International Journal of Colorectal Disease

, Volume 20, Issue 4, pp 349–352 | Cite as

Reversal of loop ileostomy under spinal anaesthesia

  • Richard John England
  • Clare Blues
  • Shwan Niazi Amin
Original Article


Background and aims

Traditionally, loop ileostomy is reversed under general anaesthetic. In patients with severe cardiorespiratory disease, many surgeons opt for a one-stage, low Hartmann’s procedure to avoid a second general anaesthetic to reverse a defunctioning stoma. Closure of loop ileostomy under spinal anaesthetic would allow high-risk patients to avoid a permanent stoma and a general anaesthetic.

Patients and methods

Seven patients (6 of whom were men) had reversal of loop ileostomy under spinal anaesthetic. The median age was 63 years (range 43–70). Six patients had significant co-morbidity with a median American Society of Anesthesiologists (ASA) grade of 3. The ileostomy was reversed in a side-to-side fashion using a linear stapler. The small bowel wall was infiltrated with local anaesthetic prior to firing the stapler.

Results and findings

All patients tolerated the procedure without discomfort. Patients started feeding on the first postoperative day. Analgesia requirements postoperatively were minimal. No complications occurred due to the anaesthetic technique.


With careful patient selection, preparation and a gentle and meticulous surgical technique, reversal of loop ileostomy can be achieved under spinal anaesthesia, thereby, saving high-risk patients with low tumours (suitable for sphincter preservation) from having a one-stage resection with permanent stoma.


Loop ileostomy Anterior resection Spinal anaesthetic 


  1. 1.
    Dehni N, Schlegel RD, Cunningham C et al (1998) Influence of a defunctioning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis. Br J Surg 85:1114–1117PubMedGoogle Scholar
  2. 2.
    Moran BJ, Heald RJ (2000) Anastomotic leakage after colorectal anastomosis. Semin Surg Oncol 18:244–248PubMedGoogle Scholar
  3. 3.
    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 81:1224–1226PubMedGoogle Scholar
  4. 4.
    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 78:196–198PubMedGoogle Scholar
  5. 5.
    Rullier E, Laurent C, Garrelon JL et al (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355–358CrossRefPubMedGoogle Scholar
  6. 6.
    O’Leary DP, Fide CJ, Foy C, Lucarotti ME (2001) Quality of life after low anterior resection with total mesorectal excision and temporary loop ileostomy for rectal carcinoma. Br J Surg 88:1216–1220CrossRefPubMedGoogle Scholar
  7. 7.
    Gooszen AW, Geelkerken RH, Hermans J et al (2000) Quality of life with a temporary stoma. Dis Colon Rectum 43:650–655PubMedGoogle Scholar
  8. 8.
    Grabham JA, Moran BJ, Lane RHS (1995) Defunctioning colostomy for low anterior resection: a selective approach. Br J Surg 82:1331–1332PubMedGoogle Scholar
  9. 9.
    Edwards DP, Chisholm EM, Donaldson DR (1998) Closure of transverse loop colostomy and loop ileostomy. Ann R Coll Surg Engl 80:33–35PubMedGoogle Scholar
  10. 10.
    Berry DP, Scholefield JH (1997) Closure of loop ileostomy. Br J Surg 33–35:524PubMedGoogle Scholar
  11. 11.
    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 83:246–249PubMedGoogle Scholar
  12. 12.
    Camilleri-Brennan J, Steele RJC (1998) Quality of life after treatment for rectal cancer. Br J Surg 85:1036–1043PubMedGoogle Scholar
  13. 13.
    Mann LJ, Stewart PJ, Goodwin RJ et al (1991) Complications following closure of loop ileostomy. Aust NZ J Surg 61:493–496Google Scholar
  14. 14.
    Lewis P, Bartolo DCC (1990) Closure of loop ileostomy after restorative proctocolectomy. Ann R Coll Surg Engl 72:263–265PubMedGoogle Scholar
  15. 15.
    Phang PT, Hain JM, Perez-Ramirez JJ et al (1999) Techniques and complications of ileostomy takedown. Am J Surg 177:463–466PubMedGoogle Scholar
  16. 16.
    Chen F, Stuart M (1996) The morbidity of defunctioning stomata. Aust NZ J Surg 66:218–221Google Scholar
  17. 17.
    Hosie KB, Grobler SP, Keighley MRB (1992) Temporary loop ileostomy following restorative proctocolectomy. Br J Surg 79:33–34PubMedGoogle Scholar
  18. 18.
    Moran MR (1997) Same-day surgery ileostomy closure? Am J Manag Care 3:1003–1006PubMedGoogle Scholar
  19. 19.
    Kalady MF, Fields RC, Klein S et al (2003) Loop ileostomy closure at an ambulatory surgery facility. Dis Colon Rectum 46:486–490CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Richard John England
    • 1
  • Clare Blues
    • 1
  • Shwan Niazi Amin
    • 1
  1. 1.Colorectal Surgery UnitNorthern General HospitalSheffieldUK

Personalised recommendations