Stapler versus Hand-sewn Ileostomy Closure Techniques Post-low Anterior Resection for Low Rectal Cancer: A Comparative Clinical Study

A BSTRACT Background: Ileostomy closure after low anterior resection for low rectal cancer significantly impacts patient outcomes, with the choice between hand-sewn and stapler techniques influencing recovery time, anastomotic integrity, and complications. Methods: This prospective study, conducted from December 2019 to March 2024, included 151 patients who underwent ileostomy closure following low anterior resection for low rectal cancer. A total of 100 oncologically matched patients were divided into two groups: 50 received hand-sewn closure, and 50 underwent stapler closure. Patients were matched 1:1 based on age, sex, body mass index, prior radiation exposure, and surgical outcomes. Primary outcomes measured included recovery time, time to first bowel movement, and hospital stay. Secondary outcomes were anastomotic leak rates, anastomosis failure, and the incidence of early and late complications, such as incisional hernias. Results: The stapler group had significantly faster recovery ( P < 0.05), earlier first bowel movement ( P < 0.05), and shorter hospital stays ( P < 0.05) compared to the hand-sewn group. Anastomotic leak and failure rates were similar in both groups ( P > 0.05). Two patients in the hand-sewn group and one in the stapler group developed incisional hernias within 2 years of closure. Conclusion: Stapler techniques for ileostomy closure provide notable advantages, including faster recovery, reduced time to first bowel movement, and shorter hospital stays without increasing the risk of anastomotic failure. The study also highlights the cost-effectiveness of stapler techniques, making them a preferable option in many cases. However, individual patient factors should guide the selection of the closure technique.