Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Diverting loop ileostomy is a surgical procedure that can be used for gynecological malignancies.1 The main indications for this technique are to protect a distal anastomosis after bowel resection, in the event of an anastomotic leak if a previous ostomy was not done, or in the case of bowel obstruction due to tumorous compression or infiltration.2 Gynecologic oncologic surgeons need to be comfortable with this surgical technique, but also with ileostomy reversal.
In this surgical video (Video 1), we show the ileostomy closure technique using multiple video sequences from four patients who previously underwent a diverting ileostomy during gynecologic cancer surgery. The surgeries were performed in three referral centers for gynecological malignancies by multidisciplinary teams, including digestive surgeons and gynecologic oncologic surgeons. We standardized the technique in 10 consecutive steps, giving alternatives in some of them (Figure 1).
We divided the procedure in the following steps:
Step 1: Skin incision
Step2: Subcutaneous tissue dissection
Step 3: Fascia and muscle dissection
Step 4: Liberation of intestinal adhesions
Step 5: Anastomosis
Step 6: Reintroduction in the abdominal cavity
Step 7: Intra-abdominal drainage (optional)
Step 8: Fascia closure
Step 9: Mesh placement (optional)
Step 10: Skin closure
To summarize, we propose a stepwise standardized technique for diverting ileostomy closure, to enhance the learning curve for gynecologic oncologic surgeons. It is also essential to know how to identify and manage postoperative complications associated with this technique, such as ileus, anastomotic leak, surgical site infection, and incisional hernia.3 During this video, we present some tips and tricks on how to decrease the risk of occurrence of these complications.4
Data availability statement
All data relevant to the study are included in the article.
Patient consent for publication
Twitter @AngelesFite, @Alejandra
AF and GF contributed equally.
VL and NB contributed equally.
Correction notice This article has been corrected since it was first published to add affiliation 3.
Contributors All authors made appropriate contributions to the manuscript. MAA is responsible for the overall content as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.