Stapled versus sutured closure of loop ileostomy - A randomized controlledtrial

Objective To compare the outcome after conventional sutured loop ileostomy closure wi th stapled ileostomy closure. Summary Background Data A defunctioning loop ileostomy is now widely used in colorectal surgery. Subsequent closure may be associated with early complications, particularly bowel obstruction. The results of a preliminary nonrandomized study suggested that there was no s ignificant difference in the rate of complications between sutured and stap led closure of loop ileostomy. Methods One hundred forty-one consecutive patients who underwent loop ileostomy bet ween 1993 and 1998 were randomized before surgery to either sutured or stap led loop ileostomy closure. Seventy-one patients had stapled closure and 70 had sutured closure. Results Both groups were comparable in terms of age, sex, original operation, durat ion after original operation, and level of operating surgeon. Postoperative bowel obstruction occurred in 10/70 (14%) patients after sutured closure c ompared with 2/71 (3%) patients after stapled closure. Subgroup analysis Of ileostomy closure in patients having an ileal pouch showed no significant difference in bowel obstruction between stapled and sutured closure (2/30 v s. 7/29). The incidence of other complications, readmissions, and reoperati ons did not differ between the two groups. The stapled closure was only 4 m inutes quicker than sutured closure. The mean total hospital slay tended to be shorter after the stapled closure than the sutured closure, but this di d not reach statistical significance. Conclusions Bowel obstruction occurred less frequently after stapled closure, but the m ean hospital stay and readmission and reoperation rate did not significantl y differ between the two groups.