ISPUB.COM The Internet Journal of Surgery Volume 22 Number 1 1 of 5 Stoma Reversal, A Hospital-Based Study of 32 Cases. J Shah, N Subedi, S Maharjan Citation J Shah, N Subedi, S Maharjan. Stoma Reversal, A Hospital-Based Study of 32 Cases.. The Internet Journal of Surgery. 2009 Volume 22 Number 1. Abstract Background/Objective: Formation of intestinal stoma is a common surgical practice. In this retrospective study we aim to study the indications for stoma creation, complications of stomas, timing and methods of stoma reversal, reasons for any delays and post-reversal complications. Material and Methods: Charts of patients who underwent stoma creation and reversal over a 3 year period from 2005 November to 2008 October at Patan Hospital are included in this study. Results: A total of 32 stomas were created out of which 23 were reversed. Overall pre- and post-takedown complications were 39% and 52%, all of which were minor complications, not requiring major interventions. There was no significant difference in outcome due to early vs. late reversal, types of anesthesia, or reversal technique. Conclusion: Reversal of temporary stomas can be done safely at an early date, with no demand of special anesthesia, requiring minimal access to the abdomen and with safe early discharge without expecting serious complications or readmissions. INTRODUCTION Formation of an intestinal stoma is frequently a component of surgical intervention for diseases of the small bowel and colorectal pathology. The most common intestinal stomas are ileostomies and colostomies; either end or loop stomas. A number of non-randomized studies 1-3 and randomized controlled trials 4-7 have been performed in an effort to determine which of these two stomas is superior. Both types of stoma effectively defunction the distal bowel. However, loop ileostomies appear to be associated with a lower incidence of complications related to stoma formation and reversal, though they may have a high risk of postoperative intestinal obstruction 7 . Both stomas are comparable with respect to patient quality of life, and the degree of subsequent social restriction is influenced more by the number and type of complications than by the types of stoma formed 8 . Reversal of a loop stoma can be carried out under local, spinal or general anesthesia by intraperitoneal or extraperitoneal (the preferred method of the author) closure. The operation is easier to perform if a period of at least 12 weeks is allowed to elapse between formation of the stoma and reversal so that there is time for edema and inflammatory adhesions to settle 1 . The freshened edges of the enterotomy can be anastomosed or a resection of a certain length of the proximal and distal ends of the stoma is done and they are anastomosed. Two randomized trials and a non-randomized study comparing suture reversal with stapled reversal yielded conflicting results with respect to complication rates 9-11 , but both trials reported that extra costs were incurred when staples were used. Once the stoma is reversed, the loop is returned to the abdominal cavity or left in extraperitoneal space, and the abdominal muscles are closed by interrupted synthetic absorbable or non-absorbable sutures. The skin may be left open or just one or two loose sutures are put to facilitate drainage and prevent infection. For the end stomas, laparotomy is carried out, the closed distal stump is identified and a simple end-to-end anastomosis is performed after adequate mobilization and freshening of both ends. The anastomosis can be performed in single layer interrupted absorbable suture or two layer (inner layer: continuous catgut, and outer layer: interrupted silk; the preferred method of the author). Complications after stoma formation are frequent and varied, which can adversely affect quality of life. The complication rate has been reported to be about 25% after a colostomy formation, as high as 57% after an end ileostomy 12 and 75% after a loop ileostomy 13 . The more common problems encountered are stomal (necrosis, stenosis, hernia, retraction, prolapse), perisotmal (dermatitis, mechanical trauma) and metabolic complications.