Are stapled and single-layer anastomoses similar and do they have advantages in reducing a patient's length of hospital stay when compared with two-layer anastomoses in the closure of loop ileostomy?

Are stapled and single-layer anastomoses similar and do they have advantages in reducing a patient's length of hospital stay when compared with two-layer anastomoses in the closure of loop ileostomy? A retrospective cohort study

Status

Completed

Phases

Unknown

Study type

Observational

Source

ANZCTR

Registry ID

ACTRN12618001596291

Enrollment

244

Registered

2018-09-26

Start date

2016-09-01

Completion date

2017-09-01

Last updated

2018-10-01

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

None listed

Brief summary

Introduction Loop ileostomy formation is a common practice for patients undergoing low anterior resection or restorative ileo-anal pouch surgery. This can be performed using either a stapled or hand-sewn technique, with or without a bowel resection. If hand-sewn, the closure can be one or two layers. Randomised controlled trials are yet to show a clear benefit of one closure technique over another, and meta-analyses are limited by the heterogeneity of published studies. Our primary aim is to compare stapled ileostomy closures with single- and two-layer, hand-sewn closures. Materials and Methods This retrospective, single-centre cohort study included all patients undergoing loop ileostomy closure between January 1999 – April 2016 at one hospital. Patient demographics, anastomotic technique, operative time, and patient outcomes were collected. Demographic data and American Society of Anaesthesiology (ASA) grade were compared, and linear regression models were used to assess differences in procedure means for operative time and length of stay. Differences in morbidity were analysed using Poisson regression models. Results The median age of patients was 67 years, and 43.4% of patients were female (n=244). There was no significant difference in mean operative time (71.5, 73.1, and 88.5 minutes, adjusted Wald P=0.262), or morbidity(21.5% vs 20.4% vs 17.6%, adjusted Wald P=0.934) between stapled, or hand-sewn anastomotic techniques, and no mortality in any group. Once adjusting for age, sex, ASA and consultant the length of stay (LOS) was similar between stapled and single-layer closures (4.2 vs 5.5 days, P=0.102), but was significantly different between stapled and two-layer closures (4.2 vs 8.3 days, adjusted Wald P=0.034, pairwise P=0.031). Conclusion Stapled and single-layered hand-sewn ileostomy closures are similar in length of the procedure, length of stay, and complication rates. Stapled ileostomy closures, however, are associated with a significant reduction in stay compared with two-layer, hand-sewn techniques.

Interventions

This retrospective, single-centre cohort study includes all patients undergoing loop ileostomy closure between January 1999-April 2016. Demographic details, anastomotic technique, operative time, and patient outcomes were recorded for patients from admission to 30 days Post-discharge. Outcomes for patients with stapled ileostomy closures were compared with outcomes for patients with single and two-layer, hand-sewn closures.

Eligibility

Sex/Gender

All

Age

18 Years to No maximum

Healthy volunteers

Inclusion criteria

Patients undergoing a closure of defunctioning or diverting loop ileostomy

Exclusion criteria

Patients were excluded from analysis if: There was incomplete documentation of the anastomotic technique, if the stoma closure was an ileo-colic anastomosis, if they had a reversal of the loop ileostomy in conjunction with another operation, or if the operation was performed acutely because of small bowel obstruction or a high output ileostomy.

Outcome results