© Masson, Paris, 2005. Gastroenterol Clin Biol 2005;27:00-00 1 ORIGINAL ARTICLE Early closure of temporary stoma of the small bowel Pere JORDI-GALAIS, Nicolas TURRIN, Christophe TRESALLET, Quang NGUYEN-THANH, Jean-Paul CHIGOT, Fabrice MENEGAUX Service de Chirurgie Générale, Viscérale et Endocrinienne, Hôpital de la Pitié, Paris. SUMMARY Aim — Transient small bowel stoma is usually closed 9-12 weeks after initial operation (late closure). Since these stoma have a poor physiological and psychological impact with frequent social conse- quences, we wanted to estimate feasibility and results of early clo- sure of small bowel stoma. Patients and method — From January 1998 to December 2001, 39 patients (21 women and 18 men, mean age: 64 years) with a tran- sient small bowel stoma were elected for early closure. Early closure was performed only if the patient was in good condition, and with- out developing wound or general sepsis. In the other patients, the stoma was closed in the usually recommended delay (> 8 weeks). Fifteen patients had an early closure of their stoma in a mean delay of 10.0 0.8 days after the initial procedure. Twenty-four patients had a late closure of their stoma in a mean delay of 11.4 3.7 weeks. Results — There were no postoperative deaths and no intestinal fis- tula. Four (10%) wound abscesses occurred and were managed without any surgical procedure, 3 in the early closure group (20%) and 1 in the late closure group (4%) (P = 0.85, NS). Time to recov- ered bowel activity and to resumed oral feeding were equivalent in the two groups. The mean length of hospital stay was longer in the delayed group (34.5 18.6 days) than in the early group (23.1 4.6 days) (P < 0.01). Conclusion — Early closure of bowel stoma can be performed with- out major complications in elective patients. This procedure shortens hospital stay. Introduction If the local or general conditions are unfavorable, a transient small bowel stoma may be required to protect a distal anasto- mosis or avoid intraperitoneal intestinal suture. This temporary stoma is usually closed 9 to 12 weeks later [1]. However since some patients tolerate the temporary stoma poorly (extracellular dehydration, difficult pouch fitting, requirement for parenteral nutrition if the stoma is very proximal, psychological or social impact) it might be advisable to opt for early closure [2]. In order to assess the feasibility of early closure and its results, we defined a minimal delay considered as optimal for closing small bowel stomas. We took into account the risk of fistulization of the protected intestinal anastomosis and acute peristomal inflammatory reactions leading to adherences which could com- promise dissection and the quality of the bowel anastomosis. After defining this optimal delay, we conducted a non-rand- omized prospective study in 39 patients, 15 with early closure and 24 with late closure. Patients and methods From January 1998 to December 2001, we closed a tempo- rary small bowel stoma in 39 patients, 21 women and 18 men, mean age 64 years (range 24-83). Twenty-six patients had a loop ileostomy above a distal anastomosis: low colorectal anas- tomoses (N = 13) for cancer of the rectum (N = 12) or the ovary with rectal invasion (N = 1) and high colorectal anastomoses (N = 13) for sigmoiditis with abscess formation or localized peritonitis (N = 11) or sigmoid cancer or obstruction (N = 2). In 13 other patients, a double-end stoma was fashioned after bowel resection due to local or general problems (perforation with generalized peritonitis in 11 patients and traumatic perfo- ration with severe hemodynamic shock in 2). The initial opera- tion had been performed in an emergency setting in 26 of the 39 patients. Early closure was discussed for all patients and was per- formed if the patient’s nutritional status was considered accepta- ble and there were no signs of active infection or organ failure (abdominal or other). When early closure was considered possible and the tempo- rary stoma had been fashioned to protect an anastomosis, the anastomosis was checked with a barium study the day before the planned closure. Closure was performed under general anesthesia with antibi- otic prophylaxis (cephazolaine) at the time of the incision. The elective incision was always associated with resection of the stoma and bowel anastomosis using two extramucosal overcast sutures performed manually with a knit polyglactin acid thread or mechanical stapling (TLC75 ® and TL60 ® , Ethicon™). The operator determined the appropriate method. The aponeurotic planes were sutured with a knit polyglactin acid thread and the skin was closed with a loose suture. Results are expressed as mean standard deviation. The exact Fisher test was used for non-parametric data and Stu- dent’s t test for parametric data. P less than 0.05 was consid- ered significant. The full text of this article is available in English on the web on: www.e2med.com Reprints : F. MENEGAUX, Service de Chirurgie Générale, Viscérale et Endocrinienne, Hôpital de la Pitié, 47-83 boulevard de l’Hôpital, 75651 Paris Cedex 13. E-mail : fabrice.menegaux@psl.ap-hop-paris.fr © 2021 Elsevier Masson SAS. Tous droits réservés. - Document téléchargé le 07/12/2021 Il est interdit et illégal de diffuser ce document.