Comparison of hand-sewn anterior repair, resection and hand-sewn anastomosis, resection and stapled anastomosis techniques for the reversal of diverting loop ileostomy after low anterior rectal resection: a randomized clinical trial

• Published in: Techniques in coloproctology 2024-12, Vol.28 (1), p.30, Article 30
• Main Authors: Meshkati Yazd, Seyed Mostafa, Shahriarirad, Reza, Keramati, Mohammad Reza, Fallahi, Mehdi, Nourmohammadi, Soheila-sadat, Kazemeini, Alireza, Fazeli, Mohammad Sadegh, Keshvari, Amir
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Anastomosis, Surgical - adverse effects; Anastomotic Leak - etiology; Colorectal cancer; Colorectal Surgery; Defecation; Female; Gastroenterology; Humans; Ileostomy - adverse effects; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Ostomy; Postoperative Complications - etiology; Postoperative period; Proctology; Rectal Neoplasms - surgery; Surgery; Surgical anastomosis; Surgical outcomes; Suture Techniques - adverse effects
• ISSN: 1123-6337; 1128-045X; 1128-045X
• DOI: 10.1007/s10151-023-02898-9

Background Low anterior resection in patients with rectal cancer may require a defunctioning loop ileostomy formation that requires closure after a period of time. There are three common techniques for ileostomy closure: anterior repair (AR or fold-over closure), resection and hand-sewn anastomosis (RHA), and resection and stapled anastomosis (RSA). We aimed to compare them on the basis of operative and postoperative features. Methods Patients with rectal cancer who underwent low anterior resection without complications were included in this study and randomly assigned to three parallel groups to undergo loop ileostomy closure via either AR, RHA, or RSA. Early and late outcomes were gathered from all included patients. Results Among 93 patients with a mean age of 56.21 ± 11.78 years, consisting of 58 (62.4%) men, 31 patients underwent AR, 30 patients RHA, and 32 patients RSA. There was no significant difference among the groups regarding the frequency and location of intraoperative injuries ( P  = 0.157). The AR groups demonstrated significantly less consumption of gauzes following intraoperative bleeding compared to the two others groups. The results showed that the duration of surgery in the RSA was significantly shorter than in the AR or RHA group (both P