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CLINICAL SCIENCE
Revisiting stapled and handsewn loop ileostomy closures: a large retrospective series
Emre BalikI,
Corresponding author
ebalik@istanbul.edu.tr

Tel.: 90 532 204 40 00
, Tunc ErenII, Dursun BugraI, Yilmaz BuyukuncuI, Ali AkyuzI, Sumer YamanerI
I Istanbul University, Istanbul Faculty of Medicine, General Surgery, Department of General Surgery Millet Caddesi, Sehremini Capa, Turkey.
II Istanbul Medeniyet University Goztepe Education & Research Hospital, Department of General Surgery, Istanbul, Turkey.
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Stoma</span> is a Greek word for mouth or opening&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a> An intestinal stoma is an opening of the intestinal tract into the abdominal wall&#46; Ileostomies were first described by the German surgeon Baum in 1879 and later by the Bohemian surgeon Maydl in 1883&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a> In 1952&#44; Brooke published his experiences with ileostomy construction and introduced a new method for suturing the mucosa to the skin&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a> Unlike the first colostomies&#44; the first ileostomies were end stomas&#46; Turnbull and Weakley were the first surgeons to describe the loop ileostomy &#40;in 1971&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib4">4</a></p><p id="para20" class="elsevierStylePara elsevierViewall">The diverting loop ileostomy is a commonly used stoma that is often employed to diminish the consequences of an anastomotic leak in low-colorectal anastomoses&#44; ileal pouch-anal anastomoses&#44; and in situations in which reversible patient factors increase the risk of an anastomotic dehiscence&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a> A defunctioning loop ileostomy is traditionally closed 6 to 12 weeks after the initial surgery&#46;<a class="elsevierStyleCrossRef" href="#bib6">6</a> Once anastomotic healing is confirmed&#44; any systemic factors are corrected&#44; and any fistulae are controlled or corrected&#44; these ileostomies are typically closed through the stoma site without a formal laparotomy&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a> Both loop ileostomy construction and subsequent closure are generally believed to be fairly straightforward&#44; safe procedures with relatively low associated morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a></p><p id="para30" class="elsevierStylePara elsevierViewall">Many opinions exist about the optimal method for performing these closures&#46; Proponents of each method claim several advantages&#44; including a diminished risk of anastomotic complications and favorable surgical outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a> Routine stoma closure can be performed either with a handsewn&#44; end-to-end anastomosis or through various techniques using staples&#46;<a class="elsevierStyleCrossRefs" href="#bib8">8&#8211;10</a></p><p id="para40" class="elsevierStylePara elsevierViewall">Proponents of stapled &#40;functional&#41; anastomoses often claim that these have a larger diameter than sutured anastomoses and thus will likely have a lower risk of small bowel obstruction or anastomotic leakage&#46; Stapling proponents also claim that these anastomoses are typically faster to construct and result in decreased operative times and potential cost reduction&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a></p><p id="para50" class="elsevierStylePara elsevierViewall">Several studies have examined the differing surgical techniques for closing loop ileostomies to identify the method that minimizes perioperative morbidity&#44; as measured in terms of bowel obstruction&#44; wound infection&#44; anastomotic leakage&#44; operative time&#44; and postoperative outcomes&#44; such as the time to first flatus&#44; time to first defecation&#44; time to initiation of oral intake&#44; and duration of hospital stay&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a> Unfortunately&#44; most of these studies have either not found significant differences or have reported conflicting results&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a> As a result&#44; no significant patient safety differences have been found between stapled and sutured anastomoses&#44; and there is no consensus on the best method for loop closure&#46;<a class="elsevierStyleCrossRefs" href="#bib9">9&#44;11</a> Thus&#44; we performed a review of 225 patients to help answer this question&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">METHODS</span><p id="para60" class="elsevierStylePara elsevierViewall">This study retrospectively evaluated the data of all patients at a single-center institution &#40;Istanbul University&#44; Istanbul Faculty of Medicine&#44; Department of General Surgery&#41; who required an ileostomy closure due to a protective loop ileostomy for coloanal or ileoanal anastomosis between 2002 and 2007&#46; All patients who underwent ileostomy closure during this period were included in the study&#44; without exclusion criteria&#46; Approval for this study was obtained from the Ethics Committee of Istanbul University&#44; Istanbul Faculty of Medicine&#46; Signed informed consent was obtained from all patients who were included in the study&#46; Clinical and epidemiological data on file and information on the primary and ileostomy closure operations were analyzed and correlated with complications in the first 30 postoperative days&#44; the need for additional surgery&#44; overall morbidity and mortality&#44; and the surgical outcomes &#40;i&#46;e&#46;&#44; the patients&#39; early postoperative follow-up parameters&#44; such as the time to the postoperative first flatus&#44; the first defecation&#44; and the initiation of oral intake&#44; and the duration of the hospital stay&#41;&#46;</p><p id="para70" class="elsevierStylePara elsevierViewall">All patients&#39; oral intake was discontinued the night before the ileostomy closure&#46; No special bowel preparation was performed preoperatively&#46; Prophylactic intravenous antibiotics &#40;second-generation cephalosporin&#41; were administered during anesthesia induction&#46;</p><p id="para80" class="elsevierStylePara elsevierViewall">The same highly experienced surgeons &#40;a senior surgeon assisted by a resident&#41; performed the procedures in all cases&#46; All patients received general anesthesia&#46; The ileostomy closure was initially attempted through a peristomal incision without midline laparotomy&#46; To accomplish the ileostomy closures&#44; all patients operated on between 2002 and 2005 underwent a <span class="elsevierStyleItalic">partial small bowel resection and handsewn end-to-end anastomosis</span> &#40;the <span class="elsevierStyleItalic">HA group</span>&#41;&#44; while every patient operated on between 2005 and 2007 underwent a <span class="elsevierStyleItalic">partial resection and stapled functional anastomosis</span> &#40;the <span class="elsevierStyleItalic">SA group</span>&#41;&#46;</p><p id="para90" class="elsevierStylePara elsevierViewall">All handsewn anastomoses were performed using a single extramucosal seromuscular layer of 3&#47;0 polyglactin sutures &#40;Vicryl&#174;&#44; Ethicon&#44; Somerville&#44; NJ&#44; USA&#41;&#44; and all the stapled anastomoses used one of two GIA 80&#47;3&#46;8 mm-type linear cutters &#40;Autosuture&#174;&#44; Covidien&#44; Norwalk&#44; CT&#44; USA&#41;&#46; The GIA 80&#47;3&#46;8 mm was preferred to the GIA 60&#47;3&#46;8 mm because it created a larger anastomotic lumen&#46; The mesenteric layers were not closed after the anastomoses in any of the patients&#46;</p><p id="para100" class="elsevierStylePara elsevierViewall">All patients were postoperatively followed with daily routine surgical examinations that included auscultation for bowel sounds&#44; abdominal examinations and wound care&#46; Administration of narcotic analgesics was ceased on the first postoperative day&#44; and analgesia was maintained with intravenous administration of nonsteroidal anti-inflammatory drugs for the next three postoperative days&#46; The patients were offered a clear liquid diet at the time of their first flatus and were questioned to determine the time of their first postoperative defecation&#46; On consecutive days following the initiation of the liquid diet&#44; the patients received semi-solid and then full-solid diets&#46; The intravenous fluid support was gradually decreased and was ceased on the day that the full-solid diet was started&#46; When sufficient flatus and defecation were confirmed&#44; patients with adequate oral intake and analgesia were discharged from the hospital&#44; and the duration of their stay was recorded&#46; All complications diagnosed within the first 30 days after surgery were considered to be postoperative&#44; including those specifically related to the operative procedure and general complications&#46; The complications were further classified as &#8220;surgical&#8221; or &#8220;medical&#8221; according to the specific treatment required&#46;</p><p id="para110" class="elsevierStylePara elsevierViewall">A statistical analysis of the two ileostomy closure techniques compared the patients in the HA group with those in the SA group&#46; In addition&#44; the effects of the primary surgeries on the outcomes of the ileostomy closures were examined by dividing the patients into those who underwent a <span class="elsevierStyleItalic">total proctocolectomy-ileal-pouch-anal anastomosis &#40;</span>the <span class="elsevierStyleItalic">TPC group&#41;</span> and those who received a <span class="elsevierStyleItalic">low-anterior resection &#40;</span>the <span class="elsevierStyleItalic">LAR group&#41;</span>&#46;</p><p id="para120" class="elsevierStylePara elsevierViewall">Student&#39;s <span class="elsevierStyleItalic">t</span>-tests were used to evaluate the independent variables of postoperative surgical outcomes &#40;the time to the first postoperative flatus&#44; first defecation&#44; and the initiation of oral intake&#44; and the duration of hospital stay&#41;&#46; Fisher&#39;s exact test and the chi-squared test were used to evaluate postoperative complications&#46; The SPSS program was used to perform the statistical analyses&#46; Differences were considered statistically significant when <span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#46;</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">RESULTS</span><p id="para130" class="elsevierStylePara elsevierViewall">Two hundred twenty-five patients who underwent diverting loop ileostomy closures were retrospectively evaluated&#46; Our study group consisted of 124 men &#40;55&#46;1&#37;&#41; and 101 women &#40;44&#46;9&#37;&#41;&#44; with a mean age of 49&#46;12 years &#40;range&#44; 17 &#8211; 85&#41;&#46; The mean time between the initial surgery and stoma closure was 10 weeks &#40;range&#44; 8 &#8211; 16&#41;&#46; The distribution of the patients according to their diagnoses and surgical interventions is summarized in <a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><p id="para140" class="elsevierStylePara elsevierViewall">All patients with an initial diagnosis of rectal cancer underwent a low-anterior resection &#40;LAR&#41;&#44; and all patients with diagnoses of familial adenomatous polyposis &#40;FAP&#41; or ulcerative colitis &#40;UC&#41; underwent a total proctocolectomy-ileal-pouch-anal anastomosis &#40;TPC&#41;&#46;</p><p id="para150" class="elsevierStylePara elsevierViewall">The secondary procedure &#40;the ileostomy closure&#41; was performed using handsewn end-to-end anastomosis &#40;HA&#41; in 129 patients &#40;57&#46;33&#37;&#41; and a stapled functional anastomosis &#40;SA&#41; in 96 patients &#40;42&#46;67&#37;&#41;&#46;</p><p id="para160" class="elsevierStylePara elsevierViewall">The overall mean time to the first postoperative flatus was 2&#46;205 days &#40;range&#44; 1 &#8211; 6&#41;&#46; The mean time was 2&#46;426 days &#40;range&#44; 1 &#8211; 6&#41; in the HA group and 2&#46;052 days &#40;range&#44; 1 &#8211; 6&#41; in the SA group &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;000 for the independent samples student&#39;s <span class="elsevierStyleItalic">t</span>-test&#41;&#46;</p><p id="para170" class="elsevierStylePara elsevierViewall">The overall mean time to the first postoperative defecation was 2&#46;878 days &#40;range&#44; 1 &#8211; 8&#41;&#46; The mean time was 3&#46;202 days &#40;range&#44; 1 &#8211; 8&#41; in the HA group and 2&#46;667 days &#40;range&#44; 1 &#8211; 6&#41; in the SA group &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;006 for the independent samples student&#39;s <span class="elsevierStyleItalic">t</span>-test&#41;&#46;</p><p id="para180" class="elsevierStylePara elsevierViewall">The overall mean time to the initiation of oral intake was 3&#46;822 days &#40;range&#44; 1 &#8211; 25&#41;&#46; The mean time was 4&#46;047 days &#40;range&#44; 1 &#8211; 25&#41; in the HA group and 3&#46;521 days &#40;range&#44; 2 &#8211; 13&#41; in the SA group &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;078 for the independent samples student&#39;s <span class="elsevierStyleItalic">t</span>-test&#41;&#46;</p><p id="para190" class="elsevierStylePara elsevierViewall">The overall mean duration of the hospital stay was 7&#46;205 days &#40;range&#44; 2 &#8211; 60&#41;&#46; The mean duration was 8&#46;581 days &#40;range&#44; 3 &#8211; 60&#41; in the HA group and 6&#46;063 days &#40;2 &#8211; 23&#41; in the SA group &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;002 for the independent samples student&#39;s <span class="elsevierStyleItalic">t</span> -test&#41;&#46;</p><p id="para200" class="elsevierStylePara elsevierViewall">The above results are summarized in <a class="elsevierStyleCrossRef" href="#tbl2">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia><p id="para210" class="elsevierStylePara elsevierViewall">The mean time to the first postoperative flatus was 2&#46;46 days &#40;range&#44; 1 &#8211; 6&#41; in the TPC group and 2&#46;15 days &#40;range&#44; 1 &#8211; 6&#41; the LAR group &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;053 for the independent samples student&#39;s <span class="elsevierStyleItalic">t</span>-test&#41;&#46; The mean time to the first postoperative defecation was 3&#46;08 days &#40;range&#44; 1 &#8211; 8&#41; in the TPC group and 2&#46;95 days &#40;range&#44; 1 &#8211; 8&#41; in the LAR group &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;518 for the independent samples student&#39;s <span class="elsevierStyleItalic">t</span>-test&#41;&#46; The mean time to the initiation of oral intake was 4&#46;19 days &#40;range&#44; 1 &#8211; 10&#41; in the TPC group and 3&#46;60 days &#40;range&#44; 1 &#8211; 25&#41; in the LAR group &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;054 for the independent samples student&#39;s <span class="elsevierStyleItalic">t</span>-test&#41;&#46; The mean duration of the hospital stay was 8&#46;35 days &#40;range&#44; 3 &#8211; 27&#41; in the TPC group and 7&#46;01 days &#40;range&#44; 2 &#8211; 60&#41; in the LAR group &#40;<span class="elsevierStyleItalic">p</span> &#61; 0&#46;103 for the independent samples student&#39;s <span class="elsevierStyleItalic">t</span>-test&#41;&#46; These results are summarized in <a class="elsevierStyleCrossRef" href="#tbl3">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl3"></elsevierMultimedia><p id="para220" class="elsevierStylePara elsevierViewall">The postoperative medical complications consisted of acute renal failure and early postoperative fever&#44; and the postoperative surgical complications consisted of anastomotic leakage&#44; small bowel obstruction and wound infection&#46; The distribution of postoperative medical and surgical complications according to the surgical technique used for the ileostomy closure is shown in <a class="elsevierStyleCrossRef" href="#tbl4">Table 4</a>&#46;</p><elsevierMultimedia ident="tbl4"></elsevierMultimedia><p id="para230" class="elsevierStylePara elsevierViewall">The medical complications were treated with simple&#44; conservative therapies&#44; which&#44; in all cases&#44; resulted in rapid improvement of the clinical condition and discharge without the need for any additional medical care&#46;</p><p id="para240" class="elsevierStylePara elsevierViewall">The cases of small bowel obstruction and wound infection were successfully treated with conservative therapies and did not require additional surgical interventions&#46;</p><p id="para250" class="elsevierStylePara elsevierViewall">Additional surgery due to anastomotic leakage was needed in seven patients &#40;3&#46;11&#37;&#41;&#46; A new ileostomy was created in four &#40;1&#46;78&#37;&#41; of these patients&#44; and three &#40;1&#46;33&#37;&#41; patients underwent partial small bowel resection and end-to-end anastomosis&#46; All patients with anastomotic leakage were eventually discharged from the hospital without additional medical or surgical complications in the postoperative follow-up periods for the additional surgeries&#46;</p><p id="para260" class="elsevierStylePara elsevierViewall">The overall complication rate was 19&#46;4&#37; in the HA group and 18&#46;8&#37; in the SA group &#40;<span class="elsevierStyleItalic">p</span>&#62;0&#46;05&#44; using the chi-squared test&#41;&#46; There were no statistically significant differences between the two groups in the rates of the individual complications &#40;i&#46;e&#46;&#44; wound infection and anastomotic leakage&#41; &#40;<span class="elsevierStyleItalic">p</span>&#62;0&#46;05&#44; using the chi-squared and Fisher exact tests&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl4">Table 4</a>&#41;&#46;</p><p id="para270" class="elsevierStylePara elsevierViewall">Additionally&#44; the overall complication rate for the TPC group was 21&#46;4&#37;&#44; whereas the overall complication rate for the LAR group was 17&#46;7&#37;&#44; revealing no statistically significant difference between these two groups in terms of the primary operation&#39;s effects on the secondary operation &#40;<span class="elsevierStyleItalic">p</span>&#62;0&#46;05&#44; using the chi-squared test&#41;&#46;</p></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">DISCUSSION</span><p id="para280" class="elsevierStylePara elsevierViewall">Loop ileostomies are frequently used after ileoanal or coloanal anastomoses in colorectal surgery to prevent probable complications associated with the anastomosis itself&#46; They are most frequently performed for colorectal cancer and inflammatory bowel disorders &#40;IBD&#41;&#46; Recently&#44; the use of neoadjuvant chemoradiation therapy has resulted in an increase in sphincter-saving operations&#44; leading to higher rates of low-colorectal and even coloanal anastomosis procedures&#46;<a class="elsevierStyleCrossRefs" href="#bib12">12&#8211;14</a> This decrease in the rate of abdominoperineal resection in favor of sphincter-saving operations may have led to an increase in the rate of diverting loop ileostomies&#46; In terms of surgical complications&#44; the postoperative morbidity and mortality rates for these low-colorectal&#44; coloanal&#44; and ileoanal anastomoses&#44; when performed alone&#44; are so remarkably high that fecal diversion has become a routine recommendation&#46;</p><p id="para290" class="elsevierStylePara elsevierViewall">Since the first report of the procedure by Turnbull and Weakley<a class="elsevierStyleCrossRef" href="#bib15">15</a> in 1966&#44; loop ileostomies have increased in popularity because of their technical simplicity&#44; lack of odor&#44; liquid discharge&#44; and decreased rates of parastomal hernia and prolapse&#46;<a class="elsevierStyleCrossRefs" href="#bib12">12&#44;16&#8211;21</a> In addition to these advantages&#44; surgeons have also preferred protective loop ileostomies over protective colostomies because of the expected decrease in morbidity and mortality associated with the stoma closure&#46;<a class="elsevierStyleCrossRefs" href="#bib12">12&#44;16&#8211;20</a></p><p id="para300" class="elsevierStylePara elsevierViewall">Nevertheless&#44; ileostomy closure is not by any means a morbidity-free procedure&#46; The reported overall complication rates for ileostomy closure range from 10&#37; to 17&#37;&#44; and can reach 30&#37; when performed to divert ileoanal pouches&#46;<a class="elsevierStyleCrossRefs" href="#bib17">17&#44;21&#44;22</a> The most frequent complication after ileostomy closure is reported to be small bowel obstruction&#46;<a class="elsevierStyleCrossRefs" href="#bib17">17&#44;23</a> This complication has been particularly associated with extensive pelvic dissection during the primary surgical procedure&#44; ileal vessel distention&#44; and inflammatory disease affecting the remaining small bowel in patients primarily treated for IBD with proctocolectomy and ileal pouch&#46;<a class="elsevierStyleCrossRefs" href="#bib17">17&#44;21</a> The relatively high rates of this complication associated with IBD have also motivated studies examining the real benefits of protective fecal diversion in this specific situation&#46;<a class="elsevierStyleCrossRefs" href="#bib17">17&#44;19&#44;23&#44;24</a></p><p id="para310" class="elsevierStylePara elsevierViewall">The temporary loop ileostomy is generally thought to be simple to construct and easy to close&#44; with low perioperative morbidity and mortality&#46; The two principal anastomotic techniques are end-to-end handsewn &#40;HA&#41; and functional stapled &#40;SA&#41; anastomoses&#46; Numerous studies have compared the integrity of handsewn versus stapled bowel anastomoses&#44; and it is generally thought that their complication rates are similar&#46;<a class="elsevierStyleCrossRefs" href="#bib25">25&#44;26</a></p><p id="para320" class="elsevierStylePara elsevierViewall">Several factors are associated with an increased risk of postoperative complications after ileostomy closure&#44; such as the interval between primary surgery and closure&#44; the use of bowel preparation&#44; antibiotic prophylaxis&#44; and technical considerations &#40;stapled vs&#46; handsewn suture techniques&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib7">7&#44;8&#44;22&#44;27&#8211;33</a> In this study&#44; our primary aim was to compare the two principal anastomotic techniques with respect to their surgical outcomes and complication rates&#46;</p><p id="para330" class="elsevierStylePara elsevierViewall">Hull et al&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a> compared handsewn and stapled loop ileostomy closures and found no significant differences in the time to the first defecation&#44; solid diet&#44; or discharge&#46; The complications were similar for the two groups&#46; Similar results were reported by Pittman et al&#46;<a class="elsevierStyleCrossRef" href="#bib34">34</a>&#44; who found no significant difference in the anastomotic leak rate&#44; length of surgery&#44; or length of hospitalization in patients with sutured versus stapled anastomoses&#46; In a systematic review of randomized controlled trials&#44; Lustosa et al&#46;<a class="elsevierStyleCrossRef" href="#bib35">35</a> found more frequent stenosis and shorter procedure times when performing colorectal anastomoses using stapling&#44; but there was insufficient evidence to demonstrate the superiority of stapling over handsewing&#46;</p><p id="para340" class="elsevierStylePara elsevierViewall">In this study&#44; we compared the postoperative surgical outcomes of patients who underwent ileostomy closures using the two different surgical techniques&#46; When the HA and SA groups were compared&#44; the statistical analysis revealed a significantly shorter time to the first flatus&#44; time to first defecation and duration of hospital stay in the SA group &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#41;&#46; No statistically significant difference in the time to initiation of oral intake could be demonstrated between the two groups &#40;<span class="elsevierStyleItalic">p</span>&#62;0&#46;05&#41;&#59; however&#44; this outcome was not of primary importance because of its dependence on the surgeon&#39;s decisions and methods during routine postoperative follow-up&#46; These results show a faster recovery for the patients who underwent ileostomy closure with the SA technique compared to those who underwent the HA technique &#40;<a class="elsevierStyleCrossRef" href="#tbl2">Table 2</a>&#41;&#46;</p><p id="para350" class="elsevierStylePara elsevierViewall">One of the major advantages observed with the SA technique was the shorter hospital stay&#46; The mean durations of hospital stay were 6&#46;063 and 8&#46;581 days in the in the SA and HA groups&#44; respectively &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#41;&#46; At first glance&#44; these times may seem excessive following such a surgical intervention&#46; This explanation is related to our institution&#39;s nature&#59; being a university hospital&#44; it is obliged to accept all patients&#44; most of whom are from the rural areas of our country&#46; The patients often have to travel long distances&#44; and so the risk of any kind of postoperative complication must be ruled out before they can be sent home&#46; Although the mean times to the initiation of oral intake were 3&#46;521 and 4&#46;047 days in the SA and HA groups&#44; respectively&#44; the patients were followed in our clinic until they received full-solid diets without any complications before they were discharged from the hospital&#46; Despite this relatively long clinical follow-up&#44; the results of our study still reflect a shorter hospital stay for the SA group compared with the HA group&#46;</p><p id="para360" class="elsevierStylePara elsevierViewall">There have been studies comparing the operative times and costs of the two techniques in addition to their surgical outcomes&#46; Horisberger et al&#46;<a class="elsevierStyleCrossRef" href="#bib36">36</a> found that the average operative time was 17&#46;8 minutes shorter for the SA technique than for the HA technique&#44; and that the costs associated with operative time were significantly higher for the HA group compared to the SA group&#46; Although the material costs for the anastomosis were significantly higher for the SA group&#44; there were no significant differences between the HA and SA groups in the overall costs &#40;including the surgical costs and hospital stay&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib36">36</a> Previous studies have shown that&#44; in general&#44; a reduction of the operative time by 15 minutes through the use of a stapled anastomosis reduced the overall cost per case&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a> We focused on postoperative surgical outcomes and surgical complications in our study&#44; and we did not evaluate the operative time and costs&#44; which is a weakness of our study&#46;</p><p id="para370" class="elsevierStylePara elsevierViewall">The effects of the primary surgical intervention on the secondary procedure &#40;ileostomy closure&#41; were also investigated in our study&#44; with the aim of determining whether the presence of remnant colonic segments affected the surgical outcomes of the ileostomy closures&#46; We compared the postoperative surgical outcomes of patients who had previously undergone TPC and LAR&#46; No statistically significant differences between the TPC group and the LAR group were found in the postoperative times to first flatus&#44; first defecation&#44; and initiation of oral intake or in the duration of the hospital stay &#40;<span class="elsevierStyleItalic">p</span>&#62;0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl3">Table 3</a>&#41;&#46; These results indicate that the primary surgical technique and the presence of a remnant colon did not significantly affect the outcomes of ileostomy closures&#46;</p><p id="para380" class="elsevierStylePara elsevierViewall">The complications in the post-closure interval that required surgery were small bowel obstruction and anastomotic leakage&#46; There have been reports of obstruction and leakage frequencies after ileostomy closure of 0&#37; to 18&#37; and 0&#37; to 3&#37;&#44; respectively&#46;<a class="elsevierStyleCrossRefs" href="#bib12">12&#44;21&#44;37&#8211;40</a> Others studies have reported obstruction rates of 0&#37; to 9&#37; for the enterotomy suture technique&#44; and 0&#37; to 0&#46;5&#37; for the stapled anastomosis technique&#46;<a class="elsevierStyleCrossRefs" href="#bib12">12&#44;21&#44;37</a> Advocates have suggested that the stapled anastomosis provides a larger lumen&#59; this consideration is particularly important in the presence of a malfunctioning distal limb&#44; which may have a smaller diameter&#46;<a class="elsevierStyleCrossRefs" href="#bib37">37&#44;38&#44;40</a></p><p id="para390" class="elsevierStylePara elsevierViewall">The distribution of postoperative medical and surgical complications according to the surgical techniques used for ileostomy closure is summarized in <a class="elsevierStyleCrossRef" href="#tbl4">Table 4</a>&#46; No statistically significant differences were found between the HA and the SA groups in the overall complication rate &#40;<span class="elsevierStyleItalic">p</span>&#62;0&#46;05&#44; using the chi-squared test&#41;&#46; There were also no statistically significant differences between the two groups in the rates of the individual complications &#40;i&#46;e&#46;&#44; wound infection and anastomotic leakage&#41; &#40;<span class="elsevierStyleItalic">p</span>&#62;0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p id="para400" class="elsevierStylePara elsevierViewall">The overall complication rates for the TPC and LAR groups were also compared&#44; and no statistically significant differences were found between these two groups &#40;<span class="elsevierStyleItalic">p</span>&#62;0&#46;05&#44; using the chi-squared test&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig2">Figure 2</a>&#41;&#46; These results show that the nature of the primary surgical technique and the presence of a remnant colon did not significantly increase the complications rate for the secondary procedure&#46;</p><elsevierMultimedia ident="fig2"></elsevierMultimedia><p id="para410" class="elsevierStylePara elsevierViewall">The two principal anastomotic techniques for ileostomy closures are HA and SA&#46; Patients who underwent ileostomy closures with the SA technique recovered significantly faster in the postoperative period and required shorter hospital stays than those who underwent the HA technique&#46;</p><p id="para420" class="elsevierStylePara elsevierViewall">There were no statistically significant differences between the two anastomotic techniques in postoperative complication rates&#46;</p><p id="para430" class="elsevierStylePara elsevierViewall">The nature of the primary surgical intervention did not significantly alter the postoperative surgical outcomes or the complication rates of the ileostomy closure&#46;</p><p id="para440" class="elsevierStylePara elsevierViewall">In our opinion&#44; the SA technique should be considered the gold standard for loop ileostomy closures&#46;</p></span></span>"
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        0 => array:2 [
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          "titulo" => "KEYWORDS"
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        1 => array:2 [
          "identificador" => "cesec10"
          "titulo" => "INTRODUCTION"
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        2 => array:2 [
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          "titulo" => "METHODS"
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        3 => array:2 [
          "identificador" => "cesec30"
          "titulo" => "RESULTS"
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        4 => array:2 [
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          "titulo" => "DISCUSSION"
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          "titulo" => "ACKNOWLEDGEMENTS"
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        6 => array:1 [
          "titulo" => "REFERENCES"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-06-26"
    "fechaAceptado" => "2011-08-02"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "KEYWORDS"
          "identificador" => "xpalclavsec1582454"
          "palabras" => array:5 [
            0 => "Loop ileostomy"
            1 => "Closure technique"
            2 => "Handsewn anastomosis"
            3 => "Stapled anastomosis"
            4 => "Surgical outcomes"
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    "resumen" => array:1 [
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        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">OBJECTIVE&#58;</span><p id="spara80" class="elsevierStyleSimplePara elsevierViewall">To compare the surgical outcomes of stapled and handsewn closures in loop ileostomies&#46;</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">METHODS&#58;</span><p id="spara90" class="elsevierStyleSimplePara elsevierViewall">The data of 225 patients requiring loop ileostomies from 2002 to 2007 were retrospectively evaluated&#46; The patients underwent partial small-bowel resections and either handsewn or stapled anastomoses for the ileostomy closures&#46; They were followed up postoperatively with routine surgical examinations&#46;</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">RESULTS&#58;</span><p id="spara100" class="elsevierStyleSimplePara elsevierViewall">The study group consisted of 124 men and 101 women with a mean age of 49&#46;12 years&#46; The ileostomy closure was performed with handsewn in 129 patients and with stapled in 96 patients&#46; The mean time to the first postoperative flatus was 2&#46;426 days in the handsewn group and 2&#46;052 days in the stapled group &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#41;&#46; The mean time to the first postoperative defecation was 3&#46;202 days in the handsewn group and 2&#46;667 days in the stapled group &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#41;&#46; The mean duration of patient hospital stay was 8&#46;581 days for the handsewn group and 6&#46;063 days for the stapled group &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#41;&#46;</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">CONCLUSIONS&#58;</span><p id="spara110" class="elsevierStyleSimplePara elsevierViewall">Patients who underwent ileostomy closure with stapled recovered faster in the postoperative period and required shorter hospital stays than those whose closures were performed with handsewn&#46; In our opinion&#44; stapled should be considered the gold standard for loop ileostomy closures&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">No potential conflict of interest was reported&#46;</p> <p class="elsevierStyleNotepara" id="cenpara20">Balik E supervised and executed the study&#44; performed most of the operations of the principal &#40;or CPC&#44; or RAF&#41;&#44; and secondary operations &#40;ileostomy closure&#41;&#44; and operated the follow-up of patients&#46; Eren T performed the study throughout his residence&#44; participated in almost all operations&#44; performed the surgery follow-up of patients in the department&#44; collected the data&#44; created Excel charts&#44; performed the statistical evaluations and wrote the manuscript&#46; Bugra D was the leader in establishing the study protocol and coordination of the surgical team during the implementation of this Protocol&#44; held two primary operations &#40;or CPC&#44; or RAF&#41;&#44; and secondary operations &#40;ileostomy closure&#41;&#44; and participated in the surgery follow-ups of patients in the department&#44; read and revised the article&#46; Buyukuncu Y performed primary operation &#40;or CPC&#44; or RAF&#41;&#44; and secondary operations &#40;ileostomy closure&#41;&#44; and participated in the surgery follow-ups of patients in the department&#44; revised the writing of the article&#46; Akyuz A&#44; chief surgeon of the surgical team&#44; held two primary operations &#40;or CPC&#44; or RAF&#41;&#44; and secondary operations &#40;ileostomy closure&#41;&#44; and participated in the surgery follow-ups of patients in the department&#44; he oversaw all steps of the study and performed the last revision of the article before submission&#46; Yamaner S had the inspiration for this work&#44; raised the idea of such study&#44; conducted operations both primary &#40;or CPC&#44; or RAF&#41;&#44; and secondary operations &#40;ileostomy closure&#41;&#44; and participated in the surgery follow-ups of patients in the department&#44; supervised every stage of the study and revised the article in order to eliminate possible errors&#46;</p>"
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          "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">A statistical analysis of the overall postoperative complications according to the surgical anastomotic technique used for the ileostomy closure&#46;</p>"
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          "leyenda" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">&#40;HA&#44; partial small bowel resection and handsewn end-to-end anastomosis&#59; SA&#44; partial resection and stapled functional anastomosis&#41;&#46;</p>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Primary diagnosis</span></th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Primary operation</span></th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Secondary operation &#40;ileostomy closure&#41;</span></th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col">FAP<a class="elsevierStyleCrossRef" href="#tfn1">a</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col">UC<a class="elsevierStyleCrossRef" href="#tfn2">b</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col">RC<a class="elsevierStyleCrossRef" href="#tfn3">c</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col">Total proctocolectomy&#40;TPC&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col">Low-anterior resection&#40;LAR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col">HA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col">SA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Number of patients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">&#37;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">10&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">27&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">62&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">37&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">62&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">57&#46;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">42&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t  " align="center" valign="top" scope="col">Overall study group&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="top">2&#46;205 &#40;1 &#8211; 6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;426 &#40;1 &#8211; 6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;052 &#40;1 &#8211; 6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="top">2&#46;878 &#40;1 &#8211; 8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">3&#46;202 &#40;1 &#8211; 8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;667 &#40;1 &#8211; 6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Initiation of oral intake</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">3&#46;822 &#40;1 &#8211; 25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">4&#46;047 &#40;1 &#8211; 25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">3&#46;521 &#40;2 &#8211; 13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;078&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Duration of hospital stay</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">7&#46;205 &#40;2 &#8211; 60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">8&#46;581 &#40;3 &#8211; 60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">6&#46;063 &#40;2 &#8211; 23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">0&#46;002&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="top" scope="col">Overall study group&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="top" scope="col">LAR Group&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="top" scope="col"><span class="elsevierStyleItalic">p</span>-value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;053&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">First defecation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">3&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;518&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold">Initiation of oral intake</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">3&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">4&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">3&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;054&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">Duration of hospital stay</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">7&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">8&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">7&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top" style="border-bottom: 2px solid black">0&#46;103&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spara60" class="elsevierStyleSimplePara elsevierViewall">A comparison and statistical analysis of the association between the presence of a remnant colon and the early postoperative outcomes&#44; using independent samples student&#39;s <span class="elsevierStyleItalic">t</span>-tests&#46;</p>"
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                              S Radley \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              DG Morton \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              MR Keighley \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1097/00000658-200002000-00008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "2000"
                        "volumen" => "231"
                        "paginaInicial" => "202"
                        "paginaFinal" => "204"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10674611"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1097/00000658-200002000-00008"
                      "WWW" => array:1 [
                        "link" => "10&#46;1097&#47;00000658-200002000-00008"
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                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications of loop ileostomy closure&#58; a retrospective cohort analysis of 123 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              SD Mansfield \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              C Jensen \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              AS Phair \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              OT Kelly \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              SB Kelly \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1007/s00268-008-9669-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Surg"
                        "fecha" => "2008"
                        "volumen" => "32"
                        "paginaInicial" => "2101"
                        "paginaFinal" => "2106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18563482"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1007/s00268-008-9669-7"
                      "WWW" => array:1 [
                        "link" => "10&#46;1007&#47;s00268-008-9669-7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stapled ileostomy closure results in reduction of postoperative morbidity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              YA Shelygin \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              SV Chernyshov \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              EG Rybakov \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1007/s10151-009-0550-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Tech Coloproctol"
                        "fecha" => "2010"
                        "volumen" => "14"
                        "paginaInicial" => "19"
                        "paginaFinal" => "23"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20013018"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1007/s10151-009-0550-y"
                      "WWW" => array:1 [
                        "link" => "10&#46;1007&#47;s10151-009-0550-y"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radioresistance-related proteins in rectal cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              AS Allal \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              T Kahne \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              AK Reverdin \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              H Lippert \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              W Schlegel \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              MA Reymond \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1002/pmic.200300854"
                      "Revista" => array:6 [
                        "tituloSerie" => "Proteomics"
                        "fecha" => "2004"
                        "volumen" => "4"
                        "paginaInicial" => "2261"
                        "paginaFinal" => "2269"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15274120"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1002/pmic.200300854"
                      "WWW" => array:1 [
                        "link" => "10&#46;1002&#47;pmic&#46;200300854"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Loop ileostomy&#58; a superior diverting stoma in colorectal surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              S Fasth \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              L Hulten \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1007/BF01655089"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Surg"
                        "fecha" => "1984"
                        "volumen" => "8"
                        "paginaInicial" => "401"
                        "paginaFinal" => "407"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6464495"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1007/BF01655089"
                      "WWW" => array:1 [
                        "link" => "10&#46;1007&#47;BF01655089"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preoperative chemoradiation therapy for low rectal cancer&#46; Impact on downstaging and sphincter-saving operations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              A Habr-Gama \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RO Perez \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              DR Kiss \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              V Rawet \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              A Scanavini \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              PM Santinho \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatogastroenterology"
                        "fecha" => "2004"
                        "volumen" => "51"
                        "paginaInicial" => "1703"
                        "paginaFinal" => "1707"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15532809"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term results of preoperative chemoradiation for distal rectal cancer correlation between final stage and survival"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              A Habr-Gama \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RO Perez \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              W Nadalin \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              SC Nahas \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              U Ribeiro Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              AH Silva E Sousa Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/j.gassur.2004.10.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gastrointest Surg"
                        "fecha" => "2005"
                        "volumen" => "9"
                        "paginaInicial" => "90"
                        "paginaFinal" => "99"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15623449"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/j.gassur.2004.10.010"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;j&#46;gassur&#46;2004&#46;10&#46;010"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ileostomy technics and indications for surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              RB Turnbull Jr \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              FL Weakley \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Surg"
                        "fecha" => "1966"
                        "volumen" => "23"
                        "paginaInicial" => "310"
                        "paginaFinal" => "314"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5919610"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Loop ileostomy&#58; a reliable method of diversion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              JD Cheape \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              VH Hooks 3rd \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1097/00007611-199403000-00014"
                      "Revista" => array:6 [
                        "tituloSerie" => "South Med J"
                        "fecha" => "1994"
                        "volumen" => "87"
                        "paginaInicial" => "370"
                        "paginaFinal" => "374"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8134860"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1097/00007611-199403000-00014"
                      "WWW" => array:1 [
                        "link" => "10&#46;1097&#47;00007611-199403000-00014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stoma-related complications are more frequent after transverse colostomy than loop ileostomy&#58; a prospective randomized clinical trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              DP Edwards \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              A Leppington-Clarke \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              R Sexton \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              RJ Heald \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              BJ Moran \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1365-2168.2001.01727.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "2001"
                        "volumen" => "88"
                        "paginaInicial" => "360"
                        "paginaFinal" => "363"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11260099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1046/j.1365-2168.2001.01727.x"
                      "WWW" => array:1 [
                        "link" => "10&#46;1046&#47;j&#46;1365-2168&#46;2001&#46;01727&#46;x"
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              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Temporary decompression after colorectal surgery&#58; randomized comparison of loop ileostomy and loop colostomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              AW GooszeN \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RH Geelkerken \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              J Hermans \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              MB Lagaay \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              HG Gooszen \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1365-2168.1998.00526.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "1998"
                        "volumen" => "85"
                        "paginaInicial" => "76"
                        "paginaFinal" => "79"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9462389"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1046/j.1365-2168.1998.00526.x"
                      "WWW" => array:1 [
                        "link" => "10&#46;1046&#47;j&#46;1365-2168&#46;1998&#46;00526&#46;x"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              WL Law \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              KW Chu \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              HK Choi \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1365-2168.2002.02082.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "2002"
                        "volumen" => "89"
                        "paginaInicial" => "704"
                        "paginaFinal" => "708"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12027979"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1046/j.1365-2168.2002.02082.x"
                      "WWW" => array:1 [
                        "link" => "10&#46;1046&#47;j&#46;1365-2168&#46;2002&#46;02082&#46;x"
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                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Temporary transverse colostomy vs loop ileostomy in diversion&#58; a case-matched study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              Y Sakai \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              H Nelson \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              D Larson \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              L Maidl \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              T Young-Fadok \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              D Ilstrup \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1001/archsurg.136.3.338"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Surg"
                        "fecha" => "2001"
                        "volumen" => "136"
                        "paginaInicial" => "338"
                        "paginaFinal" => "342"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11231858"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1001/archsurg.136.3.338"
                      "WWW" => array:1 [
                        "link" => "10&#46;1001&#47;archsurg&#46;136&#46;3&#46;338"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The outcome of loop ileostomy closure in 293 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              HD Van de Pavoordt \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              VW Fazio \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              DG Jagelman \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              IC Lavery \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              FL Weakley \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Colorectal Dis"
                        "fecha" => "1987"
                        "volumen" => "2"
                        "paginaInicial" => "214"
                        "paginaFinal" => "217"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1007&#47;BF01649508"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications of abdominal stoma surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => """
                              PC Shellito \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1007/BF02237308"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dis Colon Rectum"
                        "fecha" => "1998"
                        "volumen" => "41"
                        "paginaInicial" => "1562"
                        "paginaFinal" => "1572"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9860339"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1007/BF02237308"
                      "WWW" => array:1 [
                        "link" => "10&#46;1007&#47;BF02237308"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results and indications of lateral ileostomy functionally terminated in colorectal surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              T Petit \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              J Maurel \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              G Lebreton \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              C Javois \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              M Gignoux \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              P Segol \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Chir"
                        "fecha" => "1999"
                        "volumen" => "53"
                        "paginaInicial" => "949"
                        "paginaFinal" => "953"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10670139"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              E Rullier \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              N LE Toux \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              C Laurent \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JL Garrelon \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              M Parneix \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              J Saric \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1007/s002680020091"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Surg"
                        "fecha" => "2001"
                        "volumen" => "25"
                        "paginaInicial" => "274"
                        "paginaFinal" => "277"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11343175"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1007/s002680020091"
                      "WWW" => array:1 [
                        "link" => "10&#46;1007&#47;s002680020091"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Handsewn vs&#46; stapled anastomoses in colon and rectal surgery&#58; a meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              HM Macrae \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RS Mcleod \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1007/BF02238246"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dis Colon Rectum"
                        "fecha" => "1998"
                        "volumen" => "41"
                        "paginaInicial" => "180"
                        "paginaFinal" => "189"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9556242"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1007/BF02238246"
                      "WWW" => array:1 [
                        "link" => "10&#46;1007&#47;BF02238246"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stapled functional end-to-end anastomosis versus sutured end-toend anastomosis after ileocolonic resection in Crohn Disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              T Yamamoto \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              IM Bain \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              E Mylonakis \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              RN Allan \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              MRB Keighley \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Scand J Gastroenterol"
                        "fecha" => "1999"
                        "volumen" => "7"
                        "paginaInicial" => "708"
                        "paginaFinal" => "713"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Closure of loop ileostomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              DP Berry \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JH Scholefield \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1365-2168.1997.02623.x"
                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "1997"
                        "volumen" => "84"
                        "paginaInicial" => "524"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9112907"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1046/j.1365-2168.1997.02623.x"
                      "WWW" => array:1 [
                        "link" => "10&#46;1002&#47;bjs&#46;1800840424"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Loop ileostomy&#58; technical aspects and complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              E Carlsen \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              AB Bergan \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1080/110241599750007324"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Surg"
                        "fecha" => "1999"
                        "volumen" => "165"
                        "paginaInicial" => "140"
                        "paginaFinal" => "143"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10192571"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1080/110241599750007324"
                      "WWW" => array:1 [
                        "link" => "10&#46;1080&#47;110241599750007324"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Protective colostomy closure&#58; the hazards of a &#8220;minor&#8221;operation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => """
                              DF Altomare \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              OC Pannarale \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              L Lupo \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              N Palasciano \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              V Memeo \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              M Rubino \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1007/BF00298472"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Colorectal Dis"
                        "fecha" => "1990"
                        "volumen" => "5"
                        "paginaInicial" => "73"
                        "paginaFinal" => "78"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2358740"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1007/BF00298472"
                      "WWW" => array:1 [
                        "link" => "10&#46;1007&#47;BF00298472"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications following closure of loop ileostomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              LJ Mann \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              PJ Stewart \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              RJ Goodwin \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              PH Chapuis \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              EL Bokey \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "ANZ J Surg"
                        "fecha" => "1991"
                        "volumen" => "61"
                        "paginaInicial" => "493"
                        "paginaFinal" => "496"
                      ]
                    ]
                    1 => array:1 [
                      "WWW" => array:1 [
                        "link" => "10&#46;1111&#47;j&#46;1445-2197&#46;1991&#46;tb00275&#46;x"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Techniques and complications of ileostomy takedown"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              PT Phang \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JM Hain \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              JJ Perez-Ramirez \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              RD Madoff \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              BT Gemlo \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/s0002-9610(99)00091-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Surg"
                        "fecha" => "1999"
                        "volumen" => "177"
                        "paginaInicial" => "463"
                        "paginaFinal" => "466"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10414694"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/s0002-9610(99)00091-4"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;S0002-9610&#40;99&#41;00091-4"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A new technique of loop ileostomy closure after endorectal ileoanal anastomosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              A Kestenberg \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              JM Becker \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Surgery"
                        "fecha" => "1985"
                        "volumen" => "98"
                        "paginaInicial" => "109"
                        "paginaFinal" => "111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4012600"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Defunctioning loop ileostomy and stapled side-to-side closure has low morbidity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              SN Amin \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              MA Memon \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              NC Armitage \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JH Scholefield \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann R Coll Surg Engl"
                        "fecha" => "2001"
                        "volumen" => "83"
                        "paginaInicial" => "246"
                        "paginaFinal" => "249"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11518371"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications of colostomy closure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => """
                              DM Pittman \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              LE Smith \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1007/BF02555488"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dis colon rectum"
                        "fecha" => "1985"
                        "volumen" => "28"
                        "paginaInicial" => "836"
                        "paginaFinal" => "843"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4053895"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1007/BF02555488"
                      "WWW" => array:1 [
                        "link" => "10&#46;1007&#47;BF02555488"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stapled versus handsewn methods for colorectal anastomosis surgery&#58; a systematic review of randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              SA Lustosa \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              D Matos \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              AN Atallah \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              AA Castro \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1590/s1516-31802002000500002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Sao Paulo Med J"
                        "fecha" => "2002"
                        "volumen" => "120"
                        "paginaInicial" => "132"
                        "paginaFinal" => "136"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12436148"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1590/s1516-31802002000500002"
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                        "link" => "10&#46;1590&#47;S1516-31802002000500002"
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                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Loop Ileostomy Closure&#58; Comparison of Cost Efectiveness between Suture and Stapler"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              K Horisberger \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              G Beldi \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              D Candinas \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1007/s00268-010-0787-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Surg"
                        "fecha" => "2010"
                        "volumen" => "34"
                        "paginaInicial" => "2867"
                        "paginaFinal" => "2871"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20842360"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                      "doi" => "10.1007/s00268-010-0787-7"
                      "WWW" => array:1 [
                        "link" => "10&#46;1007&#47;s00268-010-0787-7"
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                  ]
                ]
              ]
            ]
            36 => array:3 [
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              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Loop ileostomy is a safe option for fecal diversion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => """
                              SD Wexner \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              DA Taranow \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              OB Johansen \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              F Itzkowitz \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              N Daniel \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              JJ Nogueras \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1007/BF02053937"
                      "Revista" => array:6 [
                        "tituloSerie" => "Dis Colon Rectum"
                        "fecha" => "1993"
                        "volumen" => "36"
                        "paginaInicial" => "349"
                        "paginaFinal" => "354"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8458260"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1007/BF02053937"
                      "WWW" => array:1 [
                        "link" => "10&#46;1007&#47;BF02053937"
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                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications of loop ileostomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => """
                              SM Feinberg \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RS Mcleod \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              Z Cohen \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/0002-9610(87)90209-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Surg"
                        "fecha" => "1987"
                        "volumen" => "153"
                        "paginaInicial" => "102"
                        "paginaFinal" => "107"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3799885"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                    1 => array:2 [
                      "doi" => "10.1016/0002-9610(87)90209-1"
                      "WWW" => array:1 [
                        "link" => "10&#46;1016&#47;0002-9610&#40;87&#41;90209-1"
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                    ]
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Temporary loop ileostomy for restorative proctocolectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              A Senapati \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              RJ Nicholls \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              JK Ritchie \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              CJ Tibbs \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              PR Hawley \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1002/bjs.1800800529"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Surg"
                        "fecha" => "1993"
                        "volumen" => "80"
                        "paginaInicial" => "628"
                        "paginaFinal" => "630"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8518908"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                      "doi" => "10.1002/bjs.1800800529"
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                        "link" => "10&#46;1002&#47;bjs&#46;1800800529"
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                ]
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              "identificador" => "bib40"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Loop ileostomy for temporary fecal diversion"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => """
                              RE Khoo \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              MM Cohen \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              GM Chapman \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              DA Jenken \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              JM Langevin \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:2 [
                    0 => array:2 [
                      "doi" => "10.1016/0002-9610(94)90249-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Surg"
                        "fecha" => "1994"
                        "volumen" => "167"
                        "paginaInicial" => "519"
                        "paginaFinal" => "522"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8185041"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                      "doi" => "10.1016/0002-9610(94)90249-6"
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        "texto" => "<p id="para450" class="elsevierStylePara elsevierViewall">The authors would like to thank Sedat ZIYADE&#44; MD for his contributions to the statistical work-up of this study&#46; Istanbul Vak&#305;f Gureba Training &#38; Research Hospital&#44; Department of Thoracic Surgery&#46;</p>"
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Article information
ISSN: 18075932
Original language: English
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