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Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy

Background: Temporary faecal diversion is recommended with a low colorectal, coloanal or ileoanal anastomosis (LA). This randomized study evaluated early (EC; 8 days) versus late (LC; 2 months) closure of the temporary stoma. Methods: Patients undergoing rectal resection with LA were eligible to par...

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Bibliographic Details
Published in:British journal of surgery 2008-06, Vol.95 (6), p.693-698
Main Authors: Alves, A., Panis, Y., Lelong, B., Dousset, B., Benoist, S., Vicaut, E.
Format: Article
Language:English
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Summary:Background: Temporary faecal diversion is recommended with a low colorectal, coloanal or ileoanal anastomosis (LA). This randomized study evaluated early (EC; 8 days) versus late (LC; 2 months) closure of the temporary stoma. Methods: Patients undergoing rectal resection with LA were eligible to participate. If there was no radiological sign of anastomotic leakage after 7 days, patients were randomized to EC or LC. The primary endpoints were postoperative morbidity and mortality 90 days after the initial resection. Results: Some 186 patients were analysed. There were no deaths within 90 days and overall morbidity rates were similar in the EC and LC groups (31 versus 38 per cent respectively; P = 0·254). Overall surgical complication (both 15 per cent; P = 1·000) and reoperation (both 8 per cent; P = 1·000) rates were similar, but wound complications were more frequent after EC (19 versus 5 per cent; P = 0·007). Small bowel obstruction (3 versus 16 per cent; P = 0·002) and medical complications (5 versus 15 per cent; P = 0·021) were more common with LC. Median (range) hospital stay was reduced by EC (16 (6–59) versus 18 (9–262) days; P = 0·013). Conclusion: Early stoma closure is feasible in selected patients, with reduced hospital stay, bowel obstruction and medical complications, but a higher wound complication rate. Registration number: NCT00428636 (http://www.clinicaltrials.gov). Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Down to a balance of risks
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.6212