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To Divert or Not to Divert: The Loop Ileostomy Dilemma

To Divert or Not to Divert: The Loop Ileostomy Dilemma. Alessio Pigazzi City of Hope Duarte, CA. Loop ileostomy background. Utilized to protect ileo - or colo -rectal/anal anastomoses When is it indicated? What are the complications? What is the morbidity? How to reverse it?.

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To Divert or Not to Divert: The Loop Ileostomy Dilemma

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  1. To Divert or Not to Divert:The Loop Ileostomy Dilemma Alessio Pigazzi City of Hope Duarte, CA

  2. Loop ileostomy background Utilized to protect ileo- or colo-rectal/anal anastomoses When is it indicated? What are the complications? What is the morbidity? How to reverse it?

  3. Consequences of Symptomatic Anastomotic leak One in five pts undergoing LAR end up with permanent stoma 56% of patients with anastomotic leak end up with permanent stoma Mortality 2-15%

  4. What affects leak rate • Height of anastomosis • ASA class • Use of preoperative chemo/radiation • Intraoperative events • Bleeding, HD status, combined liver procedure, +leak test

  5. When things go wrong

  6. Is there high level evidence?

  7. Ostomy closure complication 13% Closure death rate 0.5 %

  8. When to close 93 patients undergoing ileostomy closure in Brasil 17 % complication rate Closure morbidity decrease after 8.5 weeks

  9. What is morbidity of ileostomyvis a vis a Laparoscopic/Robotic TME Our experience 57 R/LTME with ileostomy

  10. How to close Loop ileostomy • Open • Around ostomy site • Midline • Lap anybody?

  11. Lap ileostomy closure

  12. Conclusions Ileostomy reduces symptomatic leak rate by about half Complications from ileostomy both while functioning and at closure are high (15%) In high volume centers a practice of selected use of protection may be warranted

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