TY - JOUR
T1 - Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis
T2 - A meta-analysis
AU - Rondelli, F.
AU - Reboldi, P.
AU - Rulli, A.
AU - Barberini, F.
AU - Guerrisi, A.
AU - Izzo, Luciano
AU - Bolognese, A.
AU - Covarelli, P.
AU - Boselli, C.
AU - Becattini, C.
AU - Noya, G.
PY - 2009
Y1 - 2009
N2 - Background: Sphincter-saving surgery for the treatment of middle and low rectal cancer has spread considerably when total mesorectal excision became standard treatment. In order to reduce leakage-related complications, surgeons often perform a derivative stoma, a loop ileostomy (LI), or a loop colostomy (LC), but to date, there is no evidence on which is the better technique to adopt. Methods: We performed a systematic review and meta-analysis of all randomized controlled trials until 2007 and observational studies comparing temporary LI and LC for temporary decompression of colorectal and/or coloanal anastomoses. Methods: Clinically relevant events were grouped into four study outcomes: - general outcome measures: dehydratation and wound infection GOM - construction of the stoma outcome measures: parastomal hernia, stenosis, sepsis, prolapse, retraction, necrosis, and hemorrhage - closure of the stoma outcome measures: anastomotic leak or fistula, wound infection COM, occlusion and hernia - functioning of the stoma outcome measures: occlusion and skin irritation. Results: Twelve comparative studies were included in this analysis, five randomized controlled trials and seven observational studies. Overall, the included studies reported on 1,529 patients, 894 (58.5%) undergoing defunctioning LI. LI reduced the risk of construction of the stoma outcome measure (odds ratio, OR = 0.47). Specifically, patients undergoing LI had a lower risk of prolapse (OR = 0.21) and sepsis (OR = 0.54). LI was associated with an excess risk of occlusion after stoma closure (OR = 2.13) and dehydratation (OR = 4.61). No other significant difference was found for outcomes. Conclusion: Our overview shows that LI is associated with a lower risk of construction of the stoma outcome measures.
AB - Background: Sphincter-saving surgery for the treatment of middle and low rectal cancer has spread considerably when total mesorectal excision became standard treatment. In order to reduce leakage-related complications, surgeons often perform a derivative stoma, a loop ileostomy (LI), or a loop colostomy (LC), but to date, there is no evidence on which is the better technique to adopt. Methods: We performed a systematic review and meta-analysis of all randomized controlled trials until 2007 and observational studies comparing temporary LI and LC for temporary decompression of colorectal and/or coloanal anastomoses. Methods: Clinically relevant events were grouped into four study outcomes: - general outcome measures: dehydratation and wound infection GOM - construction of the stoma outcome measures: parastomal hernia, stenosis, sepsis, prolapse, retraction, necrosis, and hemorrhage - closure of the stoma outcome measures: anastomotic leak or fistula, wound infection COM, occlusion and hernia - functioning of the stoma outcome measures: occlusion and skin irritation. Results: Twelve comparative studies were included in this analysis, five randomized controlled trials and seven observational studies. Overall, the included studies reported on 1,529 patients, 894 (58.5%) undergoing defunctioning LI. LI reduced the risk of construction of the stoma outcome measure (odds ratio, OR = 0.47). Specifically, patients undergoing LI had a lower risk of prolapse (OR = 0.21) and sepsis (OR = 0.54). LI was associated with an excess risk of occlusion after stoma closure (OR = 2.13) and dehydratation (OR = 4.61). No other significant difference was found for outcomes. Conclusion: Our overview shows that LI is associated with a lower risk of construction of the stoma outcome measures.
KW - Derivative enterostomy
KW - Loop colostomy
KW - Loop ileostomy
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U2 - 10.1007/s00384-009-0662-x
DO - 10.1007/s00384-009-0662-x
M3 - Article
C2 - 19219439
AN - SCOPUS:63649157662
VL - 24
SP - 479
EP - 488
JO - International Journal of Colorectal Disease
JF - International Journal of Colorectal Disease
SN - 0179-1958
IS - 5
ER -