Closing A Temporary Stoma - The Procedure Tactics

Abstract

The paper presents the results of clinical trials and meta-analyses regarding the closing time of: ileostomy (protective) after primary colorectal resection with anastomosis and colostomy - after Hartman's surgery. Rectal cancer surgery and ileal pouch-anal anastomosis (IPAA) in inflammatory bowel diseases often involves an ileostomy (temporary protective, preventive), which in a significant proportion of cases is eliminated at different times from the initial surgery. There is a discussion in the literature regarding the selection of the appropriate time of stoma closure, taking into account the experience of many clinical centers. An ileostomy is performed when the entire colon and rectum must be removed, or to protect the colon or ileorectal anastomosis. The creation of a protective stoma reduces the frequency of clinically significant anastomotic leakages and the need for surgical revisions in patients at increased risk of leakage. Also, the time of digestive system reconstruction, i.e., colostomy elimination, after Hartman's surgery depends on many factors, including the stage of disease and indications for adjuvant treatment. Should it be standard practice to close the stoma early? Based on previous studies and meta-analyses, as well as own experience - it is advisable to individualize the procedure, taking into account many factors that determine the clinical and oncological status (selection of the date - early or deferred, but not as a standard [!]).

Keywords: anastomotic leak; anterior rectal resection; closing ileostomy; colostomy.