1. Ileostomy closure from local site versus
laparotomy site: A comparative study
Comparison of post operative complications of stoma closure from local site versus
laparotomy site
Presenter- Dr. Manish Singh (JR2)
Moderators- Dr.Dheeraj Raj Baliyan (MS)
Dr. Himanshu Sangwan (MS)
Dr. Azharuddin (SR)
2. Introduction
Surgical procedure involving the reversal of an ileostomy. This procedure is typically performed after a temporary
diversionary ileostomy was created to allow healing of a specific portion of the digestive tract.
Importance in Patient Care:
1. Restoration of Continuity.
2. Improved Quality of Life.
3. Functional Restoration.
4. Prevention of Complications.
5. Enhanced Nutritional Status.
6. Reduced Healthcare Costs.
7. Psychological Well-being.
8. Individualized Patient Care.
In summary, ileostomy closure is a crucial step in the patient’s journey towards recovery, focusing on restoring normal
bowel function and improving overall well-being. This procedure plays a significant role in enhancing the patient’s
quality of life and represents a key aspect of comprehensive and patient-centered care.
3. Laparotomy site closure and local site closure
techniques
Local Site Closure:
1. Stoma Excision
2. Mobilization of Local Tissues
3. Tissue Approximation
4. Layered Closure
5. Hemostasis
Laparotomy Site Closure:
1. Layered Closure:
• Peritoneum: Closed first to prevent bowel adhesions and promote healing within the abdominal cavity.
• Fascia: Closure provides strength to the incision site and helps support internal structures.
• Skin: Closed usually with staples or sutures, to complete the closure.
4. 2. Suture Techniques:
• Use of absorbable or non-absorbable sutures with various stitching patterns like
interrupted or continuous sutures.
3. Drain Placement:
• Drains may be inserted to prevent fluid accumulation, reduce the risk of
infection and to know about any anastomotic leak.
4. Hemostasis:
• Ensuring effective control of bleeding during closure.
Both laparotomy site closure and local site closure techniques aim to achieve secure
secure wound closure, minimize complications, and promote optimal healing. The
healing. The choice between these approaches depends on the surgical context, patient
context, patient factors, and the surgeon’s expertise.
5. Literature Review
• In a 1952 paper entitled “Management of the Ileostomy and Its
Complications,” Brooke described the ileostomy that remains in use
today. One sentence, “A more simple device is to evaginate the ileal end
at the time of operation and suture the mucosa to the skin; no
complications have occurred from this” accompanied by a single
illustration, changed the ileostomy from a chronically inflamed and
ulcerative stoma, frequently associated with dysfunction, to the
functional “rosebud” we know today.
• Reversal of a temporary ileostomy is generally associated with a low
morbidity and mortality. However, ostomy reversal may cause
complications requiring reoperation with subsequent major
complications, in ranges from 0% to 7-9% and minor complications
varying from 4-5% to 30%.
6. • A retrospective study, however, had a remarkably high
mortality of 1% for temporary colostomy and 5.3% for
temporary ileostomy. Deaths were related to anastomotic
leaks, sepsis, acute myocardial infarction.
• Stoma reversal may cause complications requiring
reoperation, and a literature review concluded,that there is
wide variation from no cases to as much as 14% - 17%,
where the presence of inflammatory bowel disease is a risk
factor.
• Indices of health related quality of life are being
increasingly demanded in the health care sector, and is one
of the important predictors of accuracy of timing of clinical
interventions.
7. Methodology
Source of Data:
The Study conducted in surgical ward of SVBP Hospital affiliated to LLRM Medical
College Meerut from October 2022 to October 2023 in patients of ileostomy.
Method of Collection of Data:
Study type: Prospective study
Sample Size: 60 patients with temporary ileostomy
Data Collection:
Age of the patient, Symptoms and their duration, Past history, Complete physical
examination, Laboratory investigations, Radiological investigations wherever,
Treatment given, Complications, Duration of hospital stay.
8. Sample Design
60 patients were enrolled in the study. Of these, 40 patients were
were allocated to local site closure group while remaining patient
patient underwent laparotomy site closure group.
The 2 groups were comparable with respect to post-operative
operative mortality and morbidities like pain, length of hospital stay,
hospital stay, anastomosis leak, reoperation, fecal fistula, wound
wound infection, wound dehiscence, incisional hernia.
9. Observation
Parameter
(Post operative)
Laparotomy site closure group.
(20)
Local site closure group
(40)
Pain (Avg VAS) 7 5
Average hospital stay (Days) 17.6 10.3
Wound infection 4 4
Wound dehiscence 2 -
Anastomosis leak 2 6
Reoperation 1 2
Incisional hernia 4 -
10. Results
• Results of the study found were that during post operative period,
average VAS score observed in local site closure is 5 versus laparotomy
site closure is 7 after post operative period of 24 hours, 48 hours and
72 hours.
• Average hospital stay of 10.3 days observed in local site closure group
which was statistically significant than laparotomy site closure that is
17.6 days.
• 4 patients each in local site closure group and laparotomy site closure
had superficial infections which was managed conservatively.
• 2 patients in laparotomy site closure had burst abdomen which was
managed conservatively first with daily sterile dressing followed by
secondary resuturing.
11. • 15% of patients in local site closure had anastomosis leak
33% of which get re-operated by laparotomy site closure.
• 10% of laparotomy site closure group had anastomotic
leak, 1 of which have finding of perforation proximal to
anastomotic site which was further managed by loop
ileostomy.
• No faecal fistula and mortality seen in my study.
• 20% have incisional hernia complication in laparotomy site
closure group which were further managed with ventral
wall hernia repair.
12. Discussion
Although ileostomy closure could be done by laparotomy site as
well as local site, local site closure led to lesser degree of pain along
with significantly lesser length of hospital stay, rate of wound
infection was also found to be on a higher side (20%) in laparotomy
site closure group as compared to local site closure group (10%),
anastomosis leak was more commonly associated with the local site
closure group, incisional hernia and wound dehiscence was
predominantly found only in laparotomy site closure group.
13. Conclusion
• On the basis of my study I found that Local site
closure had many advantages comparative to
laparotomy site closure mainly in terms of:
i. Post operative pain
ii. Wound infection
iii. Wound dehiscence
iv. Length of hospital stay and
v. Incisional hernia.
