Forty-eight studies were included in the review (n=6,107 patients, range 16 to 1,504); seven randomised controlled trials (RCTs, n=468 patients), 16 non-randomised prospective studies (n=1,588 patients), and 25 retrospective studies (n=4,051 patients).
Overall morbidity following closure of loop ileostomy was 17.3% (823 patients out of 4,765) and overall mortality was 0.4% (19 patients out of 4,319). A midline laparotomy incision at the time of closure was required in 3.7% of cases (102 patients out of 2,771).
Bowel-related morbidity included the following: small bowel obstruction in 7.2% of patients (339 patients out of 4,735) of whom 32% (107 patients out of 339) required repeat laparotomy; anastomotic leak at the stoma closure site in 1.4% of patients (60 patients out of 4,439); intraoperative bowel perforation and peritonitis in 1.2% (13 patients out of 1,119); and postoperative enterocutaneous fistula in 1.3% (37 patient out of 2,885).
Commonly reported non-bowel-related morbidity included wound infection, which occurred in 5% of patients (228 patients out of 4,574), and incisional hernia in the stoma site, which occurred in 1.8% (68 patients out of 3,697). Few studies reported cardiac, respiratory or renal complications as an outcome.
The mean operative time for ileostomy closure was 63.5 minutes (range 32 to 103 minutes, 18 studies). The mean postoperative hospital stay was 5.1 days (range three to ten days, 27 studies).