Ileostomy Reversal

Indications
Ileostomy reversal

Special Preparation
Nil

Prep
Supine

Procedure Notes
Incise skin around mucocutaneous border with cutting diathermy
Dissect through subcut fat around ileostomy, freeing it up from skin edges.
Approximate ileostomy edges togeter with an Ellis to reduce leakage during surgery.
Dissect through into the plane containing the bowel loop and define the fascial edge
Free it from the fascia with careful diathermy dissection,
At this point if in the right plane, can often insert a finger into the space around the ileostomy and progressively dissect around it onto that finger
So mobilising the loop completely from fascia.
Sometimes more dense adhesions will require time spent dissecting these free.
At this point I take a divide a band of mesentery, close to the bowel, that directly underlies the iloestomy site.
This makes the join more straightforward and reduces the mesentery potentially caught in the join, which can bleed.
Ensure bowel mobile and not twisted, then do the anastomosis.
I prefer a stapled anastomosis for its speed and the reliability and integrity of the stapled join.
Approximate the bowel adjacent to the ileostomy in a side to side fashion.
Make two small enterotomies at the antimesenteric border, insert the stapler arms, ensure mesentery clear down the middle, wait 20s and fire straight down bowel.
Watch during stapler removal to ensure no bleeding at staple lines internally.
Grasp enterotomy bowel ends with three babcocks, one on the staple line and retract back to straighten join.
Apply a linear TA 90 stapler to the ends in front of the babcocks, fire, divide bowel beyond staple line.
Underun TA staple line with a 3-0 prolene continuous suture.
Interrupted trouser sutures with 3-0 prolene.
Check integrity.
Close fascia with interrupted 1 nylon.
Skin with interruted dermal 3-0 moncryl sutures, leaving a gap in the middle for gauze packing of the dirty wound
Post-Operative Issues
Routine

Complications
Routine

Alternatives and Controversies
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