Impact of temporary ileostomy on long‐term quality of life and bowel function: a systematic review and meta‐analysis. Issue 5 (7th November 2019)

• Record Type: Journal Article
• Authors: Keane, Celia; Sharma, Puja; Yuan, Lance; Bissett, Ian; O'Grady, Greg
• Is Part Of: ANZ journal of surgery. Volume 90:Issue 5(2020)
• Page Start: 687
• Page End: 692
• Publication Date: 2019-11-07
• Subjects: functional outcome -- ileostomy -- quality of life -- rectal cancer; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.15552
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract: Background: Defunctioning ileostomy is widely used to protect a low colorectal anastomosis. However, the use of an ileostomy may have an impact on long‐term bowel function and quality of life after anterior resection. The objectives were to compare bowel function and quality of life outcomes between patients undergoing an anterior resection for rectal cancer, with and without the formation of a diverting ileostomy, and to compare outcomes for early versus late closure of diverting ileostomy. Method: A systematic literature review was performed to identify studies published between 2007 and 2018 comparing bowel function and quality of life outcomes after an anterior resection for rectal cancer in those with and without formation of a diverting ileostomy. Results: Four studies (three randomized controlled trials) reported bowel function and quality of life outcomes. Pooled analysis for 227 participants showed that having an ileostomy is associated with twice the risk of suffering from low anterior resection syndrome (odds ratio (major low anterior resection syndrome) 1.96, 95% confidence interval 1.1, 3.5; P = 0.02). There were no consistent differences in quality of life. Based on single studies there is limited evidence of some improvements in bowel function but no difference in quality of life after early compared to late closure of ileostomy. Conclusion: There is some evidence for an association between low anterior resection syndrome and the use of a diverting ileostomy to protect a rectal anastomosis. Potential confounders include height of the anastomosis. Further research into the mechanisms underlying this potential association may inform methods to mitigate the harms of an ileostomy. Abstract : This systematic review investigates whether the use of an ileostomy has an impact on long‐term bowel function and quality of life after anterior resection. Pooled analysis for 227 participants showed that having an ileostomy is associated with twice the risk of suffering from low anterior resection syndrome (OR (major LARS) 1.96; 95% CI: 1.1, 3.5; P = 0.02). Based on single studies there also some of improvements in bowel function but no difference in quality of life after early compared to late closure of ileostomy.