Laparoscopic ileostomy closure with intracorporeal anastomosis offers potential advantages over open reversal with extracorporeal anastomosis, including earlier return of bowel function and reduced postoperative pain. In this study, we aim to compare the outcome and cost of laparoscopic ileostomy reversal (utilizing either intracorporeal or extracorporeal anastomosis) with open ileostomy reversal.
A retrospective review of sequential patients undergoing elective loop ileostomy reversal between 2013 and 2016 at a single, high-volume institution was performed. Patients were stratified on the basis of operative approach: open reversal, laparoscopic-assisted reversal with extracorporeal anastomosis (LE), and laparoscopic reversal with intracorporeal anastomosis (LI). Linear and logistic regressions were utilized to perform multivariate analysis and determine risk-adjusted outcomes.
Of 132 sequential cases of loop ileostomy reversal, 50 (38%) underwent open, 49 (37%) underwent LE, and 33 (22%) underwent LI. Demographic data and preoperative comorbidities were similar between the three cohorts. Median length of stay was significantly shorter for LI (52.1 h, p < 0.05) compared to open (69.0 h) and LE (69.6 h). After risk-adjusted analysis, length of stay was significant shorter in LI compared to LE (GM 0.78, 95% CI 0.64–0.93, p < 0.01) and open reversal (GM 0.78, 95% CI 0.66–0.93, p < 0.01). Risk-adjusted 30-day morbidity rates were similar for LI compared to LE (OR 0.43, 95% CI 0.081–2.33, p = 0.33) and open reversal (OR 0.53, 95% CI 0.09–3.125, p = 0.48). Median in-hospital direct cost was similar for LI ($6575.00), LE ($6722.50), and open reversal ($6181.00).
Laparoscopic ileostomy reversal with intracorporeal anastomosis was associated with shorter length of stay without increased overall direct cost. The technique of laparoscopic ileostomy reversal warrants continued study in a randomized clinical trial.
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Dr. Mehraneh D. Jafari receives an educational grant from Medtronic. Dr. Joseph C. Carmichael, Dr. Michael J. Stamos, Dr. Steven Mills and Dr. Alessio Pigazzi all receive an educational grant from Ethicon and Medtronic. Drs. Sarath Sujatha-Bhaskar, Matthew Whealon, Colette S. Inaba, Christina Y. Koh have no conflicts of interest or financial ties to disclose.
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Sujatha-Bhaskar, S., Whealon, M., Inaba, C.S. et al. Laparoscopic loop ileostomy reversal with intracorporeal anastomosis is associated with shorter length of stay without increased direct cost. Surg Endosc 33, 644–650 (2019) doi:10.1007/s00464-018-6518-0
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