Ileostomy Closure

Closure of A Loop Ileostomy

The great majority of loop ileostomies may be closed without repeat laparotomy. Whether the use of antiadhesion barriers or sprays during loop ileostomy construction makes subsequent closure easier has been studied. Salum et al randomized 191 patients to Seprafilm around the stoma and under the midline, only under the midline, or not at all. At the time of stoma closure, there were fewer adhesions in the group that received Seprafilm around the stoma. This did not translate into shorter operative times or decrease in complications. The study was limited by the number of surgeons and varying techniques. Additionally, patients were not stratified by the extent of preexisting adhesions. A randomized trial has also been performed in Singapore. Tang et al randomized patients to wrapping the ileostomy with Seprafilm versus standard ileostomy creation. Closure was performed 3 weeks postoperation. There were significantly fewer adhesions in the Seprafilm group. There was no difference in operative time for takedown. Fewer patients in the Seprafilm group required laparotomy or extension of the incision, but statistical analysis was not performed on this outcome. In Japan, a small nonrandomized trial found significantly shorter operative times and no difference in complications with the use of Seprafilm. One randomized trial has evaluated a sprayable antiadhesion barrier. Use of SprayGel resulted in fewer adhesions, shorter time to mobilization and to closure of the ileostomy without a difference in complications.