Endoscopy-Assisted Minimally Invasive Loop Ileostomy After Previous Restorative Proctocolectomy

Abstract

Complications after proctocolectomy with ileal pouch-anal anastomosis may impair pouch function. Loop ileostomy can be performed to allow recovery of function before intestinal continuity is restored. To minimize operative trauma and to form the stoma with as little damage to the abdominal wall as possible, the invasiveness of the procedure should be minimized as far as possible. To minimize the extent of surgical invasion, we developed a technical modification of loop ileostomy in which lower endoscopy is used to assist the procedure. The procedure requires only a single incision, which is made at the site of the ileostomy. While the surgeon incises the fascia and peritoneum, the endoscopist advances a flexible endoscope through the pouch to the distal part of the ileum up to approximately 40 cm above the anal verge. The operation lamp is switched off, allowing the surgeon to see the lighted end of the endoscope in a loop of the ileum near the incision. This loop is drawn out through the incision and the stoma is created in a standard manner. Clinical factors such as the presence of adhesions or obesity limit the use of the procedure in certain patients. We believe this technique of endoscopic-assisted loop ileostomy is a safe method for minimizing the invasiveness of surgery in patients who require ileostomy after restorative proctocolectomy.