The Feasibility of Early Closure of Defunctioning Loop Ileostomy after Low Anterior Resection for Rectal Cancer

Ahmed S. Elgammal1*, Ahmed Gaber1, Ahmed Fawzy1

1General Surgery Department, Faculty of Medicine, Menoufia University, Egypt.

Background: The advantages of defuctioning loop ileostomy in some cases of rectal carcinoma is not questionable, but many patients experience serious stoma related complications and impaired quality of life. Early closure of the defunctioning ileostomy could mitigate these problem.

Methods: This is a controlled randomized study done on 100 patients suffering of rectal cancer who had low anterior resection of the rectum and covering ileostomy at Menofiya University Hospital between April 2016 to august 2019. The patients were randomly divided (by closed envelope method) in two equal groups, Group A (Early group) and Group B (Late group).

Results: As regards the pre-closure ileostomy complications: skin infection and maceration occurred in 4 pts. In early group and in 15 late group while dehydration and electrolyte imbalance occurred in 3 pts. In early group and in11 pts. In the late one, with both complications were significantly higher in late group (P value; 0.009 and 0,04 respectively). The health related quality of life was found to be higher in early group at 2 and 6 months than that in late group, but this did not yet reach significant difference, and at 12 month, the results were almost the same.

Conclusion: Early ileostomy closure is safe, and not associated with higher complication rates in patients with an uncomplicated postoperative course and radiologically verified intact distal loopogram study.

Keywords: Early closure; Rectal resection; Rectal cancer; Loop ileostomy

Free Full-text PDF

How to cite this article:

Ahmed S. Elgammal, Ahmed Gaber, Ahmed Fawzy. The Feasibility of Early Closure of Defunctioning Loop Ileostomy after Low Anterior Resection for Rectal Cancer. American Journal of Surgical Research and Reviews, 2021; 4:19. DOI:10.28933/ajsrr-2021-04-1805


1. 1-American Cancer Society. Cancer facts and figures 2014.
2. Ibrahim AS, Khaled HM, Mikhail NN, Baraka H, Kamel H. Cancer incidence in Egypt: results of the national population-based cancer registry program. J Cancer Epidemiol. 2014;2014: 437971.webcontent/acspc-042151.pdf. Accessed January 20, 2017.
3. Gessler B, Haglind E, Angenete E. Loop ileosto-mies in colorectal cancer patientsmorbidity and risk factors for nonreversal. J Surg Res. 2012;178(2):708-14.
4. Chadi SA, Fingerhut A, Berho M, et al. Emerging trends in the etiology, prevention, and treatment of gastrointestinal anastomotic leakage. J Gastroin-test Surg. 2016;20:2035- 2051.
5. Vallance A, Wexner S, Berho M, et al. A collabo-rative review of the current concepts and chal-lenges of anastomotic leaks in colorectal surgery. Colorectal Dis. 2017;19:O1-O12. doi: 10.1111/codi.13534.
6. Montedori A, Cirocchi 6-R, Farinella E, et al. Cov-ering ileo- or colostomy in anterior resection for rectal carcinoma. Cochrane Database Syst Rev. 2010;(5):CD006878.
7. Matthiesen P, Hallbo¨o¨k O, Rutegaard J, et al. Defunctioning stoma reduces sympto-matic anastomotic leakage after low an-terior resection of the rectum for cancer. Ann Surg. 2007; 246:207e14.
8. Pommergaard H-, Gessler B, Burcharth J, An-genete E, Haglind E, Rosenberg J. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis. 2014;16(9):662-71.
9. Shah NA, Hussain M, Kalim M, Mehreen T, Shah I, Abid J. Experience with early versus routine en-teric stoma closures: A comparative study. J Postgrad Med Inst. 2016;30(4):360-3.
10. Eypasch E,Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E et al. Gastroin-testinal Quality of Life Index: development, vali-dation and application of a new instrument. Br J Surg. 1995;82:216–222.
11. Marusch F, Koch A, Schmidt U et al. Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum. 2002;45:1164 –1171.
12. O’Toole GC, Hyland JM, Grant DC et al. Defunc-tioning loop ileostomy: a prospective audit. J Am Coll Surg. 1999;188:6–9.
13. Alves A, Panis Y, Lelong B et al. Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy. Br J Surg. 2008;95:693–698.
14. Velmahos GC, Degiannis E, Wells M et al. Early closure of colostomies in trauma patients—a prospective randomized trial. Surgery. 1995;118: 620–815
15. Bakx R, Busch ORC, van Geldere D et al. Feasi-bility of early closure of loop ileostomies. Dis Colon Rectum. 2003;46:1680–1684
16. Worni M, Witschi A, Gloor B, Candinas D, Laffer UT, Kuehni CE. Early closure of ileostomy is associ-ated with less postoperative nausea and vomiting. Dig Surg. 2011;28(5-6):417-23.
17. Afroz Khan F. Airani*, Chitra Y. Bhat, Bharat S. V., Gabriel Rodrigues. How temporary is temporary ileostomy: variables delaying reversal of an ile-ostomy, Int Surg J. 2019;6(1):66-72
18. Sier MF, van Gelder L, Ubbink DT, Bemelman WA, Oostenbroek RJ. Factors affecting timing of clo-sure and non-reversal of temporary ileostomies. Int J Colorectal Dis. 2015;30(9): 1185-92.
19. Robertson I, Eung E, Hughes D, Spires M, Don-nelly L, Mackenzie I, et al. Prospective analysis of stoma related complications. Colorectal Dis. 2005;7: 279–85.
20. Taha Mohamed Fayed, Ayman Mohammed Ab-dulMohaymen, and Eid Rizk El Gammal. Early Versus Delayed Reversal of Covering Stoma after Low Anterior Resection for Colo- rectal Carcinoma, The EGYPTIAN JOURNAL OF HOSPITAL MEDICINE. 6920-6915 Page (6), 73 Vol.
21. Bausys A, Kuliavas J, Dulskas A, et al. Early versus standard closure of temporary ileostomy in patients with rectal cancer: A randomized con-trolled trial. J Surg Oncol. 2019;1‐6.
22. Krand O, Yalti T, Berber I et al. Early vs delayed closure of temporary covering ileostomy: a pro- spective study. Hepatogastroenterology. 2008; 55:142–145.
23. Danielsen AK, Park J, Jansen JE et al. Early closure of a temporary ileostomy in patients with rectal cancer: a multicenter randomized controlled trial. Ann Surg. 2017;265:284–290.
24. Lasithiotakis K, Aghahoseini A, Alexander D (2016) Is early reversal of defunctioning ileostomy a shorter, easier and less expensive operation? World J Surg 40:1737–1740. https://doi. org/10.1007/s00268-016-3448-7
25. Anne Kjaergaard Danielsen, Adiela Correa- Marinez,Eva Angenete, Stefan Skullmann, Eva Haglind, Jacob Rosenberg, SSORG (Scandi- navian Outcomes Research Group). Early closure of temporary ileostomydthe EASY trial: protocol for a randomised controlled trial, BMJ Open (2011).doi:10.1136/bmjopen-2011-000162 5.
26. O_Leary DP, Fide CJ, Foy C, et al. Quality of life efter low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma. Br J Surg. 2001;88:1220.