Ileostomy Site Research Articles

The rate of ileostomy site incisional hernias: more common than we think?

Incisional hernias (IH) rates after diverting loop ileostomy reversal (DLI-R) have been reported up to 24%. We aimed to characterize the incidence rate and risk factors associated with DLI-R site IH formation within 1-year in a large patient cohort. A retrospective review at a single quaternary referral center hospital of adult patients who underwent DLI-R over a 5-year period and abdominal computerized tomography (CT) imaging performed within 1-year for any indication postoperatively was conducted. All CTs scans were independently reviewed by staff surgeons to determine the presence of a fascial defect at the DLI-R site. 2,196 patients underwent DLI-R; of these, 569 (25.9%) underwent CT imaging for any indication. Mean patient age, 54.8 (± 14.9), BMI 27.6kg/m2. 87 (15%) patients had a parastomal hernia at time of DLI-R. After median follow-up of 10 months, 203 patients (35.7%) had IH at the DLI-R site. Age (p = 0.14), sex (p = 0.39), race (p = 0.75), and smoking status (p = 0.82) weren't associated with IH after DLI-R. Comorbidities weren't significantly associated with IH following DLI-R. In univariate analysis, increased BMI (p < 0.001), presence of a parastomal hernia (p = 0.008), and suture type (p = 0.01) were associated with IH development. On multivariate analysis, BMI remained significant, and polyglyconate compared to polydioxanone suture were associated with higher rates of IH (p < 0.001). We observed that the rate of incisional hernias within 1-year of diverting ileostomy reversal was indeed common at 36%. Granted, a high percentage of the population was excluded due to heterogeneity in radiographic evaluation that could be mitigated in future prospective studies. Our study suggests that IH preventative strategies include weight loss for overweight and obese patients prior to DLI-R and that the optimal suture for DLI-R is polydioxanone.

Comparison of purse-string technique vs linear suture for skin closure after ileostomy reversal. A randomized controlled trial.

Protective stoma after rectal surgery has been associated with important complications. The most common is surgical site infection (SSI) high rates after stoma reversal reported in literature. Our study compared the rate of SSI of two skin closure techniques, linear closure, and purse string closure. We carried out a single center, prospective, randomized controlled trial in the Department of Colorectal Surgery of Fondazione Policlinico Campus Bio-Medico of Rome between January 2018 through December 2021, to compare LC vs PS closure of ileostomy sites. A total of 117 patients (53.84% male) with a mean age of 65.68 ± 14.33years were finally evaluated in the study. 58 patients were included in the PS group and 59 patients in the LC one. There was a marked difference in the SSI rate between the two arms of the study: 3 of 58 patients in the purse-string arm versus 11 of 59 in the control arm (p = 0.043). The outcome of cosmesis was also higher in PS, with a statistical significance (mean ± DS 4,01 ± 0,73 for PS group vs mean ± DS 2,38 ± 0,72 for LC group, p < 0,001). Our study demonstrated that the PS technique had a significantly lower incidence of stoma site SSI compared with LC technique. Our findings are in line with other randomized studies and suggest that PS closure could be considered as standard of care for wound closure after ileostomy reversal.

A propensity score matching investigation of short-term results of single-incision laparoscopic low anterior rectal resection via ileostomy site.

The study was performed to verify the results of single-incision laparoscopic surgery (SILS) through the ileostomy site for low rectal cancer compared with conventional laparoscopic surgery (CLS). From January 2019 to November 2021, 133 patients with low rectal cancer underwent single-incision (n = 27) or conventional (n = 106) methods of low anterior rectal resection surgery with ileostomy. All patients were balanced by propensity score matching for basic information in a ratio of 1:2, resulting in 27 and 54 in SILS and CLS groups, respectively. Relative to the CLS group, the SILS group exhibited fewer leucocyte changes, shorter time to first exhaust and first bowel sounds, shorter length of hospital stay and lower Visual Analogue Score on post-operative days (POD2) and POD3. Intraoperative or post-operative complications or readmissions were comparable between the two groups. The oncologic results remained consistent between the two groups other than the number of lymph nodes dissected in group no. 253. Single-incision laparoscopic low rectal resection surgery through the ileostomy site has advantages in terms of reduced post-operative pain, shorter post-operative exhaust time and length of hospital stay while also achieving oncologic outcomes similar to those of conventional laparoscopy. It can be an alternative procedure for patients with low rectal cancer who require ileostomy.

Primary Adenocarcinoma at Ileostomy—A Rare Late Complication: Three Cases and Literature Review

Introduction Primary adenocarcinoma at the ileostomy site is a rare complication, with only 57 cases reported in the literature. The primary diagnosis is usually ulcerative colitis (UC) or familial adenomatous polyposis (FAP). Cases We present 3 cases of adenocarcinoma at the ileostomy site. Two of our 3 cases have a previous diagnosis of cancer, with no previous diagnosis of UC or FAP. Discussion Adenocarcinoma at ileostomy is a rare late complication of permanent ileostomy. Possible etiologies are chronic irritation and changes in bacterial flora that lead to metaplasia and cancer development. Conclusion Adenocarcinoma at the ileostomy site is a rare complication with good prognosis if detected early. Diagnosis is by biopsy, and treatment is surgical. A biopsy should be considered in any abnormal growth around the ileostomy.

S374 Endoscopic Coiling of Mesenteric Varices Causing Stomal Bleeding Caused by Extensive Portal Vein and Superior Mesenteric Thrombus

Introduction: Ectopic varices are collateral vessels located outside the gastro-esophageal area. Small bowel varices, while an uncommon result of portal hypertension can be a life-threatening cause of gastrointestinal bleeding. We present a case of refractory stomal bleeding secondary to mesenteric varices, treated with endoscopic ultrasound (EUS) guided coiling. Case Description/Methods: A 54-year-old male presented with history of ulcerative colitis status post proctocolectomy and ileostomy, primary sclerosing cholangitis (PSC), and auto-immune hepatitis (AIH) overlap syndrome treated with a deceased donor liver transplant in 2019. This was further complicated by portal hypertension secondary to portal vein and superior mesenteric vein thrombus. The patient presented with refractory stomal bleeding at this ileostomy site requiring multiple blood transfusions. On CT imaging, prominent mesenteric varices extending to the area of the stoma were noted. An interventional radiology (IR) approach from the portal system was not feasible given thrombosis in the portal vein and superior mesenteric vein. Percutaneous IR approach was also felt to be suboptimal given the depth of the peri-stomal varices. After a multidisciplinary discussion, the patient underwent ileoscopy with EUS guided coiling of the terminal/culprit branches of the mesenteric varices. The linear echoendoscope was introduced through the ileostomy and advanced approximately 5-10cm. Multiple tubal anechoic structures consistent with varices were noted with flow seen on doppler examination. This was confirmed on pulse wave doppler. A large feeding variceal vein towards the patient’s left side was punctured with a 22G needle. Saline was injected and it was visualized on EUS to confirm location. Next, embolization coils (8mm x 2, 10mm x1) were inserted for varix eradication. Reduced flow downstream of the coiling site was confirmed on doppler exam after embolization. Brief fluoroscopic images showed appropriate placement of coils in the patients right lower quadrant, without any migration. There was no significant flow toward the lumen on EUS after coiling. Since this procedure, the patient’s stomal bleeding resolved. (Figure) Discussion: Small bowel varices in the setting of significant portal hypertension are a rare but clinically significant cause of gastrointestinal bleeding. EUS-guided interventions such as coil embolization can be an effective treatment modality, especially in patients who are poor interventional radiology candidates. Watch the video at https://tinyurl.com/ACGAbstractS374Figure 1.: (1a) Prominent mesenteric varices extending into the ostomy (1b) EUS-guided coil embolization (1c) Status post successful endoscopic coil embolization

Hirschsprung’s disease and associated syndrome and malformation -A report of four cases.

Background: Hirschsprung’s disease is a genetic disorder characterized by the absence of ganglion cells in different lengths of the intestine. It is one of the common causes of intestinal obstruction in neonates.&#x0D; Materials and Methods: The study was carried out from January 2017 to January 2020 in the Department of Pathology in a Tertiary care hospital. The biopsy specimens from spastic segment and colostomy or ileostomy sites were sent for evaluation of ganglion cells. &#x0D; Results: During carrying out the study we came across two cases of biopsy that proved Hirschsprung’s disease who manifested the various signs and symptoms associated with two different syndromes and one malformation and one associated neoplasm&#x0D; Conclusion: Two different syndromes and one associated malformation and neoplasm were detected in patients of Hirschsprung’s disease during a 3-year study.&#x0D; Keywords: Hirschsprung's disease, ganglion cell, hypertrophic nerve fiber, malformation, neoplasm, syndrome.

Diagnosis and Treatment Difficulty in Early-Onset Peristomal Pyoderma Gangrenosum Associated With Ulcerative Colitis: A Case Report

Peristomal pyoderma gangrenosum (PPG) is a rare dermatological condition associated with gastroenterological disease. Most gastrointestinal surgeons find it difficult to suspect and treat PPG, especially at early onset. The patient was an 18-year-old female. The patient underwent three-stage restorative proctocolectomy for refractory ulcerative colitis. On postoperative day (POD) 9, the trocar wound near the ileostomy site dehisced. Because the wound culture was positive, the wound was treated with an antibacterial agent as an infection. However, the wound worsened. The patient was referred to a dermatologist for diagnosis. PPG was diagnosed on POD 37. Wound management was initiated using topical steroids. The wound caused difficulties in pain and dressing management. Although infliximab was administered as a systemic therapy, it was discontinued because of allergic symptoms. Sealing therapy with hydrofiber dressing and adequate stoma pouching with stoma paste provided good exudate absorption and a clean environment by protecting the wound from stoma excretion. Oral prednisone was initiated on POD 82. Improvement in the wound condition was observed with a prednisone dose of 30 mg/day. Complete remission was achieved seven months after onset. Twelve months after the surgery, stoma closure was performed. The local cutaneous condition remained in remission without exacerbation. Suspicion of PPG can be difficult when it develops early after stoma creation. We never forget that PPG should be suspected when a progressive ulcerative lesion is found around the stoma, even early after operation. If PPG is suspected, a multidisciplinary team plays an essential role in its diagnosis and management.

A systematic review of primary ileostomy site malignancies.

This paper aimed to elucidate the etiologies of all primary ileostomy site malignancies published in the literature. A review of the literature was conducted following PRISMA guidelines by querying PubMed, Global Health, and Web of Science for articles published before November 2020. Search criteria contained broad terminology for ileostomy site neoplasms without language, date, or publication limitations. A full-text review of the abstracts confirmed primary malignant pathologies and was evaluated for study inclusion. Literature search discovered 858 publications, with 76 meeting eligibility criteria. The final sample contained 91 patients, with equal males and females. The mean age of patients with ileostomy site malignancy was 62.0 ± 12.2, with an average ileostomy age of 29.4 ± 12.4. The most common indications for ileostomy creation were inflammatory bowel disease (IBD) (73.6%) and familial adenomatous polyposis (FAP) (20.9%). There was a total of eight ileostomy malignant pathologies reported, with adenocarcinoma being the most common (76.9%), followed by squamous cell carcinoma (SCC) (11.0%). Adenocarcinoma was diagnosed at a younger age than SCC (59.7 vs. 72.3) and developed over a shorter time (28.8 vs. 37.0). Patients with FAP almost exclusively developed adenocarcinoma (94.4%) at a younger stoma age (25.8 vs. 31.4) than those with IBD who developed seven diverse pathologies. With a median follow-up of 0.75years, four patients developed disease recurrence and received oncologic resection of their cancer less often than the 55 negative patients (p = 0.04). Ileostomy site malignancies are late-appearing complications that require curative surgery. Their presentation is associated with ileostomy duration and creation indication, such as FAP or IBD. We recommend screening at a stoma age ≥ 20 or patient age ≥ 50 for patients with FAP, while stoma age ≥ 25 or patient age ≥ 60 for IBD patients.

Primary mucinous adenocarcinoma at the end ileostomy site with multiple metachronous colorectal cancers

Adenocarcinoma occurring at the end ileostomy site is a rare complication, with 70 cases reported in the literature to date. Most patients with adenocarcinoma occurring at the ileostomy site underwent total proctocolectomy for ulcerative colitis and familial adenomatous polyposis. Here, we present a case of adenocarcinoma arising at the end ileostomy site post total proctocolectomy for colorectal adenocarcinoma.

Effects of anchoring sutures at diverting ileostomy after rectal cancer surgery on peritoneal adhesion at following ileostomy reversal.

PurposeDuring diverting ileostomy reversal for rectal cancer patients who underwent previous sphincter-saving surgery, the extent of adhesion formation around the ileostomy site affects operative and postoperative outcomes. Anchoring sutures placed at the time of the ileostomy procedure may reduce adhesions around the ileostomy. This study aimed to evaluate the effects of anchoring sutures on the degree of adhesion formation and the postoperative course at the time of ileostomy reversal.MethodsPatients who underwent sphincter-saving surgery with diverting ileostomy for rectal cancer between January 2013 and December 2017 were enrolled. Variables including the peritoneal dhesion index (PAI) score, operation time, the length of resected small bowel, operative complications, and postoperative hospital stay were collected prospectively and compared between the anchoring group (AG) and non-anchoring group (NAG).ResultsA total of 90 patients were included in this study, with 60 and 30 patients in the AG and NAG, respectively. The AG had shorter mean operation time (46.88 ± 16.37 minutes vs. 61.53 ± 19.36 minutes, P = 0.001) and lower mean PAI score (3.02 ± 2.53 vs. 5.80 ± 2.60, P = 0.001), compared with the NAG. There was no significant difference in the incidence of postoperative complications between the AG and NAG (5.0% vs. 13.3%, respectively; P = 0.240).ConclusionAnchoring sutures at the formation of a diverting ileostomy could decrease the adhesion score and operation time at ileostomy reversal, thus may be effective in improving perioperative outcomes.

Initial experience with transanal proctectomy in children

BackgroundThe use of transanal proctectomy may have particular advantages for pediatric patients with small pelvic working space. We report short-term outcomes of transanal completion proctectomy (taCP) during surgery for inflammatory bowel disease. MethodsAll patients (age≤19) underwent taCP from January 1, 2018 to December 31, 2019. Prior total abdominal colectomy (TAC) was performed using a single-incision technique. At operation, patients underwent single-incision laparoscopy with taCP. Patient demographics, pre and perioperative details, and postoperative complications were abstracted. ResultsSeven patients (n = 6) with a median age of 18 years [Range: 13–19] were included in this initial series. All patients had a prior TAC with end-ileostomy with taCP occurring a median of 6 [Range: 3–89] months after TAC. Six of 7 had a diagnosis of ulcerative colitis (UC) while 1 patient had Crohn's colitis. For patients with UC, taCP was part of an ileal pouch-anal anastomosis with the majority (n = 4) proceeding as a modified-two stage and the remaining (n = 2) a three-stage approach. Single-incision laparoscopy through the prior ileostomy site was used in all IPAA patients. Median operative time was 226 [Range: 150–264] minutes with no conversions to more invasive technique. Median hospital length of stay (LOS) was 5 [Range: 2–8] days.In-hospital complications occurred in two patients who had watery diarrhea that prolonged LOS but resolved postdischarge. One patient was readmitted for bowel obstruction that resolved with placement of red rubber catheter at the ileostomy site.Of the 4 patients with a functioning ileal pouch, 1 patient reported 6–10 bowel movements per day, while 3 others reported ≤5 bowel movements per day. Half (n = 2) reported 1–2 nocturnal bowel movements at their first postoperative visit. No patients reported soiling or leakage, though one patient had a single episode of incontinence. ConclusionIn this pilot series, transanal proctectomy was effective and safe. Future work should compare traditional MIS completion proctectomy to taCP for applications in pediatric inflammatory bowel disease. Type of study: Case series. Level of Evidence: IV.

A Randomized Controlled Study on Patients Who Underwent Ileostomy Closure with Mesh Reinforcement and its Value in Prevention of Closure Site Incisional Hernia

Abstract Background: Stomal site incisional hernia is often an underestimated complication following ileostomy closure, with rates about 40%. This was because there were no sufficient previous studies undergone to find a definite solution for it. Therefore, various preventive methods was studied to reduce the incidence of post-ileostomy closure incisional hernia. One of these methods was the usage of prophylactic mesh rein-forcement (using a mesh manufactured from approximately equal parts of absorbable poliglecaprone monofilament fiber and non-absorbable polypropylene monofilament fiber) during ileostomy closure and study its role in prevention of stomal site incisional hernia without increasing the incidence of wound complications. Aim of Study: Evaluation of the role of prophylactic mesh reinforcement during closure of ileostomy in prevention of stomal site incisional hernia. Patients and Methods: This was a retrospective study, included 30 Egyptian patients presenting for ileostomy closure. Half of them were control and the other half applied mesh at ileostomy site during closure. Patients of the two groups underwent ileostomy closure between February 2016 and March 2018 and then they had been assessed in the following two years for the occurrence of post-operative incisional hernias. Results: Regarding the incidence of incisional hernia, 9 out of 30 patients (30%) in the current study developed incisional hernias. In group B (without mesh reinforcement) 7 patients (46.7%) developed incisional hernias, while in group A (with mesh reinforcement) 2 patients (13.3%) devel-oped incisional hernias. Although there was trend for devel-oping incisional hernia in patients without mesh reinforcement and the study shows significant result of incisional hernia reduction with mesh reinforcement during the first six months after closure (p=0.0421), prophylactic mesh repair did not significantly reduce that incidence in the total follow-up period of the two years (p=0.1086). Conclusion: We have concluded that the study shows significant result of incisional hernia reduction with mesh reinforcement during the first six months after closure. However, in the total follow-up period of the two years prophylactic mesh repair did not significantly reduce post-ileostomy closure incidence of incisional hernia, without significantly increasing the incidence of wound infection.

Primary Neuroendocrine Tumor of the Ileostomy Stoma on 68Ga-DOTATATE PET/CT

A 75-year-old man presented with bleeding ileostomy stoma 20 years after total colectomy and end ileostomy for chronic ulcerative colitis. On physical examination, the stoma was mass-like and firm with friable mucosa. Wedge biopsy of the ileostomy stoma revealed well-differentiated neuroendocrine tumor (intermediate grade). Ga-DOTATATE PET/CT showed mass-like focal radiotracer uptake at the ileostomy site without radiotracer-avid lymphadenopathy or distant metastatic disease. No additional sites of neoplasm in the gastrointestinal tract were further identified by endoscopy. The diagnosis of isolated primary neuroendocrine tumor of the ileostomy stoma was confirmed, an extremely rare entity.

Predictors of hernia after loop ileostomy closure: a single-center retrospective review.

Our aims were to determine the rate of incisional hernia after closure of a loop ileostomy (LI) and to identify any perioperative risk factors that may be associated with hernia development. We performed an IRB-approved retrospective review that included consecutive patients who underwent LI closure from January 1, 2012, to December 31, 2014. The primary outcome was identification of hernia on physical exam or by abdominal imaging. A stepwise logistic regression analysis was used to determine predictors of ileostomy site hernia. A total of 243 consecutive patients had LI closure during the study timeframe. The overall rate of hernia formation was 11.9% (29/243). The median time to discovery of the hernia was 16.4 (range, 2.2-55.9) months with a median follow-up time of 49 months. Although LI performed in conjunction with sigmoidectomy for diverticulitis consisted of only 19% of ileostomy cases, 62% of hernias were (18/29) identified in this cohort. Rates of hernia formation increased with respect to body mass index (underweight 0%; normal 4.6%; overweight 13.8%; obese 21%). The multivariable model identified increased BMI (underweight/normal weight versus overweight: OR 4.13, 95% CI 1.06-16.04; underweight/normal weight versus obese: OR 8.74, 95% CI 2.17-35.23) and surgical indication (reference variable: diverticulitis; rectal cancer: OR 0.21, 95% CI 0.06-0.76; Crohn's/ulcerative colitis: OR 0.06, 95% CI 0.01-0.53; other: OR 0.15, 95% CI 0.04-0.64) as significant predictors of ileostomy site hernia. The development of a hernia at the site of LI closure was influenced mostly by BMI, surgical indication, and operative time.

A Rare Lesion at the Ileostomy Site of a Patient With Intestinal Behçet's Disease

Question: The patient is a 71-year-old woman who was diagnosed with intestinal Behçet's disease at the age of 41 and underwent loop ileostomy for intractable ulcer and ileal enterocutaneous fistula at the age of 57. After surgery, she consumed steroids for >10 years and became steroid dependent. Adalimumab was introduced at the age of 68, and the steroid dose was successfully decreased from 20 mg/d before adalimumab administration to 2.5 mg/d, after which the patient’s course was uneventful for a while.

Thoughtful Ileostomy Creation in Patients Undergoing Redo IPAA.

Redo IPAA is a viable option to maintain intestinal continuity in patients with ileal pouch failure. Most patients with ileal pouch failure are physiologically and psychologically too deconditioned to undergo a 1- or 2-stage redo ileal pouch surgery, so a 3-staged redo ileal pouch surgery is needed. This consists of an initial proximal diverting loop ileostomy for 6 months, followed by redo ileal pouch construction with temporary stoma, and, lastly, stoma closure. The location of the initial diverting ileostomy is paramount, because 40% of cases will require pouch excision and construction of a de novo pouch, and a thoughtfully placed ileostomy will allow construction of a redo pouch without sacrificing any bowel length. In our report, we described our technique to create thoughtful ileostomy in patients who undergo redo IPAA. We create a loop ileostomy ≈20 cm proximal to the existing ileal pouch, from the level of the tip of the J or the proximal inlet of an S-pouch. We call this a thoughtful ileostomy. By doing that, the thoughtful ileostomy site can be used as the apex of the new ileal pouch and become the ileal-anal anastomosis when a de novo ileal pouch needs to be constructed. We created a thoughtful ileostomy in 50 patients in the Inflammatory Bowel Disease Center at New York University Langone Health who either subsequently underwent or will undergo a redo IPAA between September 2016 and March 2019 (laparoscopic, n = 37; open, n = 13). Ten of the laparoscopic cases were preemptively converted to open because of dense adhesions. A thoughtful ileostomy is important so as to not sacrifice bowel in patients being prepared for redo ileal pouch surgery. Initial diversion with thoughtful ileostomy 6 months before redo ileal pouch construction also allows patients to be prepared for a major operation both physiologically and psychologically.

A Case of Surgically Resected Ileal Cancer Developing at the Ileostomy Site 23 Years after Total Colectomy in a Patient with Familial Adenomatous Polyposis

A Case of Surgically Resected Ileal Cancer Developing at the Ileostomy Site 23 Years after Total Colectomy in a Patient with Familial Adenomatous Polyposis

2046 Peristomal B-Cell Lymphoma in a Patient With Complicated Ulcerative Colitis

INTRODUCTION: Ulcerative colitis (UC) is an inflammatory disease that predominantly involves the colon and rectum often requiring treatment with corticosteroids and immunomodulators. However chronic use of immunomodulators is usually associated with increased risk for lymphoma. Extranodal involvement of GI tract is typically seen however primary GI lymphoma is very rare. Here we present a unique case of B-cell lymphoma diagnosed from stomal biopsies. CASE DESCRIPTION/METHODS: A 76-year-old caucasian male with history of Ulcerative Colitis for almost 28 years, status post multiple abdominal surgeries including ventral hernia repair, ileostomy and colostomy presented with ongoing stoma complications for about 6 months. These complications included new fistula formation around the colostomy and ileostomy sites. Despite aggressive wound care, lesions did not regress, and continued to grow producing sharp, burning type of pain. There was ongoing purulent discharge from new fistula formation. Peri-ostomal biopsy from both ileostomy and colostomy was positive for B-cell lymphoma. On further history, patient endorsed fever, night sweats, and 30-lb weight loss over 5 months. PET scan showed increased uptake in both the stomas as well as liver. Chemotherapy options were discussed with Oncology, however patient opted for hospice as the prognosis was deemed poor. DISCUSSION: Primary GI lymphoma is common in stomach. Small intestine and colonic lymphoma account for 9% and 1% respectively. There have been multiple reports published citing association of lymphoma in IBD patients treated with immunomodulators. Our patient had two stomas (ileostomy and colostomy). Both periostomal biopsies were positive for B cell lymphoma. Periostomal lymphoma has been rarely reported. Parnesh et al (Case 1) reported a similar case of stomal lymphoma in a patient with history of Ulcerative Colitis. Levecq et al (Case 2) reported a stromal lymphoma in a patient with transfusion related AIDS who underwent total colectomy and ileostomy for indeterminate colitis. The lymphoma was diagnosed at 20 years (Case 1) and 2 years (Case 2) post stoma formation. Lymphoma should be in the differential of stoma being complicated by peristomal tissue proliferation, fistula and infection.

Incidence and risk factors for incisional hernia after temporary loop ileostomy closure: choosing candidates for prophylactic mesh placement.

The primary aim of this study was to identify the incisional hernia rate after temporary loop ileostomy closure. Secondary outcomes were determining the risk factors linked to this incisional hernia, which could improve the patient selection for mesh prophylaxis. Retrospective cohort study of all consecutive patients with temporary loopileostomy reversal through a peristomal incision from 1st January 2011 to 1st January 2017 at our centre. Data were extracted from electronic clinical records: baseline patient characteristics, surgical factors and postoperative events. CT scans performed during follow-up were precisely analysed. Survival analysis was applied to identify risk factors for hernia development. 129 patients were analysed of whom 15 (11.6%) developed an incisional hernia at previous ileostomy site. The median time for incisional hernia development was 11months (IQR = 7-21) and the median follow-up time was 37months (IQR = 22-57). The identified patient risk factors for hernia development in survival analysis were female sex, older age, higher Body Mass Index, clinically significant parastomal hernia, clinically detectable midline incisional hernia and major postoperative complications ranked as Clavien-Dindo gradeIIIandIV. Incisional hernia after temporary loop ileostomy is a relevant problem that affects at least one in every ten patients. The previously cited risk factors might favour its development, therefore the use of a prophylactic mesh should be considered in those high-risk patients.

Robotic transanal total mesorectal excision assisted by laparoscopic transabdominal approach: A preliminary twenty-case series report

Laparoscopy-assisted robotic transanal total mesorectal excision is a novel surgical technique for rectal cancer resection. Compared to prior DaVinci Si system case series, this case series is the first to report robotic taTME assisted by laparoscopy (r-taTME) in which the "transanal team" operates via the DaVinci Xi system. As a result, we aim to delineate and discuss preliminary findings from our robotic taTME experiences. A total of twenty patients (twelve males) who underwent robotic taTME assisted by laparoscopy (r-taTME) between January 2016 and November 2016at a single institution were documented. Surgical outcomes, including complications, pathological outcomes, and short-term results, were then retrospectively analyzed. All patients underwent r-taTME via a two-team approach. The "abdominal team" operated via a single port method (ileostomy site), while the "transanal team" operated via the DaVinci Xi system. The mean patient age was 56.7±14.3 years (range 31-79), and the mean distance from tumor to anal verge was 6.0±2.7cm (range 2-10). The mean estimated intraoperative blood loss was 88±107ml (range 30-500), and circular stapling was utilized to restore continuity in 80% of study patients. The overall postoperative complication rate was 35%, and the mean distal margin length was 3.1±1.3cm. There were three patients who had a circumferential margin (CRM) involved by cancer cells (≤1mm). Our preliminary series report demonstrates that utilization of r-taTME assisted by laparoscopy is safe and feasible. Development of a novel transanal approach that allows single-port access alongside a multi-arm robotic system may increase the convenience and efficiency of future operation.