Suturing Equal to Stapling for Closure of Loop Ileostomy

Hand suturing for loop ileostomy closure results in equal rates of bowel obstruction when compared to using a stapler, according to a new study.

Researchers at the University of Heidelberg (Germany), Ruhr University (Bochum, Germany), and other institutions conducted a multicenter randomized trial involving 337 randomized patients in 27 centers undergoing closure of loop ileostomy following low anterior resection of the large colon due to rectal cancer. The patients were randomized to two parallel groups to compare hand suture to mechanical stapling for the closure. The primary endpoint was the rate of bowel obstruction within 30 days after ileostomy closure.

The results showed that the overall rate of postoperative ileus after ileostomy closure was 13.4%; 17 of 165 (10.3%) patients in the stapler group and 27 of 163 (16.6%) in the hand suture group developed bowel obstruction within 30 days postoperatively. The duration of surgical intervention was significantly shorter in the stapler group. Multivariable analysis of potential risk factors did not reveal any significant correlation with development of postoperative ileus. Rate of anastomotic leakage did not differ significantly, as well as all other secondary endpoints. The study was published in the November 2012 issue of Annals of Surgery.

“Hand-sewn anastomosis versus stapler ileo-ileostomy for ileostomy closure are equally effective in terms of postoperative bowel obstruction, with stapler anastomosis leading to a shorter operation time,” concluded lead author Thorsten Löffler, MD, of the University of Heidelberg, and colleagues. “Postoperative ileus after ileostomy reversal remains a relevant complication.”

During a loop ileostomy, a loop of the small intestine is brought out through the stoma. The procedure is usually only used as a temporary measure, when it is necessary to remove part of the rectum. Once the remaining colon has healed, it can be reconnected to the small intestine and the stoma can be closed. Bowel obstruction is one of the main and the clinically and economically most relevant complication following closure of loop ileostomy.

Related Links:
University of Heidelberg
Ruhr University