title: Day-case closure of ileostomy: feasible, safe and efficient.
abstract: OBJECTIVE
  Over 5000 loop ileostomy closures were performed in the UK in 2013 with a median inpatient stay of 5 days. Previously we have successfully implemented a 23-h protocol for loop ileostomy closure which was modified for same-day discharge. We present our early experience of day-case loop ileostomy closure.
  
  
  METHODS
  A specific patient pathway for day-case discharge following loop ileostomy closure was implemented with inclusion criteria to conform with British Association of Day Surgery guidelines. Exclusion criteria included postoperative chemoradiotherapy, multiple comorbidities and social care needs. Follow-up consisted of telephone contact (24 and 72 h after discharge) and a routine outpatient appointment. Patients were provided with a 24-h contact point in case of emergency.
  
  
  RESULTS
  Fifteen (12 male) patients were enrolled of median age 67 (39-80) years. The median operating time was 41 (23-80) min. The indication for ileostomy formation was to cover a low anterior resection for adenocarcinoma (13), reversal of Hartmann's procedure (1) and functional bowel disorder (1). The median interval from the primary procedure to day-case loop ileostomy closure was 8 (3-14) months. Every patient was discharged on the day of surgery. There were no complications related to the surgery and there was one readmission due to a urinary tract infection. The median length of follow-up was 4 (2-16) months.
  
  
  CONCLUSIONS
  Our early experience shows that day-case loop ileostomy closure is feasible, safe and efficient. This protocol will become standard within our institution for suitable patients, saving on average five inpatient bed days per patient.
authors: Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Derby, UK.|School of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK.
authors: A
authors: A
authors: Bhalla
authors: Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Derby, UK.
authors: O
authors: O
authors: Peacock
authors: Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Derby, UK.
authors: G M
authors: GM
authors: Tierney
authors: Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Derby, UK.
authors: S
authors: S
authors: Tou
authors: Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Derby, UK.
authors: N G
authors: NG
authors: Hurst
authors: Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Derby, UK.
authors: W J
authors: WJ
authors: Speake
authors: School of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK.|Department of Anaesthesia, Royal Derby Hospital NHS Trust, Derby, UK.
authors: J P
authors: JP
authors: Williams
authors: Department of Colorectal Surgery, Royal Derby Hospital NHS Trust, Derby, UK.|School of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK.
authors: J N
authors: JN
authors: Lund
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods*; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007081:Ileostomy; D007082:Ileum / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010351:Patient Discharge; D019990:Perioperative Care; D010865:Pilot Projects; D013997:Time Factors
keywords: Day-case; enhanced recovery; reversal of ileostomy