title: Postoperative complications after closure of a diverting ileostoma--differences according to closure technique.
abstract: OBJECTIVE
  The aim of this study was to compare three methods for closure of a diverting ileostoma according to development of postoperative small-bowel obstruction (SBO) and anastomotic leakage (AL).
  
  
  METHODS
  Complications arising within 30 days after closure of a defunctioning loop ileostomy in 351 patients during the period 1999-2006 were studied retrospectively by evaluation of case records. The techniques employed were: hand-sewn anastomosis without bowel resection, hand-sewn anastomosis with bowel resection and stapled anastomosis.
  
  
  RESULTS
  Of the 351 patients, 149 had a hand-sewn anastomosis without bowel resection (HS), 70 had a hand-sewn anastomosis with bowel resection (HSR) and 132 patients had a stapled anastomosis (S). The total number of SBOs was 44 patients (12.5%). In the two hand-sewn groups, 15.5% (34 patients) suffered postoperative SBO compared to 7.6% (10 patients) in the stapled group (p = 0.029). No difference in AL could be found between the groups, where the overall frequency was 2.8% (10 patients). Median hospital stay was 6 days in the HS group, 5 days in the HSR group and 4 days in the S group (p = 0.001).
  
  
  CONCLUSIONS
  In the present study, stapled anastomosis was associated with a lower frequency of postoperative SBO and a shorter hospital stay compared to sutured anastomosis (either with or without a short small-bowel resection) after closure of a diverting ileostoma.
authors.affiliation: Department of Surgical Gastroenterology, Karolinska University Hospital, Huddinge, Karolinska Institutet, 141 85, Stockholm, Sweden. kajsa.gustafsson@karolinska.se
authors.forename: Kajsa
authors.initials: K
authors.lastname: Gustavsson
authors.forename: Ulf
authors.initials: U
authors.lastname: Gunnarsson
authors.forename: Pia
authors.initials: P
authors.lastname: Jestin
mesh_terms: D000714:Anastomosis, Surgical; D003710:Demography; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D007415:Intestinal Obstruction / Q000209:etiology; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D013536:Suture Techniques