Temporary Protective Loop Ileostomy in Open Low Rectal Resection - An Alternative Technique

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Temporary Protective Loop Ileostomy in Open Low Rectal Resection - An Alternative Technique

D.A. Cristian, F.A. Grama, T. Burcoş, A. Bordea
How I do it, no. 2, 2014
The paper presents a simplified method for performing atemporary protective loop ileostomy as a result of ourexperience in 33 cases of low rectal resections for cancer.The particularities of this technique are: the skin incision issmaller than the muscle one, the seromuscular layer of the loopis fixed at the skin level only by marking a small portion of theantimesenteric wall, with no mucosal eversion. No supportingrod is used. The reversal requires resection of the thickened freemargins and enterorrhaphy. It involves a direct approach andavoids median laparotomy and segmental bowel resection.There was no case of peristomal abscess, bleeding, prolapse,retraction of the loop after the stoma was formed. Four patients(12.12%) had peristomal dermatitis. Five patients (15.62%) hadhigh output fluid losses with electrolyte disorders, one of them(3.12%) with acute renal failure. Closure was performed after 6weeks on average for the colorectal anastomoses and 10 weeksfor the coloanal ones. We recorded a case (3.12%) of enterocutaneousfistula that was managed conservatively and 4 cases(12.12%) of incisional hernia, all of them surgically treated. Nomortality was attributed to either creation or closure of thetemporary loop ileostomy. It is a simple and fast technique inaccordance with the temporary character of its indication.