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Feasibility of laparoscopic end ileostomy closure after emergency laparotomy for perforated Crohn’s disease

Tamar B Nobel, MD, Philip George, MD, Alexander J Greenstein, MD, MPH. Mount Sinai Hospital

Introduction: End ileostomy reversal in patients with Crohn’s Disease (CD) after emergent laparotomy for perforation is known be high risk procedure. A laparoscopic approach to Hartmann’s colostomy reversal for diverticulitis has been demonstrated to improve postoperative morbidity and decrease hospital length of stay (LOS). There is a paucity of evidence for the feasibility of a laparoscopic approach to end ileostomy reversal in patients with penetrating and/or perforated CD.

Methods and Procedures: A retrospective review of a prospective database was performed to identify patients with penetrating and/or perforated CD who underwent end ileostomy reversal between November 2011 and April 2017. Preoperative demographic data, operative details and postoperative complications were collected from hospital records. Patients who underwent laparoscopic reversal were compared to those treated with an open approach.

Results: There were 10 (37%) open and 17 (63%) laparoscopic end ileostomy reversals performed during the study period. The most common indication for emergent/urgent surgery with end ileostomy formation was perforating CD for both groups. The groups had comparable median body mass index (laparoscopic 22 vs open 21.2; p=0.54) and American Society of Anesthesiology score (2 vs 3; p=0.08). Patients in the laparoscopic group had a lower median age (34 vs 58 years; p=0.02) and longer interval time to ostomy reversal (138 vs 97.5 days; p= 0.01). There was no significant difference in median operative time (150 vs 137 minutes; p= 0.67) or intraoperative blood loss (75 vs 62.5cc; p=0.78). Four patients (23.5%) in the laparoscopic group required conversion to laparotomy. The average LOS was significantly shorter for patients in the laparoscopic group (4.9 vs 12.2 days; p=0.02). No statistically significant difference was seen in complication rates between the two groups (6/17, 35.2% vs 5/10, 50%; p=0.48). One patient in the laparoscopic group was readmitted and one patient in the open group had a reoperation within 30 days.

Conclusions: This study demonstrates that a laparoscopic approach for end ileostomy reversal in perforating CD has a similar complication rate and decreased LOS when compared to an open approach. Despite the technical difficulty associated with reoperation, laparoscopy is a safe and feasible option for closure of end ileostomy and should be the preferred initial approach even in the most severe cases. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 86852

Program Number: P277

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

174

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