Early Closure of Defunctioning Loop Ileostomy: Is It Beneficial for the Patient? A Meta-analysis

ObjectiveTo perform a meta-analysis to answer the question, whether early closure (EC) of defunctioning loop ileostomy may be beneficial for patient as compared with late closure (LC) without exceeding the risk of surgical-related morbidity.DesignMedline and the Cochrane Trials Register were searched for trials published up to November 2016 comparing EC (defined as14days from the index operation in which the ileostomy was performed) versus LC for stoma closure after rectal surgery. Meta-analysis was performed using Review Manager 5.0. Inclusion criteriaMain outcome measuresOverall morbidity rate, anastomotic leakage rate, and wound infection rate within 90days after elective surgery.ResultsSix studies were included and analyzed, yielding 570 patients (252 in EC group and 318 in LC). Meta-analysis showed no significant difference in the overall morbidity rate between the EC and LC groups (OR 0.63; 95% CI, 0.22-1.78; P=0.38). Despite a significant higher wound infection rate of stoma site (OR 3.83; 95% CI 2.14-6.86; P<0.00001), meta-analysis showed no significant difference in the anastomotic leakage rate between the EC and LC groups (OR 0.63; 95% CI 0.22-1.78; P=0.38). Moreover, both stoma-related complications (OR 0.46; 95% CI 0.24-0.86; P=0.02) and small bowel obstruction rates (OR 0.11; 95% CI 0.06-0.20; P<0.00001) were significantly lower in the EC group than in the LC group, respectively.LimitationsHeterogeneity of the studiesConclusionThis meta-analysis suggests that EC of a defunctioning loop ileostomy is effective and safe in careful selected patients without increasing overall postoperative complications. This promising strategy should be proposed in patients in order to reduce stoma-related complications.