title: Single-incision laparoscopic ileorectal anastomosis.
abstract: OBJECTIVE
  Minimally invasive approaches for stoma closure offer considerable benefits for patients. Single port access via an end ileostomy site after stoma take-down in patients with prior total colectomy and a rectal stump remnant could allow restoration of ileorectal continuity by anastomosis but has not been detailed previously.
  
  
  METHODS
  After mobilisation of the end ileostomy, the anvil of a circular stapler is secured into the open end of the distal ileum and the intestine returned into the abdominal cavity. A single port access device (in this description, a 'surgical glove port') is placed then into the stoma site and full laparoscopy performed. Once the rectal stump is identified and prepared, an intracorporeal anastomosis can be constructed in a tension-free manner using a Knight-Griffin technique. Leak-testing can also be performed and the operation concluded with closure of the solitary incision.
  
  
  RESULTS
  In selected cases, adhesiolysis and anastomosis can be safely performed in toto. If the peritoneal environment is challenging, access can be escalated to multiport laparoscopy or even laparotomy.
  
  
  CONCLUSIONS
  Initiation of ileorectal anastomosis construction by single port laparoscopy at least allows peritoneal assessment but can provide for the operation's completion. This can confer maximum patient benefit for the most minimally invasive option.
authors: Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.
authors: Syed Ali
authors: SA
authors: Naqi
authors: James
authors: J
authors: Smyth
authors: Neil
authors: N
authors: Mortensen
authors: Roel
authors: R
authors: Hompes
authors: Ronan
authors: R
authors: Cahill
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D003082:Colectomy / Q000379:methods; D006801:Humans; D007081:Ileostomy / Q000379:methods; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D012007:Rectum / Q000601:surgery*; D017792:Surgical Stapling / Q000379:methods; D000267:Tissue Adhesions / Q000601:surgery
keywords: Laparoscopy; ileorectal anastomosis; single site/port laparoscopy; surgical innovation