Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Giglio MC, Persico M, Quarto G, Benassai G, Luglio G, Tarquini R, Celentano V, Sollazzo V, Bucci L (2013) Intersphinteric resection for rectal cancer: role in fecal continence and quality of life. Ann Ital Chir 84:287–290

    PubMed  Google Scholar 

  2. De Palma GD, Luglio G (2015) Quality of life in rectal cancer surgery: what do the patient ask? World J Gastrointest Surg 7:349–355

    Article  PubMed  PubMed Central  Google Scholar 

  3. Karanjia ND, Corder AP, Holdsworth PJ, Heald RJ (1991) Risk of peritonitis and fatal septicaemia and the need to defunction the low anastomosis. Br J Surg 78:196–198

    Article  CAS  PubMed  Google Scholar 

  4. Hallböök O, Sjödahl R (1996) Anastomotic leakage and functional outcome after anterior resection of the rectum. Br J Surg 83:60–62

    Article  PubMed  Google Scholar 

  5. Leichtle SW, Mouawad NJ, Welch KB, Lampman RM, Cleary RK (2012) Risk factors for anastomotic leakage after colectomy. Dis Colon rectum 55:569–575

  6. Biondo S, Parés D, Kreisler E, Ragué JM, Fraccalvieri D, Ruiz AG, Jaurrieta E (2005) Anastomotic dehiscence after resection and primary anastomosis in left-sided colonic emergencies. Dis Colon rectum 48:2272–2280

  7. Choi HK, Law WL, Ho JWC (2006) Leakage after resection and intraperitoneal anastomosis for colorectal malignancy: analysis of risk factors. Dis Colon rectum 49:1719–1725

  8. Konishi T, Watanabe T, Kishimoto J, Nagawa H (2006) Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg 202:439–444

    Article  PubMed  Google Scholar 

  9. Boccola MA, Buettner PG, Rozen WM, Siu SK, Stevenson ARL, Stitz R, Ho Y-H (2010) Risk factors and outcomes for anastomotic leakage in colorectal surgery: a single-institution analysis of 1576 patients. World J Surg 35:186–195

    Article  Google Scholar 

  10. Milone M, Elmore U, Di Salvo E, Delrio P, Bucci L, Ferulano GP, Napolitano C, Angiolini MR, Bracale U, Clemente M, D’ambra M, Luglio G, Musella M, Pace U, Rosati R, Milone F (2015) Intracorporeal versus extracorporeal anastomosis. Results from a multicentre comparative study on 512 right-sided colorectal cancers. Surg Endosc 29:2314–2320

    Article  PubMed  Google Scholar 

  11. Dwivedi A, Chahin F, Agrawal S, Chau WY, Tootla A, Tootla F, Silva YJ (2002) Laparoscopic colectomy vs. open colectomy for sigmoid diverticular disease. Dis Colon rectum 45:1309–1314 discussion 1314–5

  12. Levack M, Berger D, Sylla P, Rattner D, Bordeianou L (2011) Laparoscopy decreases anastomotic leak rate in sigmoid colectomy for diverticulitis. Arch Surg 146:207–210

    Article  PubMed  Google Scholar 

  13. Lipska MA, Bissett IP, Parry BR, Merrie AEH (2006) Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg 76:579–585

    Article  PubMed  Google Scholar 

  14. Hellan M, Anderson C, Pigazzi A Extracorporeal versus intracorporeal anastomosis for laparoscopic right hemicolectomy. JSLS 13:312–317

  15. Hsu T-C (2005) Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon. Am J Surg 189:384–387

    Article  PubMed  Google Scholar 

  16. Richardson DL, Mariani A, Cliby WA (2006) Risk factors for anastomotic leak after recto-sigmoid resection for ovarian cancer. Gynecol Oncol 103:667–672

    Article  PubMed  Google Scholar 

  17. Tsikitis VL, Holubar SD, Dozois EJ, Cima RR, Pemberton JH, Larson DW (2010) Advantages of fast-track recovery after laparoscopic right hemicolectomy for colon cancer. Surg Endosc 24:1911–1916

    Article  PubMed  Google Scholar 

  18. Sugerman HJ, Sugerman EL, Meador JG, Newsome HH, Kellum JM, DeMaria EJ (2000) Ileal pouch anal anastomosis without ileal diversion. Ann Surg 232:530–541

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Karanjia ND, Corder AP, Bearn P, Heald RJ (1994) Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg 81:1224–1226

    Article  CAS  PubMed  Google Scholar 

  20. Graf W, Glimelius B, Bergström R, Påhlman L (1991) Complications after double and single stapling in rectal surgery. Eur J Surg 157:543–547

    CAS  PubMed  Google Scholar 

  21. Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, Strong SA, Oakley JR (1997) Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 185:105–113

    Article  CAS  PubMed  Google Scholar 

  22. Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358

    Article  CAS  PubMed  Google Scholar 

  23. Averbach AM, Chang D, Koslowe P, Sugarbaker PH (1996) Anastomotic leak after double-stapled low colorectal resection. Dis Colon rectum 39:780–787

  24. Wong K-S, Remzi FH, Gorgun E, Arrigain S, Church JM, Preen M, Fazio VW (2005) Loop ileostomy closure after restorative proctocolectomy: outcome in 1,504 patients. Dis Colon rectum 48:243–250

  25. Perez RO, Habr-Gama A, Seid VE, Proscurshim I, Sousa AH, Kiss DR, Linhares M, Sapucahy M, Gama-Rodrigues J (2006) Loop ileostomy morbidity: timing of closure matters. Dis Colon rectum 49:1539–1545

  26. Sharma A, Deeb A-PP, Rickles AS, Iannuzzi JC, Monson JRT, Fleming FJ (2013) Closure of defunctioning loop ileostomy is associated with considerable morbidity. Color Dis 15:458–462

    Article  CAS  Google Scholar 

  27. Pokorny H, Herkner H, Jakesz R, Herbst F (2005) Mortality and complications after stoma closure. Arch Surg 140:956–960 discussion 960

    Article  PubMed  Google Scholar 

  28. Thalheimer A, Bueter M, Kortuem M, Thiede A, Meyer D (2006) Morbidity of temporary loop ileostomy in patients with colorectal cancer. Dis Colon rectum 49:1011–1017

  29. Mowschenson PM, Critchlow JF, Peppercorn MA (2000) Ileoanal pouch operation: long-term outcome with or without diverting ileostomy. Arch Surg 135:463–465 discussion 465–6

    Article  CAS  PubMed  Google Scholar 

  30. Wong NY, Eu KW (2005) A defunctioning ileostomy does not prevent clinical anastomotic leak after a low anterior resection: a prospective, comparative study. Dis Colon rectum 48:2076–2079

  31. Ikeuchi H, Nakano H, Uchino M, Nakamura M, Noda M, Yanagi H, Yamamura T (2005) Safety of one-stage restorative proctocolectomy for ulcerative colitis. Dis Colon rectum 48:1550–1555

  32. Remzi FH, Fazio VW, Gorgun E, Ooi BS, Hammel J, Preen M, Church JM, Madbouly K, Lavery IC (2006) The outcome after restorative proctocolectomy with or without defunctioning ileostomy. Dis Colon rectum 49:470–477

  33. Löffler T, Rossion I, Bruckner T, Diener MK, Koch M, von Frankenberg M, Pochhammer J, Thomusch O, Kijak T, Simon T, Mihaljevic AL, Krüger M, Stein E, Prechtl G, Hodina R, Michal W, Strunk R, Henkel K, Bunse J, Jaschke G, Politt D, Heistermann HP, Fuer M, Lange C, Stamm A, Vosschulte A, Holzer R, Partecke LI, Burdzik E, Hug HM, et al. (2012) HAnd suture versus STApling for closure of loop ileostomy (HASTA trial. Ann Surg 256:828–836

    Article  PubMed  Google Scholar 

  34. Luglio G, Pendlimari R, Holubar SD, Cima RR, Nelson H (2011) Loop ileostomy reversal after colon and rectal surgery: a single institutional 5-year experience in 944 patients. Arch Surg 146:1191–1196

    Article  PubMed  Google Scholar 

  35. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  36. Marusch F, Koch A, Schmidt U, Geibetaler S, Dralle H, Saeger H-D, Wolff S, Nestler G, Pross M, Gastinger I, Lippert H (2002) Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon rectum 45:1164–1171

  37. Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H (2005) Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 92:1137–1142

    Article  CAS  PubMed  Google Scholar 

  38. Shogan BD, Carlisle EM, Alverdy JC, Umanskiy K (2013) Do We really know why colorectal anastomoses leak? J Gastrointest Surg 17:1698–1707

    Article  PubMed  Google Scholar 

  39. Haga Y, Wada Y, Takeuchi H, Ikejiri K, Ikenaga M (2011) Prediction of anastomotic leak and its prognosis in digestive surgery. World J Surg 35:716–722

    Article  PubMed  Google Scholar 

  40. Hüser N, Michalski CW, Erkan M, Schuster T, Rosenberg R, Kleeff J, Friess H (2008) Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 248:52–60

    Article  PubMed  Google Scholar 

  41. Flikier-Zelkowicz B, Codina-Cazador A, Farrés-Coll R, Olivet-Pujol F, Martín-Grillo A, Pujadas-de Palol M (2008) Morbidity and mortality associated with diverting ileostomy closures in rectal cancer surgery. Cirugía española 84:16–19

    Article  PubMed  Google Scholar 

  42. Courtier R, Parés D, Silva CA, Gil MJ, Pascual M, Alonso S, Pera M, Grande L (2010) Clinical results of loop ileostomy closures in rectal cancer surgical patients. Effect of chemotherapy in the waiting period. Cirugía española 88:308–313

    Article  PubMed  Google Scholar 

  43. Mengual-Ballester M, García-Marín JA, Pellicer-Franco E, Guillén-Paredes MP, García-García ML, Cases-Baldó MJ, Aguayo-Albasini JL (2012) Protective ileostomy: complications and mortality associated with its closure. Rev Española Enfermedades Dig 104:350–354

    Article  Google Scholar 

  44. Koperna T (2003) Cost-effectiveness of defunctioning stomas in low anterior resections for rectal cancer: a call for benchmarking. Arch Surg 138:1334–1338 discussion 1339

    Article  PubMed  Google Scholar 

  45. Giannakopoulos GF, Veenhof AAFA, van der Peet DL, Sietses C, Meijerink WJHJ, Cuesta MA (2009) Morbidity and complications of protective loop ileostomy. Color Dis 11:609–612

    Article  CAS  Google Scholar 

  46. Löffler T, Rossion I, Gooßen K, Saure D, Weitz J, Ulrich A, Büchler MW, Diener MK (2015) Hand suture versus stapler for closure of loop ileostomy—a systematic review and meta-analysis of randomized controlled trials. Langenbeck’s Arch Surg 400:193–205

    Article  Google Scholar 

  47. Hasegawa H, Radley S, Morton DG, Keighley MR (2000) Stapled versus sutured closure of loop ileostomy: a randomized controlled trial. Ann Surg 231:202–204

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Amin SN, Memon MA, Armitage NC, Scholefield JH (2001) Defunctioning loop ileostomy and stapled side-to-side closure has low morbidity. Ann R Coll Surg Engl 83:246–249

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Suh YJ, Park JW, Kim YS, Park SC, Oh JH (2014) A beneficial effect of purse-string skin closure after ileostomy takedown: a retrospective cohort study. Int J Surg 12:615–620

    Article  PubMed  Google Scholar 

  50. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Medicine and Surgery, University of Naples Federico II—Italy, Via Stellato, 26, 81054, San Prisco, CE, Italy

    Gaetano Luglio

  2. Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Napoli, Italy

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

Authors
  1. Gaetano Luglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Terracciano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mariano Cesare Giglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michele Sacco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto Peltrini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Viviana Sollazzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Emanuela Spadarella
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Cristina Bucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Giovanni Domenico De Palma
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Luigi Bucci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gaetano Luglio.

Ethics declarations

Disclosures

None

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Luglio, G., Terracciano, F., Giglio, M.C. et al. Ileostomy reversal with handsewn techniques. Short-term outcomes in a teaching hospital. Int J Colorectal Dis 32, 113–118 (2017). https://doi.org/10.1007/s00384-016-2645-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-016-2645-z

Keywords

Search

Navigation