Laparoscopic loop ileostomy reversal: reducing morbidity while improving functional outcomes.
BACKGROUND
Loop ileostomy reduces the morbidity associated with pelvic sepsis. However, its reversal carries a 10% to 30% complication rate. We present our technique for laparoscopic ileostomy closure.


METHODS
We conducted a retrospective chart review of subjects  undergoing laparoscopic-assisted loop ileostomy closure between 2006 and 2009. Operating time, length of hospital stay, return of bowel function, and complication rates were assessed.


RESULTS
There were 24 (13 males) patients. Average age was 63 with a BMI of 25.9. Eighteen (75%)  had a planned loop ileostomy, and 6 (25%) were emergent. Average time to reversal was 135 days. Average length of surgery was 79 minutes (range, 48 to 186), average stay was 4 days and return to bowel function was 3.6 days. We had no wound infections. Our complication rate was 29% (n=7), and  reoperation rate was 12.5% (n=3). Only 1 major complication occurred, an anastomotic dehiscence.


CONCLUSIONS
A thorough, well-visualized lysis of adhesions and mobilization of the stoma and surrounding small bowel is the main advantage of our approach. We had no wound infections  and no reoperation for bowel obstruction, which we feel is a direct advantage of our technique. Our complication rate and surgical time are comparable to those of the open technique.
Texas Endosurgery Institute, San Antonio, TX, USA. fellow@texasendosurgery.com
Karla
K
Russek
Jojy M
JM
George
Naveed
N
Zafar
Pedro
P
Cuevas-Estandia
Morris
M
Franklin
D003113:Colonoscopy; D004238:Diverticulitis / Q000601:surgery*; D005260:Female; D006801:Humans; D007081:Ileostomy; 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; D012004:Rectal Neoplasms / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome