title: Gasless laparoscopic-assisted ileostomy or colostomy closure using an abdominal wall-lifting device.
abstract: BACKGROUND
  Restoration of intestinal continuity in patients with ileostomy after total colectomy or with colostomy after Hartmann's procedure is a major operation. Herein we illustrate the validity of gasless laparoscopically assisted reversal using abdominal wall lifting.
  
  
  METHODS
  The operation was performed on 10 patients from February 1997 to May 1999. Seven of them had a left iliac stoma after a Hartmann resection, and three had an ileostomy after total colectomy.
  
  
  RESULTS
  The laparoscopic reversal was completed in eight patients; the two others were converted to an open procedure. Three major complications occurred (30%). There were no deaths. The average operation time was 192 min (range, 125-265). Time of discharge from surgery averaged 9.5 days. Mean follow-up of these patients was 12 months and negative.
  
  
  CONCLUSIONS
  Laparoscopically assisted ileo- or colorectal anastomosis without pneumoperitoneum and using a laparotenser can be considered for the reversal of patients with ileostomy or colostomy. Even taking the high rate of intraoperative or postoperative complications into consideration, the advantages that make such a laparoscopic approach suitable include reduced trauma related to a second major abdominal operation, reduced postoperative pain, and fewer cutaneous tissues exposed to bacterial contamination. Moreover, the use of a laparotenser makes it possible to operate on elderly patients with cardiovascular diseases. In the absence of pneumoperitoneum, it becomes possible to use traditional instruments, with a consequent reduction in costs.
authors.affiliation: Department of Surgery, Presidio Sanitario Gradenigo-Ente Autonomo, Corso Regina Margherita 8, 10153 Torino, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bossotti
authors.forename: A
authors.initials: A
authors.lastname: Bona
authors.forename: R
authors.initials: R
authors.lastname: Borroni
authors.forename: R
authors.initials: R
authors.lastname: Mattio
authors.forename: A
authors.initials: A
authors.lastname: Coda
authors.forename: F
authors.initials: F
authors.lastname: Ferri
authors.forename: F
authors.initials: F
authors.lastname: Martino
authors.forename: M
authors.initials: M
authors.lastname: Dellepiane
mesh_terms: D000009:Abdominal Muscles; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D003125:Colostomy / Q000379:methods*; D005740:Gases; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D007416:Intestinal Perforation / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D017770:Lifting; D008297:Male; D008875:Middle Aged
chemical_list: D005740:Gases