title: Scarless single-incision laparoscopic loop ileostomy: a novel technique.
abstract: BACKGROUND
  Laparoscopic surgery has become a favorable alternative to conventional open surgery for the creation of intestinal stomas, and it offers many benefits including reduced postoperative pain, ileus, and hospital stay. Single-incision laparoscopic surgery has been described for many abdominal operations. It may offer better cosmetic outcomes and reduce incisional pain, adhesions, and recovery time.
  
  
  OBJECTIVE
  In this study, we aimed to describe a novel technique of scarless single-incision laparoscopic loop ileostomy for fecal diversion and to report our experience with 8 patients who underwent this procedure within a 1-year period.
  
  
  METHODS
  This study was designed as a retrospective case series.
  
  
  METHODS
  This investigation was conducted at a single-institution, tertiary referral center.
  
  
  METHODS
  Eight consecutive patients undergoing scarless single-incision laparoscopic loop ileostomy between August 2009 and August 2010 were included.
  
  
  METHODS
  Scarless single-incision laparoscopic loop ileostomies were performed.
  
  
  METHODS
  Among the outcomes measured were operation time, intraoperative blood loss, recovery of intestinal function, length of hospital stay, and surgical complications.
  
  
  RESULTS
  Seven patients underwent surgery for active Crohn's disease refractory to medical therapy. One patient underwent surgery for radiation-induced rectovesical fistula. Median surgery time was 76 minutes, and median intraoperative blood loss was 10 mL. Median length of postoperative hospitalization was 7 days. Of the 8 patients included in our series, 2 patients (25%) required reoperation for stoma ischemia because of vascular congestion that we attribute to a tight fascial opening or extensive bowel manipulation. Other surgical complications included nonoperative readmission for ileus and partial small-bowel obstruction (n = 2), anal dilation to evacuate an obstructed distal colon (n = 1), and peristomal cellulitis (n = 1).
  
  
  CONCLUSIONS
  This study was limited by its small sample size and its retrospective nature.
  
  
  CONCLUSIONS
  Scarless single-incision laparoscopic loop ileostomy is a feasible alternative to standard laparoscopy for fecal diversion. Surgeons attempting this technique should do so with caution, given the high stoma ischemia rate in our small case series.
authors: Division of Colorectal Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors: Karen N
authors: KN
authors: Zaghiyan
authors: Zuri
authors: Z
authors: Murrell
authors: Phillip R
authors: PR
authors: Fleshner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002921:Cicatrix / Q000517:prevention & control; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D020127:Recovery of Function; D012003:Rectal Fistula / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome