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Purpose: Complications have been reported following loop both sutured and stapled loop ileostomy closure; any association between linear cutting stapler (LCS) length and postoperative complications remains unclear. Therefore, the aim of this study was to compare the outcomes of stapled loop ileostomy closure performed with different LCS lengths.
Methods: Medical records of consecutive patients who underwent stapled loop ileostomy closure from 2006 to 2012 were reviewed from an IRB-approved database. Three different LCS lengths were evaluated: 55, 75, and 100 mm. Method of common enterotomy closure, LCS staple height, pre-operative steroid use, index operative time and method of access (laparotomy or laparoscopy), and duration of time from the index operation to ileostomy closure were evaluated. Outcome measures included complications, resolution of ileus (defined by passage of flatus and bowel movement with toleration of a diet) and length of hospitalization. Univariate and multivariate analyses were performed.
Results: 350 patients (55% males) of a mean age of 46 (15-89) years were included. LCS anastomosis was performed using 55 mm in 20%, 75 mm in 50%, and 100 mm in 30% of patients. The common apical enterotomy was closed with a LCS, linear stapler (TA) or sutures. Per surgeons' preference, the stapler cartridge was blue (2.5 mm thickness) in 60% and green (3.8 mm thickness) in 40% of patients. The overall complication rate was 24%, including postoperative ileus 17% (n=59), wound infection 5% (n=17), and anastomotic leak 1% (n=5). LCS length was not associated with ileus (p=0.49), however patients in whom the 100 mm LCS was used had an average one day earlier resolution of ileus: postoperative day (POD) 2 vs 3 (range 2 to 15) days, p=0.02) and one day shorter hospitalization: (POD 3 (range 2 to 33 days), p=0.04). Incidences of post-operative complications did not differ according to LCS length when evaluating patients BMI (p=.81), pre-operative steroid use (p=0.92), staple height (p=.74), or method for common enterotomy closure (p=0.99). There were no differences between ileus resolution or length of hospitalization and operative time for either the index procedure or the ilesotomy closure or index operation method of access.
Conclusions: The 100-mm LCS was associated with more rapid resolution of ileus and a shorter duration of hospitalization than were the 55mm or 75mm LCSs.