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Tips and tricks for ileostomy closure after diverting ileostomy for gynecological cancer surgery
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  1. Martina Aida Angeles1,
  2. Victor Lago2,3,
  3. Nicolò Bizzarri4,
  4. Elodie Chantalat1,
  5. Carlo Abatini5,
  6. Matteo Frasson6,
  7. Alejandra Martinez1,
  8. Santiago Domingo2,
  9. Anna Fagotti4 and
  10. Gwenael Ferron1
  1. 1 Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, France
  2. 2 Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
  3. 3 CEU Cardenal Herrera University, Valencia, Spain
  4. 4 UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
  5. 5 General Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  6. 6 Department of Colorectal Unit, Hospital La Fe, Valencia, Spain
  1. Correspondence to Dr Martina Aida Angeles, Department of Surgical Oncology, Institut Claudius Regaud, 31100 Toulouse, Occitanie, France; martinangeles22{at}hotmail.com

https://doi.org/10.1136/ijgc-2022-004085

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    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).

    Video 1 .
    Figure 1
    Figure 1

    Side-to-side ileal anastomosis for diverting ileostomy closure.

    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.

    Ethics statements

    Patient consent for publication

    Ethics approval

    Not applicable.

    References

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      2. Lago V ,
      3. Fotopoulou C ,
      4. Chiantera V , et al
      . Indications and practice of diverting ileostomy after colorectal resection and anastomosis in ovarian cancer cytoreduction. Gynecol Oncol 2020;158:603–7.doi:10.1016/j.ygyno.2020.05.047 pmid:http://www.ncbi.nlm.nih.gov/pubmed/32571682
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      . Surgical intervention for mechanical large bowel obstruction at a tertiary hospital: which patients receive a stoma and how often are they reversed? Am J Surg 2021;221:594–7.doi:10.1016/j.amjsurg.2020.11.029 pmid:http://www.ncbi.nlm.nih.gov/pubmed/33288223
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      2. Lago V ,
      3. Sanchez-Migallón A ,
      4. Flor B , et al
      . Comparative study of three different managements after colorectal anastomosis in ovarian cancer: conservative management, diverting ileostomy, and ghost ileostomy. Int J Gynecol Cancer 2019;29:1170–6.doi:10.1136/ijgc-2019-000538 pmid:http://www.ncbi.nlm.nih.gov/pubmed/31296558
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      2. Aktaş A ,
      3. Kayaalp C ,
      4. Ateş M , et al
      . Risk factors for postoperative ileus following loop ileostomy closure. Turk J Surg 2020;36:333–9.doi:10.47717/turkjsurg.2020.4911 pmid:http://www.ncbi.nlm.nih.gov/pubmed/33778391
      OpenUrlPubMed

    Footnotes

    • 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.