Comparative Study of Early Stoma Closure with Conventional Stoma Closure Following Bowel Surgery

Introduction

Stoma closure is usually performed after 8–12 weeks. However, quality of life (QoL) is affected due to stoma?related complications during this period. Early closure of temporary stoma might reduce both stoma?related morbidity and patient discomfort.

Aim

To compare early stoma closure with conventional stoma closure following defunctioning diversion stoma surgery with respect to the frequency of complications, health? QoL, and length of hospitalization (LoH).

Patient Profile

Patients between the ages of 18 years and 70 years who underwent temporary stoma following bowel surgery

Methods

•  A prospective parallel?arm randomized controlled trial
• Conducted at the Department of Surgery in a tertiary care hospital in South India

Study Outcome

• The rate of complications (medical and surgical) following early and conventional stoma closure was assessed
• Health?related QoL and LoH were also measured.

Results

• The distribution of age, gender, comorbidities, personal habits, biochemical parameters, and operating times were comparable across the two groups
• In early closure group, 14 (28%) patients (5 diabetes mellitus [DM], 7 hypertension [HTN], 2 both) had comorbidities whereas in conventional closure group, it accounted for 10 (20%) patients (4 DM, 4 HTN, 2 both

• The rate of complications and LoH were comparable across early and conventional stoma closure groups
• The length of hospital stay, overall mortality and morbidity were similar across the two groups

• There was a significant reduction in the cost towards stoma care (96% vs 2%; P = 0.001) in the early stoma closure group
• Patients in the early stoma closure group also had a significantly better QoL
• No significant difference was observed in operating time between early closure group and conventional closure group

Conclusion

• Early stoma closure is safe and feasible when patients are selected appropriately
• It does not carry an increased risk of bleeding, need for midline laparotomy, anastomotic leak, or medical complications
• Early stoma closure also improves the QoL with a considerable reduction in cost towards stoma care

Reference

Saudi J Gastroenterol 2018; 24:52-8.