Our Summary

The study looks at the early closure (within two weeks) of an ileostomy (a surgical opening in the belly) which is a somewhat new process. Previous studies have shown that this method is safe, possible, and cost-effective. However, it’s not a common practice in North America and hasn’t been studied much in this region. This research aimed to understand the viewpoints of both patients and surgeons on this early closure method.

The study used a mix of surveys and interviews. Patients surveyed were those who had rectal cancer, underwent surgery to create a ileostomy, and then had it closed within the last 5 years. Surgeons included were those who handle a high volume of rectal cancer cases.

Results showed that patients had their ileostomy closed after an average of 7.7 months, with half of them finding it hard to live with. Patients saw the main benefits of early closure as an improved quality of life and a quicker return to normal. However, they also thought that having two operations within two weeks could be too much for the body to handle. Most patients said they would have chosen early closure if given the option.

Surgeons identified several benefits of early closure, but also pointed out that it might not be suitable for all patients. They also mentioned several challenges in implementing this approach.

In conclusion, while early closure of an ileostomy has several benefits, it also presents logistical challenges. Both patients and surgeons are interested in further exploring this method and believe it should be studied more in North America.

FAQs

  1. What is the significance of the study about early closure of an ileostomy?
  2. What were the major findings of the study on the early closure of an ileostomy?
  3. What are the potential benefits and drawbacks of the early closure of an ileostomy according to patients and surgeons?

Doctor’s Tip

One helpful tip a doctor might give a patient about proctectomy is to discuss the option of early closure of the ileostomy with their surgeon. It is important to weigh the potential benefits of improved quality of life and quicker recovery against the risks and challenges associated with having two operations within a short timeframe. Patients should have an open and honest conversation with their healthcare provider to determine if early closure is a suitable option for them.

Suitable For

Patients who have undergone surgery to create an ileostomy, specifically those with rectal cancer, are typically recommended proctectomy. This procedure involves the removal of the rectum and is often performed in cases where the rectal cancer is advanced or has not responded to other treatments. Additionally, patients who have had their ileostomy closed and experienced difficulties with living with it may also be recommended proctectomy as a potential solution to improve their quality of life. Surgeons who handle a high volume of rectal cancer cases may also recommend proctectomy for patients who are not suitable candidates for other treatment options.

Timeline

Overall, the timeline for a patient before and after a proctectomy may look something like this:

Before:

  • Diagnosis of rectal cancer
  • Consultation with surgeon to discuss treatment options
  • Preparation for surgery, including bowel cleansing and dietary restrictions
  • Undergoing proctectomy surgery, which may involve creating an ileostomy
  • Living with an ileostomy for a period of time, which can range from a few months to over a year

After:

  • Consultation with surgeon to discuss options for closing the ileostomy
  • Undergoing a second surgery to close the ileostomy, either early within two weeks or at a later date
  • Recovery from surgery, which may involve pain management, wound care, and dietary adjustments
  • Adjustment to life without an ileostomy, including potential changes in bowel function and lifestyle modifications
  • Follow-up appointments with surgeon to monitor healing and address any concerns

It’s important to note that every patient’s experience with proctectomy and ileostomy closure can vary, and individual timelines may be influenced by factors such as the extent of the surgery, overall health, and personal preferences.

What to Ask Your Doctor

Some questions a patient should ask their doctor about proctectomy and early closure of an ileostomy include:

  1. What are the potential benefits of early closure of my ileostomy compared to waiting longer?
  2. Are there any specific risks or complications associated with early closure that I should be aware of?
  3. How will early closure affect my recovery time and overall quality of life?
  4. What criteria do you use to determine if a patient is a suitable candidate for early closure of an ileostomy?
  5. How experienced are you in performing early closure procedures, and what is your success rate?
  6. Are there any alternative options to consider instead of early closure?
  7. What is the typical timeline for scheduling and undergoing early closure surgery?
  8. How will my post-operative care and follow-up appointments differ if I choose early closure?
  9. Are there any ongoing studies or research projects related to early closure of ileostomies that I should be aware of?
  10. Can you provide me with any patient testimonials or references who have undergone early closure of their ileostomy?

Reference

Authors: Caminsky NG, Moon J, Morin N, Alavi K, Auer RC, Bordeianou LG, Chadi SA, Drolet S, Ghuman A, Liberman AS, MacLean T, Paquette IM, Park J, Patel S, Steele SR, Sylla P, Wexner SD, Vasilevsky CA, Rajabiyazdi F, Boutros M. Journal: Surg Endosc. 2023 Jan;37(1):669-682. doi: 10.1007/s00464-022-09580-5. Epub 2022 Oct 4. PMID: 36195816