Ileostomy reversal with handsewn techniques. Short-term outcomes in a teaching hospital.

Abstract

Fecal diversion is considered an effective procedure to protect bowel anastomosis at high risk for leak. Some concerns exist regarding the risk for a significant morbidity associated to ileostomy creation itself and moreover to its closure. Surgical expertise and closure techniques are considered potential factors influencing morbidity. Aim of the study is to present a single-institution experience with ileostomy closures, in a teaching hospital, whereas ileostomy reversal is mainly performed by young residents. A prospective database was investigated to extract data of patients who underwent loop ileostomy closure between January 2005 and December 2014. Ileostomy reversion was always realized in a handsewn fashion, performing either a direct closure (DC) or a resection plus end-to-end anastomosis (EEA). Postoperative morbidity was graded according to Clavien-Dindo classification. Outcomes after DC and EEA were compared by Fisher's exact test and Wilcoxon rank-sum test. Two hundred ninety-eight patients were included. Ileostomy reversal was performed by EEA in 236 patients (79.19%) and by DC in 62 patients (20.81%). Surgery was performed with a peristomal access in 296 cases (99.33%). Incidence of anastomotic leak was 0.67% (2/298). Overall reoperation rate was 0.34% (1/298). Short-term overall morbidity rate was 20.47%; but major complications (≥ grade III) occurred in only one patient (0.34%). Mortality was nil. No significant differences in postoperative morbidity were found between the DC and EEA group. Loop ileostomy reversal is a safe procedure, associated to a low major morbidity and excellent results, even if performed with a handsewn technique by supervised trainee surgeons.