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. 2025 Jan;77(1):97-106.
doi: 10.1007/s13304-024-02033-9. Epub 2024 Nov 9.

Current approach to loop ileostomy closure: a nationwide survey on behalf of the Italian Society of ColoRectal Surgery (SICCR)

Roberto Peltrini  1 , Francesco Ferrara  2 , Dario Parini  3 , Daniela Pacella  4 , Antonio Vitiello  5 , Fabrizio Scognamillo  6 , Vincenzo Pilone  4 , Renato Pietroletti  7 , Paola De Nardi  8 ; Stoma Closure Collaborative Group
Collaborators, Affiliations

Current approach to loop ileostomy closure: a nationwide survey on behalf of the Italian Society of ColoRectal Surgery (SICCR)

Roberto Peltrini et al. Updates Surg. 2025 Jan.

Abstract

Compared to standardized minimally invasive colorectal procedures, there is considerable perioperative heterogeneity in loop ileostomy reversal. This study aimed to investigate the current perioperative practice and technical variations of loop ileostomy reversal following rectal cancer surgery. A nationwide online survey was conducted among members of the Italian Society of ColoRectal Surgery (SICCR). A link to the questionnaire was sent via mail. The survey consisted of 31 questions concerning the main procedural steps and application of the ERAS protocol after loop ileostomy reversal. Overall, 219 participants completed the survey. One respondent in four used a combination of water-soluble contrast studies (WSCS) and digital rectal examination to assess the integrity of the anastomosis before ileostomy closure. Conversely, 17.8% of them used either only WSCS or only endoscopy. Surgeons routinely perform hand-sewn or stapled anastomoses in 45.2% and 54.8% of the cases, respectively. Side-to-side antiperistaltic stapled anastomosis was the most performed anastomosis (36%). Most surgeons declared that they have never used prostheses for abdominal wall closure (64%), whereas 35% preferred retromuscular mesh placement in selected cases only. Forty-six respondents (66.7%) reported using interrupted stitches for skin closure, while 65 (29.7%) a purse-string suture. Furthermore, skin approximation at the stoma site using open methods was significantly more common among surgeons with greater experience in ileostomy reversal (p = 0.031). Overall, a good compliance with the ERAS protocol was found. However, colorectal surgeons were significantly more likely to follow the ERAS pathway than general surgeons (p < 0.05). Surgeons use different anastomotic techniques for ileostomy reversal after rectal cancer surgery. Based on current evidence, purse-string skin closure and ERAS pathway should be implemented, while the role of mesh prophylactic strategy needs to be explored further.

Keywords: Anastomosis; ERAS protocol; Ileostomy closure; Purse string suture; Stoma reversal; Survey.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have not conflict of interest. Ethical approval: The article does not contain any studies with human participants or animals performed by any of the authors. Informed consent: For this type of study, formal consent is not required. The collaborators for the “StomaClosure Collaborative Group” are listed in the acknowledgements.

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