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Laparoscopic Versus Open Loop Ileostomy Reversal: Is there an Advantage to a Minimally Invasive Approach?

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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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Authors and Affiliations

  1. Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA

    Monica T. Young, Grace S. Hwang, Gopal Menon, Timothy F. Feldmann, Mehraneh D. Jafari, Fariba Jafari, Eden Perez & Alessio Pigazzi

  2. Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA

    Grace S. Hwang

Authors
  1. Monica T. Young
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  2. Grace S. Hwang
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  3. Gopal Menon
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  5. Mehraneh D. Jafari
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  6. Fariba Jafari
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  7. Eden Perez
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Correspondence to Alessio Pigazzi.

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Disclosures

Dr. Pigazzi is a consultant for Intuitive Surgical, Cook, Ethicon, Covidien, and Cubist. He has received consultancy fees and educational grants paid to the Department of Surgery, University of California, Irvine. Dr. Young, Dr. Hwang, Gopal Menon, Dr. Feldmann, Dr. Jafari, Fariba Jafari, and Eden Perez have no disclosures. Dr. Young, Dr. Hwang, and Gopal Menon had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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Young, M.T., Hwang, G.S., Menon, G. et al. Laparoscopic Versus Open Loop Ileostomy Reversal: Is there an Advantage to a Minimally Invasive Approach?. World J Surg 39, 2805–2811 (2015). https://doi.org/10.1007/s00268-015-3186-2

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