Monica T Young1, Grace S Hwang2,3, Gopal Menon1, Timothy F Feldmann1, Mehraneh D Jafari1, Fariba Jafari1, Eden Perez1, Alessio Pigazzi4. 1. Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA. 2. Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA. grace.hwang@med.usc.edu. 3. Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA. grace.hwang@med.usc.edu. 4. Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA. apigazzi@uci.edu.
Abstract
BACKGROUND: Ileostomy reversals are commonly performed procedures after colon and rectal operations. Laparoscopic ileostomy reversal (LIR) with lysis of adhesions has potential benefits over conventional open surgery. The aim of this study was to compare outcomes of laparoscopic and open ileostomy reversal. METHODS: 133 consecutive patients undergoing ileostomy reversal at our institution between June 2009 and August 2013 were analyzed using a retrospective database. The group comprised 53 laparoscopic cases and 80 open cases, performed by four surgeons at a single center. The data were analyzed for patient demographics, operative characteristics, postoperative outcomes, and 30-day morbidity and mortality. RESULTS: The two groups had comparable mean age, gender distribution, ASA scores, and BMI. The laparoscopic group had a significantly longer duration of surgery compared to the open reversal group (109 versus 93 min, p < 0.05). However, this group underwent more lysis of adhesions (60.4 % versus 26.3 %, p < 0.01) as well as concurrent stoma site mesh reinforcement (32.1 % versus 6.3 %, p < 0.01). In the laparoscopy group, 20.7 % of patients underwent intra-corporeal ileo-ileal anastomosis. There were no significant differences between the laparoscopic and open groups with regard to estimated blood loss (31 versus 40 ml, respectively) or mean length of stay (5.3 vs. 5.7 days, respectively). The rates of overall 30-day morbidity (16.9 % for laparoscopic vs. 21.3 % for open) as well as rates of specific complications were equivalent between groups. 30-day mortalities were not noted in either group. CONCLUSION: LIR is safe and effective with low perioperative morbidity and mortality. The use of laparoscopy as an option in terms of concomitant hernia repair and lysis of adhesions may be considered in selected patients.
BACKGROUND: Ileostomy reversals are commonly performed procedures after colon and rectal operations. Laparoscopic ileostomy reversal (LIR) with lysis of adhesions has potential benefits over conventional open surgery. The aim of this study was to compare outcomes of laparoscopic and open ileostomy reversal. METHODS: 133 consecutive patients undergoing ileostomy reversal at our institution between June 2009 and August 2013 were analyzed using a retrospective database. The group comprised 53 laparoscopic cases and 80 open cases, performed by four surgeons at a single center. The data were analyzed for patient demographics, operative characteristics, postoperative outcomes, and 30-day morbidity and mortality. RESULTS: The two groups had comparable mean age, gender distribution, ASA scores, and BMI. The laparoscopic group had a significantly longer duration of surgery compared to the open reversal group (109 versus 93 min, p < 0.05). However, this group underwent more lysis of adhesions (60.4 % versus 26.3 %, p < 0.01) as well as concurrent stoma site mesh reinforcement (32.1 % versus 6.3 %, p < 0.01). In the laparoscopy group, 20.7 % of patients underwent intra-corporeal ileo-ileal anastomosis. There were no significant differences between the laparoscopic and open groups with regard to estimated blood loss (31 versus 40 ml, respectively) or mean length of stay (5.3 vs. 5.7 days, respectively). The rates of overall 30-day morbidity (16.9 % for laparoscopic vs. 21.3 % for open) as well as rates of specific complications were equivalent between groups. 30-day mortalities were not noted in either group. CONCLUSION: LIR is safe and effective with low perioperative morbidity and mortality. The use of laparoscopy as an option in terms of concomitant hernia repair and lysis of adhesions may be considered in selected patients.
Authors: Seok In Seo; Chang Sik Yu; Gwon Sik Kim; Jong Lyul Lee; Yong Sik Yoon; Chan Wook Kim; Seok-Byung Lim; Jin Cheon Kim Journal: World J Surg Date: 2013-10 Impact factor: 3.352
Authors: Sarath Sujatha-Bhaskar; Matthew Whealon; Colette S Inaba; Christina Y Koh; Mehraneh D Jafari; Steven Mills; Alessio Pigazzi; Michael J Stamos; Joseph C Carmichael Journal: Surg Endosc Date: 2018-10-25 Impact factor: 4.584