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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 1/2017

01-01-2017 | Original Article

Ileostomy reversal with handsewn techniques. Short-term outcomes in a teaching hospital

Authors: Gaetano Luglio, Francesco Terracciano, Mariano Cesare Giglio, Michele Sacco, Roberto Peltrini, Viviana Sollazzo, Emanuela Spadarella, Cristina Bucci, Giovanni Domenico De Palma, Luigi Bucci

Published in: International Journal of Colorectal Disease | Issue 1/2017

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Abstract

Introduction

Fecal diversion is considered an effective procedure to protect bowel anastomosis at high risk for leak. Some concerns exist regarding the risk for a significant morbidity associated to ileostomy creation itself and moreover to its closure. Surgical expertise and closure techniques are considered potential factors influencing morbidity. Aim of the study is to present a single-institution experience with ileostomy closures, in a teaching hospital, whereas ileostomy reversal is mainly performed by young residents.

Methods

A prospective database was investigated to extract data of patients who underwent loop ileostomy closure between January 2005 and December 2014. Ileostomy reversion was always realized in a handsewn fashion, performing either a direct closure (DC) or a resection plus end-to-end anastomosis (EEA). Postoperative morbidity was graded according to Clavien-Dindo classification. Outcomes after DC and EEA were compared by Fisher’s exact test and Wilcoxon rank-sum test.

Results

Two hundred ninety-eight patients were included. Ileostomy reversal was performed by EEA in 236 patients (79.19 %) and by DC in 62 patients (20.81 %). Surgery was performed with a peristomal access in 296 cases (99.33 %). Incidence of anastomotic leak was 0.67 % (2/298). Overall reoperation rate was 0.34 % (1/298). Short-term overall morbidity rate was 20.47 %; but major complications (≥ grade III) occurred in only one patient (0.34 %). Mortality was nil. No significant differences in postoperative morbidity were found between the DC and EEA group.

Conclusion

Loop ileostomy reversal is a safe procedure, associated to a low major morbidity and excellent results, even if performed with a handsewn technique by supervised trainee surgeons.
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Metadata
Title
Ileostomy reversal with handsewn techniques. Short-term outcomes in a teaching hospital
Authors
Gaetano Luglio
Francesco Terracciano
Mariano Cesare Giglio
Michele Sacco
Roberto Peltrini
Viviana Sollazzo
Emanuela Spadarella
Cristina Bucci
Giovanni Domenico De Palma
Luigi Bucci
Publication date
01-01-2017
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 1/2017
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-016-2645-z

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