduction in stoma‐related complications despite higher wound infection rates. However, the results need to be interpreted with caution due to the heterogeneity of the studies included, especially in respect of the definition of complications that were used. Further well‐designed prospective studies are required prior to confident adoption of early stoma closure into clinical practice.
The overall morbidity rate was 20.6% (58/281) after early stoma closure as compared to 32% (111/347) after late stoma closure with relative difference ‐0.05 (95% confidence interval −0.22 to 0.11, P = 0.531).</description><subject>Anastomotic Leak</subject><subject>Bleeding</subject><subject>closure</subject><subject>complication</subject><subject>Complications</subject><subject>Confidence intervals</subject><subject>early</subject><subject>Feasibility</subject><subject>Feasibility Studies</subject><subject>Heterogeneity</subject><subject>Humans</subject><subject>Ileostomy</subject><subject>Ileostomy - adverse effects</subject><subject>Infections</subject><subject>Intestinal obstruction</subject><subject>Meta-analysis</subject><subject>Morbidity</subject><subject>Ostomy</subject><subject>Postoperative Complications - epidemiology</subject><subject>Prospective Studies</subject><subject>reversal</subject><subject>Safety</subject><subject>Sepsis</subject><subject>Small intestine</subject><subject>stoma</subject><subject>Surgical Stomas - adverse effects</subject><subject>Systematic review</subject><subject>Wound infection</subject><issn>1445-1433</issn><issn>1445-2197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kM1O3DAQx62qCJaPQ1-gitRLe1iwY8eOe0OopUgIDsDZmnjHqlGy2XqyrHLrI_CMPAnej3JA6lxmNPrNX6MfY58EPxW5zmBOp0JzYz-wiVCqmpbCmo-7WSgpD9gh0SPnQmtb7bMDWVbWcFFPmLv_jUVAoNjENg5jAfNZQRAwj30oEFI7FrHFnoa-G4uET5gI2u8FFDTSgB0M0a_XEVeb2w4HePn7DHNoR4p0zPYCtIQnu37EHn7-uL_4Nb2-vby6OL-eellJO22M98FWWjVCggRdYe2DnEllLARrFIfgq9KjMb60svFaasMRtQiN1BK8PGJft7mL1P9ZIg2ui-SxbWGO_ZJcqURtSlvVNqNf3qGP_TLlf9eUKrk0taoz9W1L-dQTJQxukWIHaXSCu7V1l627jfXMft4lLpsOZ2_kP80ZONsCq6xy_H-SO7-520a-AlcBjUI</recordid><startdate>202009</startdate><enddate>202009</enddate><creator>Ng, Zi Qin</creator><creator>Levitt, Michael</creator><creator>Platell, Cameron</creator><general>John Wiley & Sons Australia, Ltd</general><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6272-4640</orcidid></search><sort><creationdate>202009</creationdate><title>The feasibility and safety of early ileostomy reversal: a systematic review and meta‐analysis</title><author>Ng, Zi Qin ; Levitt, Michael ; Platell, Cameron</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3539-b7ccf9564b13a3a65e8cf3d3479af9740afc52ce77c293bc63670ee61fb363ac3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anastomotic Leak</topic><topic>Bleeding</topic><topic>closure</topic><topic>complication</topic><topic>Complications</topic><topic>Confidence intervals</topic><topic>early</topic><topic>Feasibility</topic><topic>Feasibility Studies</topic><topic>Heterogeneity</topic><topic>Humans</topic><topic>Ileostomy</topic><topic>Ileostomy - adverse effects</topic><topic>Infections</topic><topic>Intestinal obstruction</topic><topic>Meta-analysis</topic><topic>Morbidity</topic><topic>Ostomy</topic><topic>Postoperative Complications - epidemiology</topic><topic>Prospective Studies</topic><topic>reversal</topic><topic>Safety</topic><topic>Sepsis</topic><topic>Small intestine</topic><topic>stoma</topic><topic>Surgical Stomas - adverse effects</topic><topic>Systematic review</topic><topic>Wound infection</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ng, Zi Qin</creatorcontrib><creatorcontrib>Levitt, Michael</creatorcontrib><creatorcontrib>Platell, Cameron</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>ANZ journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ng, Zi Qin</au><au>Levitt, Michael</au><au>Platell, Cameron</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The feasibility and safety of early ileostomy reversal: a systematic review and meta‐analysis</atitle><jtitle>ANZ journal of surgery</jtitle><addtitle>ANZ J Surg</addtitle><date>2020-09</date><risdate>2020</risdate><volume>90</volume><issue>9</issue><spage>1580</spage><epage>1587</epage><pages>1580-1587</pages><issn>1445-1433</issn><eissn>1445-2197</eissn><abstract>Background
Recent evidence supports the safety of early reversal of a temporary stoma, within 14 days of construction. The aim of this systematic review and meta‐analysis was to evaluate the post‐operative morbidity and overall feasibility of early stoma reversal.
Methods
Medline and Cochrane databases were searched for studies up to June 2019 that investigated the outcomes of early stoma reversal (EC, defined as closure ≤14 days from the index operation) versus late stoma reversal (LC, ≥8 weeks from the index operation). Meta‐analysis was performed on the respective rates of post‐operative morbidity, anastomotic leak, wound infection, bleeding, sepsis, small bowel obstruction and ileus.
Results
Nine studies were included (667 patients analysed). Meta‐analysis showed no significant difference in the post‐operative morbidity rate, anastomotic leak rate, rates of small bowel obstruction, bleeding and ileus between EC and LC. However, the wound infection rate was significantly higher after EC than LC; relative difference 0.10 (95% confidence interval 0.00–0.19, P = 0.047). The stoma‐related complication rate was significantly higher after LC than EC; relative difference −0.28 (95% confidence interval ‐0.45 to −0.11, P = 0.001).
Conclusion
The concept of early stoma reversal is appealing, and this meta‐analysis confirms the safety of early stoma closure with an associated reduction in stoma‐related complications despite higher wound infection rates. However, the results need to be interpreted with caution due to the heterogeneity of the studies included, especially in respect of the definition of complications that were used. Further well‐designed prospective studies are required prior to confident adoption of early stoma closure into clinical practice.
The overall morbidity rate was 20.6% (58/281) after early stoma closure as compared to 32% (111/347) after late stoma closure with relative difference ‐0.05 (95% confidence interval −0.22 to 0.11, P = 0.531).</abstract><cop>Melbourne</cop><pub>John Wiley & Sons Australia, Ltd</pub><pmid>32597018</pmid><doi>10.1111/ans.16079</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-6272-4640</orcidid></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Anastomotic Leak Bleeding closure complication Complications Confidence intervals early Feasibility Feasibility Studies Heterogeneity Humans Ileostomy Ileostomy - adverse effects Infections Intestinal obstruction Meta-analysis Morbidity Ostomy Postoperative Complications - epidemiology Prospective Studies reversal Safety Sepsis Small intestine stoma Surgical Stomas - adverse effects Systematic review Wound infection |
| title | The feasibility and safety of early ileostomy reversal: a systematic review and meta‐analysis |
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