Hand-Sewn Direct Repair Versus Resection and Hand-Sewn Anastomosis Techniques for the Reversal of Diverting Loop Ileostomy After Lower Anterior Rectal Resection Surgery: A Randomized Clinical Trial Publisher Pubmed



Keramati MR^{1, 2} ; Meshkati Yazd SM^{1, 2} ; Shahriarirad R^{3, 4} ; Ahmadi Tafti SM^{1, 2} ; Kazemeini A^{1, 2} ; Behboudi B^{1, 2} ; Fazeli MS^{1, 2} ; Keshvari A^{1, 2} Show Affiliations
Source: Journal of Surgical Oncology Published:2023

Abstract

Introduction: Several techniques have been proposed for the closure of loop ileostomy. This is the first study comparing bowel function and outcomes of two different hand-sewn surgical techniques used for the closure of diverting protective loop ileostomy. Method: In this prospective, randomized, double-blind clinical trial, 40 patients with a history of rectal cancer, low anterior resection, and diverting loop ileostomy who were candidates for ileostomy reversal were included and randomly assigned into two groups, hand-sewn direct repair of the ileal defect (group A) and resection and hand-sewn anastomosis of the ileum (group B). Results: The mean age of patients was 56.42 and 52.10 years in groups A and B, respectively. Regarding early postoperative period, group A developed earlier first gas passage (1.68 vs. 2.25 days, p = 0.041) and stool passage (2.10 vs. 2.80 days, p = 0.032). Group A also revealed shorter operating time (83.68 vs. 89.50 min, p = 0.040) and hospital stay (4.73 vs. 6.80 days, p = 0.001). None of the participants in both groups developed signs of bowel obstruction during the early and late postoperative follow-up period. Conclusions: Direct hand-sewn repair for the closure of diverting loop ileostomy is a safe technique with better postoperative bowel function, oral diet tolerance, and less hospital stay compared to resection and hand-sewn anastomosis of the ileum. © 2022 Wiley Periodicals LLC.