Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy

Br J Surg. 2008 Jun;95(6):693-8. doi: 10.1002/bjs.6212.


Background: Temporary faecal diversion is recommended with a low colorectal, coloanal or ileoanal anastomosis (LA). This randomized study evaluated early (EC; 8 days) versus late (LC; 2 months) closure of the temporary stoma.

Methods: Patients undergoing rectal resection with LA were eligible to participate. If there was no radiological sign of anastomotic leakage after 7 days, patients were randomized to EC or LC. The primary endpoints were postoperative morbidity and mortality 90 days after the initial resection.

Results: Some 186 patients were analysed. There were no deaths within 90 days and overall morbidity rates were similar in the EC and LC groups (31 versus 38 per cent respectively; P = 0.254). Overall surgical complication (both 15 per cent; P = 1.000) and reoperation (both 8 per cent; P = 1.000) rates were similar, but wound complications were more frequent after EC (19 versus 5 per cent; P = 0.007). Small bowel obstruction (3 versus 16 per cent; P = 0.002) and medical complications (5 versus 15 per cent; P = 0.021) were more common with LC. Median (range) hospital stay was reduced by EC (16 (6-59) versus 18 (9-262) days; P = 0.013).

Conclusion: Early stoma closure is feasible in selected patients, with reduced hospital stay, bowel obstruction and medical complications, but a higher wound complication rate.

Registration number: NCT00428636 (http://www.clinicaltrials.gov).

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anastomosis, Surgical
  • Colostomy / methods*
  • Feasibility Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Care
  • Postoperative Complications / etiology
  • Proctocolectomy, Restorative / methods*
  • Quality of Life
  • Rectal Diseases / surgery*
  • Time Factors
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT00428636