Systematic review and meta analysis of published trials comparing the effectiveness of transanal endoscopic microsurgery TEMS and endoscpic submucosal dissection ESD in the management of early rectal cancer T1,T2
International Journal of Surgery
Aim: Defunctioning loop ileostomy (DLI) is widely used as a component of various resectional procedures to reduce or ameliorate anastomotic leakage. However, the effectiveness of routine DLI remains unproven and reversal is associated with procedure-specific complications and hospital stay. We aim to describe the nature, rate of complications and hospital stay after DLI closure. Method: The department database was queried and charts reviewed for all patients who underwent DLI closure in the
... ear period from January 2004 to November 2015. Result: There were 421 patients who underwent DLI closure (median age 61 yrs, range 17-98yrs). Length of hospital stay after Ileostomy closure was 0-17 days, median ¼ 8 days with a total bed usage of 3423 days. Significant complications arose in 79 patients (18.76%) with 14 requiring re-operative intervention (3.33%). 33 developed a post-operative ileus. C. difficile infection arose in 9 cases and MRSA in 5. 17 patients were re-admitted with a total stay of 48 nights. Conclusion: This study describes an appreciable morbidity (18.76%) and bed-day requirement associated with DLI closure. The findings inform discussion around the role and value of defunctioning ileoanal and coloanal anastomosis. The findings also provide useful data in the consideration of an appropriately-powered RCT of ileoanal and coloanal anastomosis. http://dx.