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Meta-Analysis
. 2020 Jul;24(7):671-684.
doi: 10.1007/s10151-020-02188-8. Epub 2020 Mar 31.

Rectal stump management in inflammatory bowel disease: a cohort study, systematic review and proportional analysis of perioperative complications

S Lawday  1 , M Leaning  2 , O Flannery  2 , S Summers  2 , G A Antoniou  3   4 , J Goodhand  5 , R Bethune  2 , S A Antoniou  2   6   7
Affiliations
Meta-Analysis

Rectal stump management in inflammatory bowel disease: a cohort study, systematic review and proportional analysis of perioperative complications

S Lawday et al. Tech Coloproctol. 2020 Jul.

Abstract

Background: The aim of this study was to analyse local single-institution data and perform a systematic review of the literature to calculate precise risk estimates of rectal stump-related morbidity and mortality following subtotal colectomy in patients with inflammatory bowel disease (IBD), including Crohn's colitis, ulcerative colitis and indeterminate colitis.

Methods: Institutional information systems were interrogated to obtain local patient data. A systematic review of MEDLINE and EMBASE was performed to identify relevant articles. Fixed-effects or random-effects meta-analysis of proportions was performed to calculate pooled incidence estimates, including local data.

Results: Sixty-one patients were included locally and all had their rectal stump closed intra-abdominally. Four patients (8.3%) had a rectal stump perforation and 30-day mortality was 0. Fourteen papers were included in our review alongside local data, with a total of 1330 patients included. Pooled mortality was 1.7% (95% confidence interval, CI 1.0-2.8), pooled incidence of pelvic abscess/sepsis, stump leak and wound infection was 5.7% (95% CI 4.4-7.3), 4.9% (95% CI 3.7-6.6) and 11.3% (95% CI 7.8-16), respectively. Subcutaneous placement of the stump was associated with the highest incidence of stump leak (12.6%, 95% CI 8.3-18.6), and closure of the stump with both staples and suture was associated with the highest incidence of pelvic abscess (11.1%, 95% CI 5.8-20.3). Mortality and the incidence of wound infection were similar across stump closure techniques. There was evidence suggesting considerable heterogeneity and publication bias among studies.

Conclusions: This study provides estimates of morbidity associated with the rectal stump after subtotal colectomy for IBD. A closed intra-abdominal stump seems to be associated with the highest rate of pelvic abscess/sepsis. Further work in form of an international collaborative project would allow individual patient data analysis and identification of risk factors for complications.

Keywords: Inflammatory bowel disease; Morbidity; Rectal stump; Surgery.

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