SSAT - Which Is the Better Procedure for the Closure of Diverting Loop Ileostomy After Ileal Pouch Anal Anastomosis for Ulcerative Colitis; Stapled or Hand-Sewn Anastomosis?

Back to 2015 Annual Meeting Program

Which Is the Better Procedure for the Closure of Diverting Loop Ileostomy After Ileal Pouch Anal Anastomosis for Ulcerative Colitis; Stapled or Hand-Sewn Anastomosis?
Munenori Nagao^*¹, Kazuhiro Watanabe¹, Hideaki Karasawa¹, Tomoya Abe¹, Shinobu Ohnuma¹, Hiroaki Musha¹, Chikashi Shibata², Takeshi Naitoh¹, Michiaki Unno¹

¹Department of surgery, Tohoku university, Sendai, Japan; ²Department of Surgery, Tohoku Pharmaceutical University, Sendai, Japan

Background: Restorative proctocolectomy with ileal pouch anal anastomosis (IPAA) is a standard procedure for ulcerative colitis (UC). Temporary diverting loop ileostomy is usually constructed to decrease the risk of anastomotic complications including leakage. There are 2 procedures for the closure of ileostomy; stapled and hand-sewn anastomosis. However it is unclear which procedure has a benefit. Aim: The aim was to study which procedure for the closure of loop ileostomy is better by comparing perioperative results. Methods: Medical records of the patients who underwent IPAA for UC were reviewed retrospectively. There were 79 patients who underwent IPAA for UC in our department since 2007. The patients were classified into 2 groups; stapled anastomosis group (Group A, N=35) and hand-sewn group (Group B, N=44). A 55 mm long linear stapler was used for stapled anasotomois, while hand-sewn anastomis was performed by an end-to-end, layer-to-layer anastomosis. Results: There were no differences in the patient age and duration between IPAA and the closure of ileostomy between 2 groups. The median operative time (range) was 107 (53-216) minutes in Group A and 99 (64-188) minutes in Group B (P>0.05). The median intraoperative blood loss (range) in group A and B was 58 (5-175) ml and 34 (5-188) ml, respectiverly (P>0.05). Morbidity rate was 34.3% (12/35) in Group A and 18.2% (8/44) in Group B (P>0.05). Morbidities included surgical site infection, intestinal obstruction, and massive hemorrhage from the small intestine. Rate of surgical site infection (5/35) and intestinal obstruction (5/35) in Group A was greater than that in Group B (3/44 for surgical site infection and 3/44 for intestinal obstruction, P>0.05, each). There were no cases of anastomotic leakage in either group. Conclusions: These results indicate that eihter procedure has no advantage for the closure of loop ileostomy; however, hand-sewn anastomosis is not inferior to stapled anastomosis, because of no differene in morbidity rate, operative time or blood loss.

Back to 2015 Annual Meeting Program