Laparoscopic loop ileostomy - Forum

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Laparoscopic loop ileostomy - Ärzteforum

Post#1 »

If you can't easily identify a loop of distal ileum through the laparoscope, why not first pull the cecum up through the ostomy incision (this should be extremely easy), then follow this to the ileum.

Also, how often do you find patients that need a loop ileostomy but no other surgery?

What diagnoses lead to this procedure?

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Lady Surgeon

Re: Laparoscopic loop ileostomy - Ärzteforum

Post#2 »

The caecum, of course, is a landmark to identify the terminal loop of ileum. If you have the laparoscope in I do not think it is useful to present the caecum to the ostomy hole. It is much better to identify the loop itself. When this is difficult the reason is usually adherences secondary to previous surgery or because of natural adherences that bind the caecum and/or the terminal loop of ileum to the posterior abdominal wall. Then one need to mobilize the loop which cannot be done from the ostomy hole.

There is a technique of just preparing the ostomy hole and identify and bring out a loop through the hole without formal laparotomy. It is quite often successful also for a sigmoidostomy as long as the bowel loops are not adherent. It has a special name which I have forgotten because I do not use it.

How often is a loop-ileostomy alone required? Our lap registry contains 8 cases of laparoscopic loop-ileostomy, one of which had to be converted. One instance for iatrogenic rectal perforation, one for anastomotic failure, one for a complex anal fistula (loop-sigmoidostomy impossible hence the loop ileostomy), and the rest for inflammatory bowel disease with temporary diversion for various reasons. The same registry has 21 laparoscopic sigmoidostomies as single procedure from which you may infer that an isolated loop-ileostomy is less often called for.

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A Doctor

Re: Laparoscopic loop ileostomy - Ärzteforum

Post#3 »

One can usually identify the terminal ileum by the presences of the vestige of ventral mesentery which is only present there. This has the appearance of a yellow comb (as in Rooster's comb) on the antimesenteric border.

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