Comparison of handsewn with stapled loop ileostomy closures

Abstract

Purpose: The aim of this study was to determine if a stapled side-to-side closure of an ileostomy results in decreased length of hospital stay compared with a handsewn closure.

Methods: From March 1993 to August 1994, patients who had previously undergone total proctocolectomy with pelvic pouch formation and loop ileostomy were studied. At the time of ileostomy closure, patients were randomized to have their stoma closed by a handsewn technique or stapled closure. Data were prospectively gathered.

Results: During 17 months, 61 consecutive patients (38 male, 23 female) with a mean age of 37.8 (range, 16-69) years had their ileostomy closed and were entered into this study. There were 31 patients in the stapled group and 30 in the handsewn group. Mean operative time was 55 (range, 32-97) minutes in the stapled group and 67 (range, 42-128) minutes in the handsewn group (P = 0.01 Wilcoxon's test). Average length of stay was three (range, 2-5) days in the stapled group and 2.5 (range, 1-19) days in the handsewn group. One patient from the stapled group and two patients from the handsewn group were readmitted because of small-bowel obstruction. One patient from the stapled group underwent additional surgery for a leaking enterotomy with no defect in staple closure. Two patients from the handsewn group underwent additional surgery for small-bowel obstruction. There was no significant difference in day of first stool or day of solid diet for the two groups.

Conclusion: Handsewn and stapled closures of loop ileostomy are not significantly different with respect to day of first stool, day until solid diet, or discharge day. Complications were similar in the two groups. Stapled closure is significantly quicker than handsewn closure.