Introduction Loop ileostomy for faecal diversion in elective distal colorectal anastomosis, and its subsequent reversal, are associated with significant patient morbidity and rarely even mortality. Tube ileostomy, may be an alternative technique in distal anastomosis protection, however its evidence base is not established as yet. This systematic review aims to examine differences in outcome between tube ileostomy and defunctioning ileostomy.
Method A systematic literature search of MEDLINE, EMBASE, Web of Science, and Cochrane database was conducted. Studies reporting on elective left sided/colorectal anastomoses were included. Studies which reported on emergent surgery, small bowel anastomoses or tube ileostomy as a bridging procedure were excluded. The preoperative aspects, such as bowel preparation, intraoperative technique including tube size and configuration, postoperative management such as tube removal timing, nutrition delivery and complications, were assessed. Outcome measures included anastomotic leak, reoperation and stoma or tube ileostomy-related complications.
Results Seven studies met the inclusion criteria. Three were case series consisting of 101 patients and four were non-randomised comparative studies consisting of 532 patients. Pooled analyses of three comparative studies, comparing tube ileostomy (n = 278) to loop ileostomy (n = 254), revealed no significant differences in anastomotic leak rates [Odds Ratio (OR) 0.85, 95% Confidence Interval (CI) 0.41 – 1.75; I2= 0%, p = 0.43].
Conclusion There is a re-emergence of interest in the tube ileostomy in the elective setting, in recent years. Pooled analyses of studies comparing tube ileostomy to loop ileostomy, do not show statistically significant differences in anastomotic leak rates. Further refinement of this technique and randomised controlled studies are necessary for this technique to be routinely used by surgeons.
Disclosure of interest None Declared.
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