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Zhang XQ, Tang RX, Pan DH, Zhang CF, Xia MY, Shuai LY, Tang H, Ji GY. Laparoscopic versus open ileostomy closure: a systematic review and meta-analysis of postoperative outcomes. Int J Colorectal Dis 2025; 40:109. [PMID: 40323516 PMCID: PMC12053327 DOI: 10.1007/s00384-025-04897-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2025] [Indexed: 05/08/2025]
Abstract
PURPOSE This study aims to compare laparoscopic versus open in ileostomy reversal techniques from multiple perspectives and to gain insight into the potential advantages and limitations of laparoscopic techniques and provide guidance on finding the best anastomosis for ileostomy reversal. METHODS This systematic review and meta-analysis has been pre-registered with PROSPERO. The registration number is CRD42025640754. A rigorous literature search was conducted across multiple databases, including Embase, PubMed, Cochrane Library, and China National Knowledge Infrastructure. The primary outcome measure was the incidence of overall postoperative complications, and the secondary outcomes included operative time, estimated blood loss, and the length hospital stay. RESULTS This research included 11 studies with a total of 867 cases, showing that the laparoscopic surgery group had a significantly lower overall complication rate compared to the open surgery group (OR = 0.40, 95% CI: 0.27-0.59, P < 0.00001). Further investigation of specific postoperative complications revealed that laparoscopic surgery significantly reduced the risk of bowel obstruction (OR = 0.39, 95% CI: 0.18-0.83, P = 0.01) and wound infection (OR = 0.41, 95% CI: 0.23-0.73, P = 0.003), with no significant difference observed for anastomotic leaks (OR = 0.40, 95% CI: 0.11-1.43, P = 0.16). Although laparoscopic surgery required a longer operative time (P = 0.002), it resulted in significantly shorter hospital stays (P < 0.00001) and did not increase estimated blood loss (P = 0.50). In addition, both extracorporeal laparoscopic surgery and intracorporeal laparoscopic surgery can effectively reduce the occurrence of postoperative complications and shorten the length of hospital stay compared with open surgery. CONCLUSION Laparoscopic-assisted ileostomy closure (both intracorporeal and extracorporeal techniques) demonstrates significant clinical benefits, including reduced postoperative complication rates, shortened hospitalization duration, and optimized recovery trajectories.
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Affiliation(s)
- Xiao-Qiang Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Run-Xi Tang
- Shanxi Provincial Institute of Traditional Chinese Medicine, Taiyuan, 030021, Shanxi, China
| | - Dong-Hao Pan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Chao-Fu Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Ming-Yang Xia
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Lei-Yuan Shuai
- Department of Anorectal Surgery, Jiangjin Central Hospital of Chongqing, Chongqing, 404000, China
| | - Hua Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Guang-Yan Ji
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China.
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Liu WH, Xiong M, Chen GQ, Long Z, Xu C, Zhu L, Wu JS. Laparoscopic intracorporeal anastomosis vs open anastomosis for ileostomy reversal in Crohn's disease: A single center retrospective study. World J Gastrointest Surg 2025; 17:98269. [PMID: 39872758 PMCID: PMC11757179 DOI: 10.4240/wjgs.v17.i1.98269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 10/24/2024] [Accepted: 11/12/2024] [Indexed: 12/27/2024] Open
Abstract
BACKGROUND There is an increased maturation of laparoscopic intracorporeal anastomosis techniques. However, research on its application for small bowel stoma reversal in patients with Crohn's disease (CD) is limited. Therefore, in this study, we compared the perioperative outcomes between laparoscopic intracorporeal ileostomy reversal (LIIR) and open ileostomy reversal (OIR). AIM To compare the safety, feasibility, bowel function recovery, and short- and long-term LIIR and OIR outcomes in patients with CD. METHODS This study included patients who underwent ileal reversal for CD between January 2021 and January 2023 at our institution. The baseline data, postoperative recovery, and complication indicators were retrospectively analyzed. Logistic regression analysis was conducted to explore factors that significantly influenced the development of enteral nutrition intolerance-related symptoms. RESULTS Notably, 15 of the 45 patients in this study underwent OIR, and the remaining 30 received LIIR. Notably, no statistically significant differences were found between the two groups regarding clinical baseline characteristics, operation time, intraoperative hemorrhage, anastomotic site, enterolysis range, first postoperative flatus, postoperative complications, reoperation rate, or incidence of postoperative enteral nutrition intolerance. Compared with the OIR group, the LIIR group had a shorter postoperative hospital stay (P = 0.045), lower incidence of enteral nutrition intolerance symptoms (P = 0.019), and earlier postoperative total enteral nutrition initiation (P = 0.033); however, it incurred higher total hospital costs (P = 0.038). Furthermore, multivariate logistic regression analysis revealed that the duration of surgery and anastomotic technique were independent risk factors for postoperative symptoms of enteral nutrition intolerance (P < 0.05). CONCLUSION Laparoscopic intracorporeal anastomosis for ileostomy reversal is safe and feasible. Patients who underwent this technique demonstrated improved tolerance to postoperative enteral nutrition and quicker resumption of total enteral nutrition.
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Affiliation(s)
- Wei-Hang Liu
- Department of General Surgery, Chongqing General Hospital, Chongqing 401120, China
| | - Mao Xiong
- Department of General Surgery, Chongqing General Hospital, Chongqing 401120, China
| | - Guo-Qing Chen
- Department of General Surgery, Chongqing General Hospital, Chongqing 401120, China
| | - Zhui Long
- Department of General Surgery, Chongqing General Hospital, Chongqing 401120, China
| | - Chao Xu
- Department of General Surgery, Chongqing General Hospital, Chongqing 401120, China
| | - Li Zhu
- Department of General Surgery, Chongqing General Hospital, Chongqing 401120, China
| | - Jing-Song Wu
- Department of General Surgery, Chongqing General Hospital, Chongqing 401120, China
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Jong BK, Chern YJ, You JF. Optimizing stoma closure: A laparoscopic technique yielding the least contamination. World J Surg 2024; 48:1767-1770. [PMID: 38777763 DOI: 10.1002/wjs.12213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
In this study, we introduce a novel method for stoma closure, aiming to reduce wound infection rates. This method involves creating the common channel of both limbs of a loop stoma extracorporeally, which is particularly beneficial during laparoscopic stoma closure surgery by potentially avoiding contamination of the wound. We applied this technique in 23 patients undergoing laparoscopic stoma reversal surgery, comprising both loop colostomy and ileostomy cases. Notably, postoperative outcomes were promising: only two patients experienced postoperative ileus, and importantly, there were no instances of wound infection. These findings suggest that our laparoscopic stoma reversal surgery approach is not only safe and feasible but also offers a significant advantage in reducing wound infection rates.
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Affiliation(s)
- Bor-Kang Jong
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yih-Jong Chern
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jeng-Fu You
- Colorectal Section, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Wang YJ, Lin KH, Kang JC, Hu JM, Chen CY, Pu TW. Benefits of laparoscopy-assisted ileostomy in colorectal cancer patients with bowel obstruction. World J Clin Cases 2023; 11:5660-5665. [PMID: 37727726 PMCID: PMC10505990 DOI: 10.12998/wjcc.v11.i24.5660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Ileostomies are commonly performed after colon and rectal surgeries. Laparoscopy-assisted ileostomy with adhesion lysis may have potential benefits over conventional open surgery. AIM To compare the outcomes of laparoscopy-assisted and conventional ileostomies. METHODS Data from 48 consecutive patients who underwent ileostomy at our institution between May 2021 and May 2022 were retrospectively analyzed. The groups comprised 26 and 22 patients who underwent laparoscopic ileostomy (laparoscopic group) and conventional ileostomy (conventional group), respectively, performed by a single surgeon. Patient demographics, operative characteristics, postoperative outcomes, and 30-d morbidities and mortality rates were analyzed. RESULTS The two groups had comparable mean ages, sex distributions, American Society of Anesthesiologists scores, and body mass indices. However, the laparoscopic group showed similar operative time, better visualization for adhesion lysis, and lower visual analog scale scores than the conventional group. CONCLUSION Laparoscopy-assisted ileostomy is a safe and efficient method that produces lower visual analog scale scores, better intraoperative visualization for effective adhesion lysis, and similar operative time compared with conventional ileostomy.
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Affiliation(s)
- Yi-Jie Wang
- Department of Surgery, Tri Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Kuan-Hsun Lin
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Jung-Cheng Kang
- Division of Colon and Rectal Surgery, Department of Surgery, Taiwan Adventist Hospital, Taipei 105, Taiwan
| | - Je-Ming Hu
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chao-Yang Chen
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Ta-Wei Pu
- Division of Colon and Rectal Surgery, Department of Surgery, Songshan branch, Tri-Service General Hospital, National Defense Medical Center, Taipei 105, Taiwan
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Rondelli F, Gemini A, Cerasari S, Avenia S, Bugiantella W, Desiderio J. Laparoscopic vs. open loop ileostomy reversal: a meta-analysis of randomized and non-randomized studies. Langenbecks Arch Surg 2023; 408:329. [PMID: 37615738 DOI: 10.1007/s00423-023-03075-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/17/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The present meta-analysis compares laparoscopic loop ileostomy reversal (LLIR) with open loop ileostomy reversal (OLIR) to evaluate the advantages of the laparoscopic technique compared to the traditional open technique in ileostomy reversal. METHODS Primary endpoints were hospital stay and overall complications. Secondary endpoints were operative time, EBL, readmission, medical complications, surgical complications, reoperation, wound infection, anastomotic leak, intestinal obstruction, and cost of the procedures. The included studies were also divided based on the type of anastomotic approach: extracorporeal laparoscopic loop ileostomy reversal (ELLIR) and intracorporeal laparoscopic loop ileostomy reversal (ILLIR). RESULTS In the analysis, 4 studies were included. Three hundred fifty-four patients were enrolled. As primary outcomes, a significant difference was found in hospital stay between the LLIR and OLIR groups (MD = -0.67, 95% CI -1.16 to -0.19, P = 0.007). The overall complications outcome resulted in favor of the LLIR group (RR = 0.64, 95% CI 0.43-0.95, P = 0.03). As secondary outcomes, the operative time was in favor of the OLIR group (MD = 19.18, 95% CI 10.20-28.16, P < 0.001). Surgical complications were lower in the LLIR group than in the OLIR group. No other differences between the secondary endpoints were found. Subgroup analysis showed a significant difference in hospital stay between the ILLIR and OLIR groups (MD = -0.92, 95% CI -1.55 to -0.30, P = 0.004). The overall complications outcome significantly favored the ILLIR group (RR = 0.38, 95% CI 0.15-0.96, P = 0.04). CONCLUSION Our meta-analysis shows an advantage in terms of shorter post-operative hospitalization and reduction of complications of LLIR compared to OLIR. The sub-group analysis shows that performing an extracorporeal anastomosis exposes the same risks of the open technique.
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Affiliation(s)
- Fabio Rondelli
- Department of General Surgery and Surgical Specialties, University of Perugia, "S. Maria" Hospital, 05100, Terni, Italy
| | - Alessandro Gemini
- Department of Digestive Surgery, University of Perugia, "S. Maria" Hospital, 05100, Terni, Italy.
| | - Saverio Cerasari
- Department of General Surgery and Surgical Specialties, University of Perugia, "S. Maria" Hospital, 05100, Terni, Italy
| | - Stefano Avenia
- Department of General Surgery and Surgical Specialties, University of Perugia, "S. Maria" Hospital, 05100, Terni, Italy
| | - Walter Bugiantella
- Department of General Surgery, "San Giovanni Battista" Hospital, Usl Umbria 2, 06034, Foligno, PG, Italy
| | - Jacopo Desiderio
- Department of Digestive Surgery, University of Perugia, "S. Maria" Hospital, 05100, Terni, Italy
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Meyer VM, Meuzelaar RR, Schoenaker IJH, de Groot JWB, Reerink O, de Vos Tot Nederveen Cappel WH, Beets GL, van Westreenen HL. Delayed TME Surgery in a Watch-and-Wait Strategy After Neoadjuvant Chemoradiotherapy for Rectal Cancer: An Analysis of Hospital Costs and Surgical and Oncological Outcomes. Dis Colon Rectum 2023; 66:671-680. [PMID: 34856587 DOI: 10.1097/dcr.0000000000002259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND A watch-and-wait strategy for patients with rectal cancer with a clinical complete response after neoadjuvant chemoradiotherapy is a valuable alternative for rectal resection. However, there are patients who will have residual tumor or regrowth during watch and wait. OBJECTIVE The aim of this study was to investigate safety and costs for patients who underwent delayed surgery after neoadjuvant chemoradiotherapy. DESIGN This is a retrospective cohort study with prospectively collected data. SETTINGS The study was conducted at a large teaching hospital. PATIENTS Between January 2015 and May 2020, 622 new rectal cancer patients were seen, of whom 200 received neoadjuvant chemoradiotherapy. Ninety-four patients were included, 65 of whom underwent immediate surgery and 29 of whom required delayed surgery after an initial watch-and-wait approach. MAIN OUTCOME MEASURES Outcome measures included 30-day postoperative morbidity rate, hospital costs. 2-year overall and disease-free survival. RESULTS There was no difference in length of stay (9 vs 8; p = 0.83), readmissions (27.6% vs 10.0%; p = 0.10), surgical re-interventions (15.0% vs 3.4%; p = 0.16), or stoma-free rate (52.6% vs 31.0%; p = 0.09) between immediate and delayed surgery groups. Hospital costs were similar in the delayed group (€11,913 vs €13,769; p = 0.89). Two-year overall survival (93% vs 100%; p = 0.23) and disease-free survival (78% vs 81%; p = 0.47) rates were comparable. LIMITATIONS Limitations included small sample size, follow-up time and retrospective design. CONCLUSION Delayed surgery for regrowth in a watch-and-wait program or for persistent residual disease after a repeated assessment is not associated with an increased risk of postoperative morbidity or a significant rise in costs compared to immediate total mesorectal excision. There also appears to be no evident compromise in oncological outcome. Repeated response assessment in patients with a near complete clinical response after neoadjuvant chemoradiotherapy is a useful approach to identify more patients who can benefit from a watch-and-wait strategy. See Video Abstract at http://links.lww.com/DCR/B836 . CIRUGA DE TME RETRASADA EN UNA ESTRATEGIA DE WATCH AND WAIT DESPUS DE LA QUIMIORRADIOTERAPIA NEOADYUVANTE PARA CNCER DE RECTO UN ANLISIS DE COSTOS HOSPITALARIOS, Y DE RESULTADOS QUIRRGICOS Y ONCOLGICOS ANTECEDENTES: Una estrategia de Watch and Wait para pacientes con cáncer de recto con una respuesta clínica completa después de quimiorradioterapia neoadyuvante es una alternativa valiosa en vez de resección rectal. Sin embargo, hay pacientes que tendrán tumor residual o un recrecimiento durante el Watch and Wait .OBJETIVO: El objetivo fue investigar la seguridad y los costos para los pacientes que se sometieron a una cirugía diferida después de la quimiorradioterapia neoadyuvante.DISEÑO: Este es un estudio de cohorte retrospectivo con datos recolectados prospectivamente.AJUSTE: El estudio se llevó a cabo en un gran hospital universitario.PACIENTES: Entre enero de 2015 y mayo de 2020, se atendieron 622 nuevos pacientes con cáncer de recto, de los cuales 200 recibieron quimiorradioterapia neoadyuvante. Se incluyeron 94 pacientes, de los cuales 65 se sometieron a cirugía inmediata y 29 pacientes requirieron cirugía diferida después de un enfoque inicial de observación y espera.PRINCIPALES MEDIDAS DE RESULTADO: se incluyeron la tasa de morbilidad posoperatoria a 30 días, los costos hospitalarios y las sobrevidas general y libre de enfermedad a dos años.RESULTADOS: No hubo diferencia en la duración de la estancia (9 vs 8, p = 0,83), reingresos (27,6% vs 10,0%, p = 0,10), reintervenciones quirúrgicas (15,0% vs 3,4%, p = 0,16) y tasa libre de estoma (52,6% vs 31,0%, p = 0,09) entre los grupos de cirugía inmediata y tardía. Los costos hospitalarios fueron similares en el grupo retrasado (11913 € frente a 13769 €, p = 0,89). Las tasas de sobrevida general a dos años (93% frente a 100%, p = 0,23) y sobrevida libre de enfermedad (78% frente a 81%, p = 0,47) fueron comparables.LIMITACIONES: Tamaño de muestra pequeño, tiempo de seguimiento y diseño retrospectivo.CONCLUSIÓN: La cirugía tardía para el recrecimiento en un programa de Watch and Wait o para la enfermedad residual persistente después de una evaluación repetida no se asocia con un riesgo mayor de morbilidad posoperatoria ni con un aumento significativo en los costos, en comparación con la escisión total de mesorrecto inmediata. Tampoco parece haber un compromiso evidente en el resultado oncológico. La evaluación repetida de la respuesta en pacientes con una respuesta clínica casi completa después de la quimiorradioterapia neoadyuvante es un enfoque útil para identificar más pacientes que pueden beneficiarse de una estrategia de Watch and Wait . Consulte Video Resumen en http://links.lww.com/DCR/B836 . (Traducción-Dr. Juan Carlos Reyes ).
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Affiliation(s)
- Vincent M Meyer
- Department of Surgery, Isala Hospitals, Zwolle, The Netherlands
| | - Richtje R Meuzelaar
- Department of Surgery, Isala Hospitals, Zwolle, The Netherlands
- Department of Oncology, Isala Hospitals, Zwolle, The Netherlands
- Department of Radiotherapy, Isala Hospitals, Zwolle, The Netherlands
- Department of Gastroenterology, Isala Hospitals, Zwolle, The Netherlands
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, The Netherlands
| | | | | | - Onne Reerink
- Department of Radiotherapy, Isala Hospitals, Zwolle, The Netherlands
| | | | - Geerard L Beets
- Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, The Netherlands
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Xu Z, Zhang Y, Su H, Guan X, Liang J, Liu Q, Wang X, Zhou H. A multidimensional learning curve analysis of totally laparoscopic ileostomy reversal using a single surgeon' s experience. Front Surg 2023; 10:1077472. [PMID: 36860945 PMCID: PMC9968790 DOI: 10.3389/fsurg.2023.1077472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023] Open
Abstract
Purpose Recently, totally laparoscopic ileostomy reversal (TLAP) has received increasing attention and exhibited promising short-term outcomes. The aim of this study was to detail the learning process of the TLAP technique. Methods Based on our initial experience with TLAP from 2018, a total of 65 TLAP cases were enrolled. Demographics and perioperative parameters were assessed using cumulative sum (CUSUM), moving average, and risk-adjusted CUSUM (RA-CUSUM) analyses. Results The overall mean operative time (OT) was 94 min and the median postoperative hospitalization period was 4 days, and there was an estimated 10.77% incidence rate of perioperative complications. Three unique phases of the learning curve were derived from CUSUM analysis, and the mean OT of phase I (1-24 cases) was 108.5 min, that of phase II (25-39 cases) was 92 min, and that of phase III (40-65 cases) was 80 min, respectively. There was no significant difference in perioperative complications between these 3 phases. Similarly, moving average analysis indicated that the operation time was reduced significantly after the 20th case and reached a steady state after the 36th case. Furthermore, complication-based CUSUM and RA-CUSUM analyses indicated an acceptable range of complication rates during the whole learning period. Conclusion Our data demonstrated 3 distinct phases of the learning curve of TLAP. For an experienced surgeon, surgical competence in TLAP can be grasped at around 25 cases with satisfactory short-term outcomes.
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Affiliation(s)
- Zheng Xu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yueyang Zhang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Su
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Xu Guan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianwei Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Correspondence: Haitao Zhou
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Xu Z, Luo S, Su H, Liang J, Liu Q, Wang X, Jin W, Zhou H. Satisfactory short-term outcomes of totally laparoscopic ileostomy reversal compared to open surgery in colorectal cancer patients. Front Surg 2023; 9:1076874. [PMID: 36684242 PMCID: PMC9852771 DOI: 10.3389/fsurg.2022.1076874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/28/2022] [Indexed: 01/09/2023] Open
Abstract
Background Recently, totally laparoscopic (TLAP) surgery has suggested its potential on ileostomy reversal. This study aimed to compare the short-term outcomes between TLAP and traditional open ileostomy reversal. Patients and methods From September 2016 to September 2021, 107 eligible patients underwent TLAP (n = 48) or open (n = 59) loop ileostomy reversal were retrospectively enrolled. Surgical parameters, postoperative recovery and complications were identified and compared between TLAP technique vs. open surgery. Results The operation time and estimated blood loss showed no obvious difference between TLAP and open group. However, TLAP reversal significantly decreased the incision length (4.5cm vs. 6cm, P < 0.001). Furthermore, patients underwent TLAP surgery showed quicker first ground activities (1 day vs. 2 days, P < 0.001), faster first flatus passage (2 days vs. 3 days, P = 0.004) and shorter postoperative stay (5 days vs. 7 days, P = 0.007). More importantly, postoperative complications were significantly reduced after TLAP reversal (3 cases vs. 10 cases, P = 0.026). Further logistic regression analyses also indicated the TLAP technique was associated with lower incidence of complications (OR=3.316, CI, 1.118-9.835; P = 0.031). Conclusions TLAP surgery is competitive in promoting postoperative recovery as well as reducing complications compared to the traditional open ileostomy reversal.
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Affiliation(s)
- Zheng Xu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shou Luo
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Su
- Department of Gastrointestinal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - Jianwe Liang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weisen Jin
- Department of Anorectal Diseases, General Hospital of Chinese Armed Police Forces, Beijing, China,Correspondence: Weisen Jin ; Haitao Zhou
| | - Haitao Zhou
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Correspondence: Weisen Jin ; Haitao Zhou
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Peltrini R, Magno G, Pacella D, Iacone B, Rizzuto A, Bracale U, Corcione F. Postoperative Morbidity Following Loop Ileostomy Reversal after Primary Elective or Urgent Surgery: A Retrospective Study with 145 Patients. J Clin Med 2023; 12:452. [PMID: 36675381 PMCID: PMC9866519 DOI: 10.3390/jcm12020452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
Temporary loop ileostomy is usually performed to protect distal anastomosis or to treat urgent surgical cases. The aim of this study is to evaluate whether, after primary urgent stoma construction, patients undergoing ileostomy reversal have different postoperative outcomes compared with patients who have protective stoma performed in an elective setting. A retrospective observational study was conducted including patients who underwent ileostomy reversal. Baseline patient characteristics and perioperative outcomes were collected in a single database. The overall morbidity rate during recovery was fixed as a primary outcome. Between 2011 and 2021, the complete data records of 145 patients were evaluated. After ileostomy reversal, the postoperative morbidity rate did not differ between groups (14.4% vs. 11.5%, p = 0.790). Even considering each complication, such as ileus, small bowel obstruction, bleeding and wound infection, no significant difference was detected. Similarly, the time to first flatus was 2.25 ± 1.24 vs. 2.1 ± 0.99 (p = 0.379) and the length of hospital stay was 5.43 ± 3.03 vs. 5.84 ± 5.15 (p = 0.568). The only significant factor associated with postoperative complications on logistic regression analysis was the presence of comorbidities (OR 4.49; 95% CI 1.19-29.4, p = 0.05). In the present cohort of patients, there was no difference in the postoperative complication rate after stoma closure following elective or urgent indication for surgery.
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Affiliation(s)
- Roberto Peltrini
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Giuseppe Magno
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Daniela Pacella
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Biancamaria Iacone
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Antonia Rizzuto
- Department of Medical and Surgical Science, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Umberto Bracale
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy
| | - Francesco Corcione
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
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10
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Wan J, Yuan XQ, Wu TQ, Yang MQ, Wu XC, Gao RY, Yin L, Chen CQ. Laparoscopic vs open surgery in ileostomy reversal in Crohn’s disease: A retrospective study. World J Gastrointest Surg 2021; 13:1414-1422. [PMID: 34950430 PMCID: PMC8649567 DOI: 10.4240/wjgs.v13.i11.1414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/23/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although minimally invasive surgery is becoming more commonly applied for ileostomy reversal (IR), there have been relatively few studies of IR for patients with Crohn's disease (CD). It is therefore important to evaluate the potential benefits and risks of laparoscopy for patients with CD.
AIM To compare the safety, feasibility, and short-term and long-term outcomes of laparoscopic IR (LIR) vs open IR (OIR) for the treatment of CD.
METHODS The baseline characteristics, operative data, and short-term (30-d) and long-term outcomes of patients with CD who underwent LIR and OIR at our institution between January 2017 and January 2020 were retrieved from an electronic database and retrospectively reviewed.
RESULTS Of the 60 patients enrolled in this study, LIR was performed for 48 and OIR for 12. There were no statistically significant differences in baseline characteristics, operation time, intraoperative blood loss, days to flatus and soft diet, postoperative complications, hospitalization time, readmission rate within 30 d, length of hospitalization, hospitalization costs, or reoperation rate after IR between the two groups. However, patients in the LIR group more frequently required lysis of adhesions as compared to those in the OIR group (87.5% vs 41.7%, respectively, P < 0.05). Notably, following exclusion of patients who underwent enterectomy plus IR, OIR was more advantageous in terms of postoperative recovery of gastrointestinal function and hospitalization costs.
CONCLUSION The safety and feasibility of LIR for the treatment of CD are comparable to those of OIR with no increase in intraoperative or postoperative complications.
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Affiliation(s)
- Jian Wan
- Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Xiao-Qi Yuan
- Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Tian-Qi Wu
- Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Mu-Qing Yang
- Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Xiao-Cai Wu
- Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Ren-Yuan Gao
- Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Lu Yin
- Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Chun-Qiu Chen
- Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai 200092, China
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11
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Garfinkle R, Savage P, Boutros M, Landry T, Reynier P, Morin N, Vasilevsky CA, Filion KB. Incidence and predictors of postoperative ileus after loop ileostomy closure: a systematic review and meta-analysis. Surg Endosc 2019; 33:2430-2443. [PMID: 31020433 DOI: 10.1007/s00464-019-06794-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/09/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Postoperative ileus (POI) is regarded as the most clinically significant morbidity following loop ileostomy closure; however, its incidence remains poorly understood. Our objective was therefore to determine the pooled incidence of POI after loop ileostomy closure and identify risk factors associated with its development. METHODS We systematically searched MEDLINE (via Ovid and PubMed), Embase, the Cochrane Library, Biosis Previews, and Scopus to identify studies reporting the incidence of POI in patients who underwent loop ileostomy closure. Two independent reviewers extracted data and appraised study quality. Cumulative incidence proportions were pooled across studies using a random-effects meta-analytic model. RESULTS Sixty-seven studies, including 9528 patients, met our inclusion criteria. The pooled estimate of POI was 8.0% (95% CI 6.9-9.3%; I2 = 74%). The estimated incidence varied by POI definition: studies with a robust definition of POI (n = 8) demonstrated the highest estimate of POI (12.4%, 95% CI 9.2-16.5%; I2 = 79%) while studies that did not report an explicit POI definition (n = 38) demonstrated the lowest estimate (6.7%, 95% CI 5.3-8.3%; I2 = 61%). Small bowel anastomosis technique (hand-sewn) and interval time from ileostomy creation to closure (longer time) were the factors most commonly associated with POI after loop ileostomy closure. However, most comparative studies were not powered to examine risk factors for POI. CONCLUSIONS POI is an important complication after loop ileostomy closure, and its incidence is dependent on its definition. More research aimed at studying this complication is required to better understand risk factors for POI after loop ileostomy closure.
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Affiliation(s)
- Richard Garfinkle
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Paul Savage
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada.,Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Marylise Boutros
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Tara Landry
- Medical Libraries, McGill University Health Center, Montreal, QC, Canada
| | - Pauline Reynier
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Nancy Morin
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Carol-Ann Vasilevsky
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Kristian B Filion
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. .,Department of Medicine, McGill University, Montreal, QC, Canada.
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12
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Sujatha-Bhaskar S, Whealon M, Inaba CS, Koh CY, Jafari MD, Mills S, Pigazzi A, Stamos MJ, Carmichael JC. Laparoscopic loop ileostomy reversal with intracorporeal anastomosis is associated with shorter length of stay without increased direct cost. Surg Endosc 2018; 33:644-650. [PMID: 30361967 DOI: 10.1007/s00464-018-6518-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic ileostomy closure with intracorporeal anastomosis offers potential advantages over open reversal with extracorporeal anastomosis, including earlier return of bowel function and reduced postoperative pain. In this study, we aim to compare the outcome and cost of laparoscopic ileostomy reversal (utilizing either intracorporeal or extracorporeal anastomosis) with open ileostomy reversal. METHODS A retrospective review of sequential patients undergoing elective loop ileostomy reversal between 2013 and 2016 at a single, high-volume institution was performed. Patients were stratified on the basis of operative approach: open reversal, laparoscopic-assisted reversal with extracorporeal anastomosis (LE), and laparoscopic reversal with intracorporeal anastomosis (LI). Linear and logistic regressions were utilized to perform multivariate analysis and determine risk-adjusted outcomes. RESULTS Of 132 sequential cases of loop ileostomy reversal, 50 (38%) underwent open, 49 (37%) underwent LE, and 33 (22%) underwent LI. Demographic data and preoperative comorbidities were similar between the three cohorts. Median length of stay was significantly shorter for LI (52.1 h, p < 0.05) compared to open (69.0 h) and LE (69.6 h). After risk-adjusted analysis, length of stay was significant shorter in LI compared to LE (GM 0.78, 95% CI 0.64-0.93, p < 0.01) and open reversal (GM 0.78, 95% CI 0.66-0.93, p < 0.01). Risk-adjusted 30-day morbidity rates were similar for LI compared to LE (OR 0.43, 95% CI 0.081-2.33, p = 0.33) and open reversal (OR 0.53, 95% CI 0.09-3.125, p = 0.48). Median in-hospital direct cost was similar for LI ($6575.00), LE ($6722.50), and open reversal ($6181.00). CONCLUSION Laparoscopic ileostomy reversal with intracorporeal anastomosis was associated with shorter length of stay without increased overall direct cost. The technique of laparoscopic ileostomy reversal warrants continued study in a randomized clinical trial.
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Affiliation(s)
- Sarath Sujatha-Bhaskar
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Matthew Whealon
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Colette S Inaba
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Christina Y Koh
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Mehraneh D Jafari
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Steven Mills
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Alessio Pigazzi
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Michael J Stamos
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Joseph C Carmichael
- Department of Surgery, University of California Irvine School of Medicine, Irvine, CA, USA.
- Department of Surgery, University of California, Irvine, 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA.
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13
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Krenzien F, Benzing C, Harders F, Junghans T, Rasim G, Bothe C, Pratschke J, Zorron R. THE VULKAN TECHNIQUE: A NOVEL OSTOMY-CLOSURE TECHNIQUE THAT REDUCES COMPLICATIONS AND OPERATIVE TIMES. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2017; 30:139-142. [PMID: 29257851 PMCID: PMC5543794 DOI: 10.1590/0102-6720201700020013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/11/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ostomy reversals remain at high risk for surgical complications. Indeed, surgical-side infections due to bacterial contamination of the stoma lead to revision surgery and prolonged hospital stay. AIM To describe the novel vulkan technique of ostomy reversal that aims to reduce operative times, surgical complications, and readmission rates. METHODS Ostomy closure was performed using the vulkan technique in all patients. This technique consists of external intestinal closure, circular skin incision and adhesiolysis, re-anastomosis, and closure of the subcutaneous tissue in three layers, while leaving a small secondary wound through which exudative fluid can be drained. The medical records of enterostomy patients were retrospectively reviewed from our hospital database. RESULTS The vulkan technique was successfully performed in 35 patients mainly by resident surgeons with <5 years of experience (n=22; 62.8%). The ileostomy and colostomy closure times were 53 min (interquartile range [IQR], 41-68 min; n=22) and 136 min (IQR: 88-188 min; n=13; p<0.001), respectively. The median hospital stay was seven days (IQR: 5-14.5 days); the length of hospital stay did not differ between ileostomy and colostomy groups. Major surgical complications occurred only in patients who underwent colostomy closure following the Hartmann procedure (n=2); grade≥IIIb according Clavien-Dindo classification. CONCLUSION The vulkan technique was successfully applied in all patients with very low rates of surgical-site infections. Off note, residents with limited surgical experience mainly performed the procedure while operating time was less than one hour.
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Affiliation(s)
- Felix Krenzien
- Center of Innovative Surgery (ZIC), Department of Surgery, Campus Virchow Klinikum and Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institut of Health (BIH), Berlin, Germany
| | - Christian Benzing
- Center of Innovative Surgery (ZIC), Department of Surgery, Campus Virchow Klinikum and Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fabian Harders
- Department of General, Visceral, Thorax and Vascular Surgery, Clinic Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - Tido Junghans
- Department of General, Visceral, Thorax and Vascular Surgery, Clinic Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - Gyurdhan Rasim
- Department of General, Visceral, Thorax and Vascular Surgery, Clinic Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - Claudia Bothe
- Department of General, Visceral, Thorax and Vascular Surgery, Clinic Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - Johann Pratschke
- Center of Innovative Surgery (ZIC), Department of Surgery, Campus Virchow Klinikum and Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ricardo Zorron
- Center of Innovative Surgery (ZIC), Department of Surgery, Campus Virchow Klinikum and Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of General, Visceral, Thorax and Vascular Surgery, Clinic Bremerhaven Reinkenheide, Bremerhaven, Germany
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14
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Young MT, Hwang GS, Menon G, Feldmann TF, Jafari MD, Jafari F, Perez E, Pigazzi A. Laparoscopic Versus Open Loop Ileostomy Reversal: Is there an Advantage to a Minimally Invasive Approach? World J Surg 2016; 39:2805-11. [PMID: 26272594 DOI: 10.1007/s00268-015-3186-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ileostomy reversals are commonly performed procedures after colon and rectal operations. Laparoscopic ileostomy reversal (LIR) with lysis of adhesions has potential benefits over conventional open surgery. The aim of this study was to compare outcomes of laparoscopic and open ileostomy reversal. METHODS 133 consecutive patients undergoing ileostomy reversal at our institution between June 2009 and August 2013 were analyzed using a retrospective database. The group comprised 53 laparoscopic cases and 80 open cases, performed by four surgeons at a single center. The data were analyzed for patient demographics, operative characteristics, postoperative outcomes, and 30-day morbidity and mortality. RESULTS The two groups had comparable mean age, gender distribution, ASA scores, and BMI. The laparoscopic group had a significantly longer duration of surgery compared to the open reversal group (109 versus 93 min, p < 0.05). However, this group underwent more lysis of adhesions (60.4 % versus 26.3 %, p < 0.01) as well as concurrent stoma site mesh reinforcement (32.1 % versus 6.3 %, p < 0.01). In the laparoscopy group, 20.7 % of patients underwent intra-corporeal ileo-ileal anastomosis. There were no significant differences between the laparoscopic and open groups with regard to estimated blood loss (31 versus 40 ml, respectively) or mean length of stay (5.3 vs. 5.7 days, respectively). The rates of overall 30-day morbidity (16.9 % for laparoscopic vs. 21.3 % for open) as well as rates of specific complications were equivalent between groups. 30-day mortalities were not noted in either group. CONCLUSION LIR is safe and effective with low perioperative morbidity and mortality. The use of laparoscopy as an option in terms of concomitant hernia repair and lysis of adhesions may be considered in selected patients.
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Affiliation(s)
- Monica T Young
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA
| | - Grace S Hwang
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA. .,Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
| | - Gopal Menon
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA
| | - Timothy F Feldmann
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA
| | - Mehraneh D Jafari
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA
| | - Fariba Jafari
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA
| | - Eden Perez
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA.
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15
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16
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Mennigen R, Sewald W, Senninger N, Rijcken E. Morbidity of loop ileostomy closure after restorative proctocolectomy for ulcerative colitis and familial adenomatous polyposis: a systematic review. J Gastrointest Surg 2014; 18:2192-200. [PMID: 25231081 DOI: 10.1007/s11605-014-2660-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 09/03/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Temporary loop ileostomy is a routine procedure to reduce the morbidity of restorative proctocolectomy. However, morbidity of ileostomy closure could reduce the benefit of this concept. The objective of this systematic review was to assess the risks of ileostomy closure after restorative proctocolectomy for ulcerative colitis or familial adenomatous polyposis. MATERIALS AND METHODS Publications in English or German language reporting morbidity of ileostomy closure after restorative proctocolectomy were identified by Medline search. Two hundred thirty-two publications were screened, 143 were assessed in full-text, and finally 26 studies (reporting 2146 ileostomy closures) fulfilled the eligibility criteria. Weighted means for overall morbidity and mortality of ileostomy closure, rate of redo operations, anastomotic dehiscence, bowel obstruction, wound infection, and late complications were calculated. RESULTS Overall morbidity of ileostomy closure was 16.5 %, there was no mortality. Redo operations for complications were necessary in 3.0 %. Anastomotic dehiscence occurred in 2.0 %. Postoperative bowel obstruction developed in 7.6 %, with 2.9 % of patients requiring laparotomy for this complication. Wound infection rate was 4.0 %. Hernia or bowel obstruction as late complications developed in 1.9 and 9.4 %, respectively. CONCLUSION The considerable morbidity of ileostomy reversal reduces the overall benefit of temporary fecal diversion. However, ileostomy creation is still recommended, as it effectively reduces the risk of pouch-related septic complications.
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Affiliation(s)
- Rudolf Mennigen
- Department of General and Visceral Surgery, University Hospital Muenster, Albert-Schweitzer-Campus 1, Geb. W1, 48149, Muenster, Germany,
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17
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López-Cano M, Pereira JA, Villanueva B, Vallribera F, Espin E, Armengol Carrasco M, Arbós Vía MA, Feliu X, Morales-Conde S. Abdominal wall closure after a stomal reversal procedure. Cir Esp 2014; 92:387-92. [PMID: 24581880 DOI: 10.1016/j.ciresp.2014.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/06/2013] [Accepted: 01/09/2014] [Indexed: 12/17/2022]
Abstract
The closure of a temporary stoma involves 2 different surgical procedures: the stoma reversal procedure and the abdominal wall reconstruction of the stoma site. The management of the abdominal wall has different areas that should be analyzed such us how to avoid surgical site infection (SSI), the technique to be used in case of a concomitant hernia at the stoma site or to prevent an incisional hernia in the future, how to deal with the incision when the stoma reversal procedure is performed by laparoscopy and how to close the skin at the stoma site. The aim of this paper is to analyze these aspects in relation to abdominal wall reconstruction during a stoma reversal procedure.
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Affiliation(s)
- Manuel López-Cano
- Cirugía de la Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Investigación de Cirugía General y Digestiva, Pared Abdominal, Biomateriales, Institut de Recerca Vall d'Hebrón (IRVH), Edificio Collserola; Lab 211A, Barcelona, España.
| | - José Antonio Pereira
- Departament de Ciéncies Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, España
| | - Borja Villanueva
- Cirugía de la Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España
| | - Francesc Vallribera
- Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España
| | - Eloy Espin
- Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España
| | - Manuel Armengol Carrasco
- Cirugía de la Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Investigación de Cirugía General y Digestiva, Pared Abdominal, Biomateriales, Institut de Recerca Vall d'Hebrón (IRVH), Edificio Collserola; Lab 211A, Barcelona, España
| | - María Antonia Arbós Vía
- Grupo de Investigación de Cirugía General y Digestiva, Pared Abdominal, Biomateriales, Institut de Recerca Vall d'Hebrón (IRVH), Edificio Collserola; Lab 211A, Barcelona, España
| | - Xavier Feliu
- Servicio de Cirugía General, Hospital General d'Igualada, Igualada, Barcelona, España
| | - Salvador Morales-Conde
- Unidad de Innovación en Cirugía Mínimamente Invasiva, Hospital Universitario Virgen del Rocío, Sevilla, España
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