Laparoscopic versus open loop ileostomy reversal: A systematic review and meta-analysis

Background: Loop ileostomies (LIs) are used for temporary fecal diversion to protect downstream colorectal anastomoses. Standard operative approach for LI reversal has been through an open technique. Recently, laparoscopic LI reversal has been employed and studied. The aim of this systematic review was to compare laparoscopic and open LI reversal. Methods: Medline, Embase, and CENTRAL were systematically searched. Articles were included if they compared rate of postoperative morbidity and/or length of stay (LOS) in patients undergoing laparoscopic or open LI reversal. Pairwise meta-analyses using inverse variance random effects was performed. The Grading of Recommendations, Assessment, Development, and Evidence (GRADE) approach was conducted to assess quality of evidence. Results: From 410 citations, four observational studies with 213 patients undergoing laparoscopic LI reversal and 176 patients undergoing open LI reversal met inclusion. Patients in the laparoscopic group had significantly shorter LOS (MD -0.39, 95%CI -0.73 to -0.04, p = 0.03). Laparoscopic and open LI reversal were comparable in postoperative morbidity, aside from a decrease of superficial surgical site infection (sSSI) with the use of laparoscopy (OR 0.22, 95%CI 0.07 to 0.71, p = 0.01). Operative time was not significantly different between groups (MD 11.91, 95%CI -1.87 to 25.70, p = 0.09). The GRADE quality of evidence was low to very low. Conclusions: This review presents low quality evidence that laparoscopic LI reversal is a feasible approach that may reduce postoperative LOS and sSSI compared to open LI reversal without increasing operative time. Future prospective comparative studies are required to confirm the findings of the present review.