Stapled Closure of Loop Ileostomy

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  • To reestablish bowel continuity after primary disease conditions are resolved or reversed
  • Rectal incontinence
  • Major organ dysfunction such that risk for complications from anesthesia is prohibitive
  • Major neurological or other deficits that prevent patients from caring for themselves
  • Operating table
  • Standard laparotomy kit
  • Surgical staplers
  • Electrocautery

The loop ileostomy commonly excises the peritoneal cavity between the rectus abdominis muscle fibers through the peritoneum and anterior and posterior rectus sheaths. It is customarily only sutured to the fascia at a few points. Adhesions form between the serosa of the small bowel and these structures as well as to the subcutaneous tissues. The mucocutaneous junction is well defined and clearly apparent in a mature stoma.

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  • Patients are typically hospitalized for 23 to 48 hours.
  • Analgesia is provided as needed.
  • Liquid oral intake can begin on the first postoperative day if there are no contraindications.
  • Packing is exchanged on the second postoperative day and repeated until sufficient granulation tissue has formed and the soft tissue defect is shallow.
  • The patient should avoid heavy lifting or straining until after at least 6 weeks and the patient is pain-free.
  • Anastomotic leak
  • Abdominal abscess
  • Inadvertent injury to abdominal organs or structures
  • Incisional hernia
  • Delayed closure of stoma site
  • Bowel obstruction
  • Enterocutaneous fistula

The overwhelming majority of patients do well after closure of the temporary ileostomy. The risk for major morbidity and mortality is very low.

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