Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2025; 17(1): 98269
Published online Jan 27, 2025. doi: 10.4240/wjgs.v17.i1.98269
Laparoscopic intracorporeal anastomosis vs open anastomosis for ileostomy reversal in Crohn's disease: A single center retrospective study
Wei-Hang Liu, Mao Xiong, Guo-Qing Chen, Zhui Long, Chao Xu, Li Zhu, Jing-Song Wu
Wei-Hang Liu, Mao Xiong, Guo-Qing Chen, Zhui Long, Chao Xu, Li Zhu, Jing-Song Wu, Department of General Surgery, Chongqing General Hospital, Chongqing 401120, China
Co-first authors: Wei-Hang Liu and Mao Xiong.
Author contributions: Liu WH and Xiong M contribute equally to this study as co-first author; Wu JS, Liu WH, Xiong M and Chen GQ contributed to the conception and design of the study; Wu JS, Liu WH and Xiong M completed laparoscopic surgery; Li Z is accountable for the ongoing management of stoma care for patients in the long term; Liu WH, Xiong M and Long Z collected clinical data; Liu WH performed the statistical analysis and wrote the manuscript; Chen GQ and Wu JS reviewed the manuscript; all authors contributed to the manuscript and approved the submitted version.
Supported by Chongqing Municipal Health Commission Medical Research Project, No. 2023WSJK104.
Institutional review board statement: Ethical approval was obtained from the Ethics Committee of Chongqing General Hospital, Chongqing, People's Republic of China (approval No. KY S2022-101-01).
Informed consent statement: In consideration of the retrospective design of this study, the requirement for informed patient consent was waived.
Conflict-of-interest statement: The author declares that there are no conflicts of interest regarding the publication of this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing-Song Wu, PhD, Professor, Department of General Surgery, Chongqing General Hospital, No. 118 Starlight Avenue, Chongqing 401120, China. wjsrmyy@163.com
Received: June 22, 2024
Revised: October 24, 2024
Accepted: November 12, 2024
Published online: January 27, 2025
Processing time: 187 Days and 23.9 Hours
Abstract
BACKGROUND

There is an increased maturation of laparoscopic intracorporeal anastomosis techniques. However, research on its application for small bowel stoma reversal in patients with Crohn's disease (CD) is limited. Therefore, in this study, we compared the perioperative outcomes between laparoscopic intracorporeal ileostomy reversal (LIIR) and open ileostomy reversal (OIR).

AIM

To compare the safety, feasibility, bowel function recovery, and short- and long-term LIIR and OIR outcomes in patients with CD.

METHODS

This study included patients who underwent ileal reversal for CD between January 2021 and January 2023 at our institution. The baseline data, postoperative recovery, and complication indicators were retrospectively analyzed. Logistic regression analysis was conducted to explore factors that significantly influenced the development of enteral nutrition intolerance-related symptoms.

RESULTS

Notably, 15 of the 45 patients in this study underwent OIR, and the remaining 30 received LIIR. Notably, no statistically significant differences were found between the two groups regarding clinical baseline characteristics, operation time, intraoperative hemorrhage, anastomotic site, enterolysis range, first postoperative flatus, postoperative complications, reoperation rate, or incidence of postoperative enteral nutrition intolerance. Compared with the OIR group, the LIIR group had a shorter postoperative hospital stay (P = 0.045), lower incidence of enteral nutrition intolerance symptoms (P = 0.019), and earlier postoperative total enteral nutrition initiation (P = 0.033); however, it incurred higher total hospital costs (P = 0.038). Furthermore, multivariate logistic regression analysis revealed that the duration of surgery and anastomotic technique were independent risk factors for postoperative symptoms of enteral nutrition intolerance (P < 0.05).

CONCLUSION

Laparoscopic intracorporeal anastomosis for ileostomy reversal is safe and feasible. Patients who underwent this technique demonstrated improved tolerance to postoperative enteral nutrition and quicker resumption of total enteral nutrition.

Keywords: Crohn’s disease; Ileostomy reversal; Laparoscopic intracorporeal anastomosis; Enteral nutrition intolerance; Total enteral nutrition

Core Tip: The maturation of laparoscopic intracorporeal anastomosis techniques is on the rise. However, there is limited research on its application in small bowel stoma reversal for patients with Crohn's disease. This study aims to investigate perioperative outcomes associated with laparoscopic intracorporeal ileostomy reversal compared to open ileostomy reversal. The use of laparoscopic intracorporeal anastomosis for ileostomy reversal is both safe and feasible. The results showed that patients undergoing this technique demonstrate improved tolerance to postoperative enteral nutrition and a quicker resumption of total enteral nutrition.