Russek Karla, George Jojy M, Zafar Naveed, Cuevas-Estandia Pedro, Franklin Morris
Texas Endosurgery Institute, San Antonio, TX, USA.
JSLS. 2011 Oct-Dec;15(4):475-9. doi: 10.4293/108680811X13176785203950.
Loop ileostomy reduces the morbidity associated with pelvic sepsis. However, its reversal carries a 10% to 30% complication rate. We present our technique for laparoscopic ileostomy closure.
We conducted a retrospective chart review of subjects undergoing laparoscopic-assisted loop ileostomy closure between 2006 and 2009. Operating time, length of hospital stay, return of bowel function, and complication rates were assessed.
There were 24 (13 males) patients. Average age was 63 with a BMI of 25.9. Eighteen (75%) had a planned loop ileostomy, and 6 (25%) were emergent. Average time to reversal was 135 days. Average length of surgery was 79 minutes (range, 48 to 186), average stay was 4 days and return to bowel function was 3.6 days. We had no wound infections. Our complication rate was 29% (n=7), and reoperation rate was 12.5% (n=3). Only 1 major complication occurred, an anastomotic dehiscence.
A thorough, well-visualized lysis of adhesions and mobilization of the stoma and surrounding small bowel is the main advantage of our approach. We had no wound infections and no reoperation for bowel obstruction, which we feel is a direct advantage of our technique. Our complication rate and surgical time are comparable to those of the open technique.
袢式回肠造口术可降低盆腔感染相关的发病率。然而，其回纳手术的并发症发生率为10%至30%。我们介绍我们的腹腔镜回肠造口关闭术技术。
我们对2006年至2009年间接受腹腔镜辅助袢式回肠造口关闭术的患者进行了回顾性病历审查。评估了手术时间、住院时间、肠功能恢复情况和并发症发生率。
共有24例患者（13例男性）。平均年龄63岁，体重指数为25.9。18例（75%）为计划性袢式回肠造口术，6例（25%）为急诊手术。平均回纳时间为135天。平均手术时长为79分钟（范围48至186分钟），平均住院时间为4天，肠功能恢复时间为3.6天。我们没有伤口感染。我们的并发症发生率为29%（n = 7），再次手术率为12.5%（n = 3）。仅发生1例严重并发症，即吻合口裂开。
充分、清晰地松解粘连以及游离造口和周围小肠是我们手术方法的主要优势。我们没有伤口感染，也没有因肠梗阻而再次手术，我们认为这是我们技术的直接优势。我们的并发症发生率和手术时间与开放手术相当。
