Effects of anchoring sutures at diverting ileostomy after rectal cancer surgery on peritoneal adhesion at following ileostomy reversal

Abstract

Purpose: During diverting ileostomy reversal for rectal cancer patients who underwent previous sphincter-saving surgery, the extent of adhesion formation around the ileostomy site affects operative and postoperative outcomes. Anchoring sutures placed at the time of the ileostomy procedure may reduce adhesions around the ileostomy. This study aimed to evaluate the effects of anchoring sutures on the degree of adhesion formation and the postoperative course at the time of ileostomy reversal.

Methods: Patients who underwent sphincter-saving surgery with diverting ileostomy for rectal cancer between January 2013 and December 2017 were enrolled. Variables including the peritoneal dhesion index (PAI) score, operation time, the length of resected small bowel, operative complications, and postoperative hospital stay were collected prospectively and compared between the anchoring group (AG) and non-anchoring group (NAG).

Results: A total of 90 patients were included in this study, with 60 and 30 patients in the AG and NAG, respectively. The AG had shorter mean operation time (46.88 ± 16.37 minutes vs. 61.53 ± 19.36 minutes, P = 0.001) and lower mean PAI score (3.02 ± 2.53 vs. 5.80 ± 2.60, P = 0.001), compared with the NAG. There was no significant difference in the incidence of postoperative complications between the AG and NAG (5.0% vs. 13.3%, respectively; P = 0.240).

Conclusion: Anchoring sutures at the formation of a diverting ileostomy could decrease the adhesion score and operation time at ileostomy reversal, thus may be effective in improving perioperative outcomes.

Keywords: Adhesion; Ileostomy; Postoperative complications; Rectal neoplasms.

Fig. 1. Anchoring sutures are placed to pull together the anterior fascia of the abdominal wall and the peritoneal layer. This prevents the rectus muscles from directly adhering to the small bowel serosa. (A) Schematic drawing of the anchoring suture procedure. (B) Photo showing peritoneum (indicated by a forcep), rectus muscle, and anterior fascia. (C) Fixation of peritoneum and anterior fascia with vicryl suture. (D) Four-point anchoring suture, minimizing the contact area between the small bowel and abdominal wall.