Laparoscopic Loop Ileostomy Reversal, Reducing Morbidity While Improving Functional Outcomes

Morris E Franklin, Jr, MD FACS, Karla Russek, MD, Jojy George, MD, Pedro Cuevas, MD. Texas Endosurgery Institute

Introduction: Loop ileostomy reduces the morbidity associated with pelvic sepsis. However its reversal carries a 10 to 30% complication rate. We present our technique for laparoscopic ileostomy closure.
Methods: We conducted a retrospective chart review of subjects undergoing laparoscopic loop ileostomy closure between 2006 and 2010. Operating time, length of hospital stay, return of bowel function, and complication rates were assessed.
Results: There were 64 (33 males) patients. Average age was 63 with a BMI of 32.6. 117 (75%) had a planned loop ileostomy and 39 (25%) were emergent. Average time to reversal was 135 days. Average length of surgery was 79 minutes (48-186), average hospital stay was 4 days and return to bowel function was 3.6 days. We had no wound infections. Our complication rate was 19% (n=29) and reoperation rate 8% (n=12). There was only one major complication, an anastomotic dehiscence.
Conclusion: A thorough well visualized lysis of adhesions and mobilization of the stoma and surrounding small bowel is the main advantage of our approach. We had no wound infections and no reoperation for bowel obstruction, which we feel is a direct advantage of our technique. Our complication rate, and surgical time are comparable to open technique.