Outcome of Early Versus Delayed Loop Ileostomy Closure: A Single Center Experience

Background: Intestinal stomas are often constructed in emergency abdominal surgeries, when primary repair of bowel carries high risk of anastomotic leakage due to peritoneal contamination or inflamed bowel or in hemodynamically unstable patient, such as typhoid ulcer perforation, trauma (penetrating or blunt), rectal or colonic injury, appendicular perforation etc. During this time stoma carries with it a lot of morbidity making the quality of life poor. That’s why some author suggested early closure of the stoma. Other mentioned early closure is not safe. But there is no established guideline to indicate the optimal timing for reversion.

Aim: The aim of the study is to compare the surgical outcomes and complication rates associated with early and delayed loop ileostomy closure

Methods: This was conducted in surgery department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh between January 2021 to June 2022. A total of 60 patients with loop ileostomy were included in this study in two groups, of them 30 patients in early closure group where reversal was done between 14 days to 28 days and other 30 patients in delayed closure group where reversal was done after 12 weeks. Data were collected from the patients, admitted in different unit of surgery for ileostomy reversion, using a semi structured case record form. Data were analyzed using SPSS (Statistical Package for Social Sciences) software (version 26.0) and findings were presented in the form of tables and graphs with due interpretation. Recorded data finally were analyzed by unpaired t-test and chi-square/fisher exact test and p value <0.05 was considered as a level significance.

Results: The mean age was found 39.9±7.17 years and 40.6±6.7 years in early closure group and delayed closure group respectively with male predominance in both groups. Most common indication for ileostomy procedure in both groups was enteric perforation. Stoma related complications significantly higher in delayed closure group (p=0.015). Mean operation time for ileostomy closure was significantly higher in delayed closure group (59.3±9.2 mins vs 72.7±10.4 mins, P <0.001). The postoperative wound infection was higher in early closure group (10.0% vs 6.7%, p=0.640. On the other hand, paralytic ileus and anastomotic leakage were higher in delayed closure group but not statistically significant. Mean hospital stay was significantly higher in delayed closure group compare to early closure group (6.73±1.46 days vs 8.20±2.62 days, p=0.01). Mortality was not found statistically significant in both groups (0% vs 3.3%, p>0.05).

Conclusion: The current study demonstrates stoma related complications, mean operation time and length of hospital stay were significantly lower in the early than in the delayed closure group.