Publication:

Early takedown of a defunctioning ileostomy, is there a downside? – a prospective analysis from Rural Bengal

Background Since the pilot study in 2002, many studies have evaluated the feasibility of an Early Ileostomy takedown by 2 weeks, thus decreasing the stoma related morbidity. However, in a developing country like India, this paradigm shift is still debatable. Our study from a tertiary teaching rural hospital in Bengal evaluates the feasibility of Early takedown by 2 weeks and compares it to a more accepted concept of Ileostomy takedown by 8-10 weeks.

Methods This prospective longitudinal comparative study conducted from February 2018 to July 2019, in our institute. Sample size was calculated to be 30 in each group. The early closure went a takedown at 2 weeks and the delayed closure underwent a takedown by 8-10 weeks. Data was analysed with Fischer’s exact or Chi square test, student’s t test. A p value of 0.05 was significant.

Results Our set of rural patients, had more stoma related complications due to lack of stoma care (13.33% vs 3.33%, EC vs DC). Intraoperative adhesions (26 vs 12, p=0.0004) significantly increased operative time (126.1667±27.5895 vs 86.0000±34.2506, EC vs DC, p<0.001), leading to post-operative complications hence, the Length of hospital stay was more in the early subset (17.9667±6.9851 vs 11.2000±4.0548, EC vs DC, p<0.001).

Conclusions An early takedown of a defunctioning ileostomy, may be a technically difficult procedure to perform, has more post-operative complications and is discouraged, in our opinion.