BACKGROUND AND AIMS: Traditionally, loop ileostomy is reversed under general anaesthetic. In patients with severe cardiorespiratory disease, many surgeons opt for a one-stage, low Hartmann's procedure to avoid a second general anaesthetic to reverse a defunctioning stoma. Closure of loop ileostomy under spinal anaesthetic would allow high-risk patients to avoid a permanent stoma and a general anaesthetic. PATIENTS AND METHODS: Seven patients (6 of whom were men) had reversal of loop ileostomy under spinal anaesthetic. The median age was 63 years (range 43--70). Six patients had significant co-morbidity with a median American Society of Anesthesiologists (ASA) grade of 3. The ileostomy was reversed in a side-to-side fashion using a linear stapler. The small bowel wall was infiltrated with local anaesthetic prior to firing the stapler. RESULTS AND FINDINGS: All patients tolerated the procedure without discomfort. Patients started feeding on the first postoperative day. Analgesia requirements postoperatively were minimal. No complications occurred due to the anaesthetic technique. CONCLUSION: With careful patient selection, preparation and a gentle and meticulous surgical technique, reversal of loop ileostomy can be achieved under spinal anaesthesia, thereby, saving high-risk patients with low tumours (suitable for sphincter preservation) from having a one-stage resection with permanent stoma.
BACKGROUND AND AIMS: Traditionally, loop ileostomy is reversed under general anaesthetic. In patients with severe cardiorespiratory disease, many surgeons opt for a one-stage, low Hartmann's procedure to avoid a second general anaesthetic to reverse a defunctioning stoma. Closure of loop ileostomy under spinal anaesthetic would allow high-risk patients to avoid a permanent stoma and a general anaesthetic. PATIENTS AND METHODS: Seven patients (6 of whom were men) had reversal of loop ileostomy under spinal anaesthetic. The median age was 63 years (range 43--70). Six patients had significant co-morbidity with a median American Society of Anesthesiologists (ASA) grade of 3. The ileostomy was reversed in a side-to-side fashion using a linear stapler. The small bowel wall was infiltrated with local anaesthetic prior to firing the stapler. RESULTS AND FINDINGS: All patients tolerated the procedure without discomfort. Patients started feeding on the first postoperative day. Analgesia requirements postoperatively were minimal. No complications occurred due to the anaesthetic technique. CONCLUSION: With careful patient selection, preparation and a gentle and meticulous surgical technique, reversal of loop ileostomy can be achieved under spinal anaesthesia, thereby, saving high-risk patients with low tumours (suitable for sphincter preservation) from having a one-stage resection with permanent stoma.
Authors: Thorsten Löffler; Inga Rossion; Käthe Gooßen; Daniel Saure; Jürgen Weitz; Alexis Ulrich; Markus W Büchler; Markus K Diener Journal: Langenbecks Arch Surg Date: 2014-12-25 Impact factor: 3.445