Early diverting stoma closure is feasible and safe: results from a before-and-after study on the implementation of an early closure protocol at a tertiary referral center

• Published in: Techniques in coloproctology Vol. 28; no. 1; p. 32
• Main Authors: Blanco Terés, L., Cerdán Santacruz, C., Correa Bonito, A., Delgado Búrdalo, L., Rodríguez Sánchez, A., Bermejo Marcos, E., García Septiem, J., Martín Pérez, E.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2024; Springer Nature B.V
• Subjects: Abdominal Surgery; Colorectal Surgery; Comparative analysis; Gastroenterology; Humans; Medicine; Medicine & Public Health; Morbidity; Original Article; Ostomy; Proctology; Surgery; Surgical Stomas - adverse effects; Tertiary Care Centers; Early stoma closure; Ileostomy closure; Colorectal surgery; Defunctioning stoma
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-023-02905-z

Background Evidence on early closure (EC) of defunctioning stoma (DS) after colorectal surgery shows a favorable effect when patients are carefully selected. Therefore, a clinical pathway adapted to the implementation of an EC strategy was developed in our center. The aim of this study was to carry out a comparative analysis of time until DS closure and DS-related morbidity before and after the implementation of an EC protocol (ECP). Methods This study is a before-and-after comparative analysis. Patients were divided into two cohorts according to the observational period: patients from the period before the ECP implementation (January 2015–December 2019) [Period 1] and those from the period after that (January 2020–December 2022) [Period 2]. All consecutive patients subjected to elective DS closure within both periods were eligible. Early closure was defined as the reversal within 30 days from DS creation. Patients excluded from EC or those not closed within 30 days since primary surgery were analyzed as late closure (LC). Baseline characteristics and DS-related morbidity were recorded. Results A total of 145 patients were analyzed. Median time with DS was shorter in patients after ECP implementation [42 (21–193) days versus 233 (137–382) days, p  < 0.001]. This reduction in time to closure did not impact the DS closure morbidity and resulted in less DS morbidity (68.8% versus 49.2%, p  = 0.017) and fewer stoma nurse visits ( p  = 0.029). Conclusions The ECP was able to significantly reduce intervals to restoration of bowel continuity in patients with DS, which in turn resulted in a direct impact on the reduction of DS morbidity without negatively affecting DS closure morbidity.