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Comparative study of early and delayed loop ileostomy and colostomy closure

Author: 
Ranjan Satish Kumar, Om Prakash, Ahmed Aftab, Kumar Rajesh And Usha Preeti
Subject Area: 
Health Sciences
Abstract: 

Background and Objectives: Ileostomy or colostomy is often constructed in emergency surgical conditions like enteric or tubercular perforations when patients present late in the course of illness to preclude primary closure. But the ostomy carries with it lot of morbidity making the quality of life poor. The early closure of ostomy can minimize the associated morbidity and help the patient to enjoy better quality of life sooner. Our aim was to prospectively compare the morbidity and mortality associated with early closure and late closure. Methods: A total of 47 ileostomies were made for various indications during period Feb. 2013- Nov. 2014. Patients were divided into two cohorts by the time of stoma closure. Early closure group in which stoma was closed within 4-6 weeks and late closure group in which stoma was closed after 90 days. No colostomy was closed early. So our observations are on early closure of ileostomy only. Results: Total 15 patients were taken up for ileostomy closure between 4-6 weeks (EC group) and remaining 32 were late closure (LC group). Only 4 patients in early closure group had minor complication of skin excoriation. Where as in late closure group 17 patients had minor complication of prolapse plus skin excoriation and 1 patient presented with obstruction requiring relaparotomy and re-stoma formation. There was no instance of anastomotic leak, intra-abdominal abscess, or mortality in EC group and only single case developed entero cutaneous fistula but was managed conservatively. Conclusions: The present study clearly highlights the potential advantages of early closure of ileostomy without any added morbidity or mortality, and is a feasible alternative to a more conventional delayed approach, provided careful selection of patients is done. This significantly cuts down the convalescence period of the patient and helps him to live a better quality of life much earlier.

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