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- W2913638049 abstract "Table: Enterocutaneous Fistula at Old Ileostomy SitePurpose: Small bowel obstruction (SBO) is a usual complication following major abdominal surgery, which frequently requires surgical intervention. Temporary ilestomy is commonly employed for fecal diversion, which requires a second surgery, albeit small, for closure. At the time of ileostomy takedown, instead of a local excision, would a full laparotomy beneficial in reducing the risk of recurrent bowel obstruction? Methods: Patients with SBO were identified from the institutional ileal pouch anal anastomosis (IPAA) database of 3176 cases during a 23-year period. Clinical details reviewed and analyzed included timing of ileostomy closure and incisions used. Results: 794 episodes of SBO from 571 patients were identified following IPAA. Surgical intervention was required in 229 episodes (29%). Seventy six patients were excluded because no ileostomy was utilized (49), or ileostomy not closed (3) or closed at another institution. For the remaining 495 patients, average ileostomy duration was 120 days. The study group numbered 140 patients who had 1st episode of SBO before ileostomy closure. Depending on the incision type at the ileostomy takedown, the study group was divided into three subgroups: A) peristomal incision at the regular time of ileostomy takedown (> 7 wks), 102 patients; B) laparotomy at the regular time of takedown, 15 patients; C) laparotomy before the regular time of takedown, 23 patients. SBO recurrence was lower in patients who underwent a laparotomy (23.7%) than those who had peristomal incision (30.4%). There were 130 patients (26.2%) who developed their 1st SBO within 60 days following ileostomy closure. Of these, 101 (77.7%) had only one episode of SBO. 80 of the 101 (80%) patients were managed medically without recurrence. Conclusion: The ileostomy take down presents a valuable opportunity for patients who already display signs of obstruction. Laparotomy with full exploration at this point can safely reduce the risk of future bowel obstruction. The majority of bowel obstruction cases occurring immediately following take down can be successfully managed medically without recurrence.Table: Small Bowel Obstruction Recurrence after Ileostomy Takedown" @default.
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- W2913638049 date "2007-09-01" @default.
- W2913638049 modified "2023-09-26" @default.
- W2913638049 title "Is Laparotomy Warranted at the Closure of Temporary Ileostomy? A Review of 571 Patients with Bowel Obstruction Following Restorative Proctocolectomy with Ileal Pouch" @default.
- W2913638049 doi "https://doi.org/10.14309/00000434-200709002-00958" @default.
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