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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. 1Department of Surgical Oncology, Institut Claudius Regaud, Toulouse, France
  2. 2Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
  3. 3CEU Cardenal Herrera University, Valencia, Spain
  4. 4UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
  5. 5General Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  6. 6Department 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

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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

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

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.