title: Loop ileostomy closure after laparoscopic versus open surgery: is there a difference?
abstract: BACKGROUND
  Temporary loop ileostomy is commonly performed to protect the distal anastomosis during both open and laparoscopic colectomies. This study aimed to evaluate the impact of initial open and laparoscopic colorectal resection on the outcomes of ileostomy closure.
  
  
  METHODS
  After institutional review board approval, all patients who underwent loop ileostomy closure from January 2008 to July 2012 were identified. The patients' demographics, diagnosis, American Society of Anesthesiology (ASA) classification, type of resection, approach (laparoscopic [LS] or open [OS] surgery), use of anti-adhesion barrier, and ileostomy closure outcomes were obtained from a chart review. The outcomes of ileostomy closure after LS and OS colorectal resections were compared using Chi-square for categorical variables and Student's t test for continuous variables.
  
  
  RESULTS
  The study identified 351 patients with a mean age of 51 years: 145 patients (41.2%) in the LS group and 206 patients (58.8%) in the OS group. The most common procedures performed were total proctocolectomy with ileal J pouch anal anastomosis (109 patients: 49 LS, 60 OS) and restorative proctectomy (99 patients: 34 LS, 65 OS). At the time of ileostomy closure, the patients in the LS group had a significantly shorter mean operative time (LS 60.9 vs OS 82.6 min; p < 0.001) and a shorter hospital stay (LS 4.9 vs OS 5.8 days; p = 0.042). The overall complication rate was 20.1% (70 patients), and the rate in the OS group was significantly higher (p = 0.028). The most common complications were postoperative ileus (41 patients: 13 LS vs 28 OS) and enterocutaneous fistula (5 patients, all in the OS group).
  
  
  CONCLUSIONS
  Loop ileostomy closure after laparoscopic colorectal surgery is associated with a significantly shorter operative time and hospital stay as well as a lower rate of postoperative complications. Superior outcomes after loop ileostomy closure lend further support to the use of laparoscopy.
authors: Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL 33331, USA.
authors: Art
authors: A
authors: Hiranyakas
authors: Assar
authors: A
authors: Rather
authors: Giovanna
authors: G
authors: da Silva
authors: Eric G
authors: EG
authors: Weiss
authors: Steven D
authors: SD
authors: Wexner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000517:prevention & control; D003108:Colonic Diseases / Q000601:surgery*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000379:methods; D012002:Rectal Diseases / Q000601:surgery*; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D055815:Young Adult