ASCRS Conference Coverage

Open Surgery Matches Laparoscopy for Ileostomy Reversal Outcomes but Shortens Operative Time

Kate Young

Key Highlights

  • Researchers found no significant difference in median length of stay between open and laparoscopic ileostomy reversal.
  • Open procedures had significantly shorter operative times compared with laparoscopic ones.

In a retrospective review comparing open versus laparoscopic diverting loop ileostomy reversal researchers found no significant difference in median length of hospital stay or rates of postoperative ileus between the two approaches. However, operative time was significantly shorter in the open procedure group. Delay to surgery was associated with increased risk of postoperative ileus, suggesting timing plays a critical role in patient outcomes. The study authors presented their results at the American Society of Colon & Rectal Surgery Scientific Meeting in San Diego, CA.

Diverting loop ileostomy closure, though often considered a straightforward surgical step after complex treatments for conditions such as cancer, diverticulitis, and inflammatory bowel disease, carries substantial risks including postoperative ileus and anastomotic leaks. The standard surgical paradigm emphasizing minimally invasive techniques does not clearly apply in these cases, as reversal often requires resection at the stoma site alone.

quote from study

Researchers conducted a retrospective review of patients who underwent diverting loop ileostomy closure between January 2020 and September 2024, after obtaining IRB approval. Patient demographics, operative characteristics, treatment histories, diagnostic details, and postoperative complications were collected and analyzed to compare outcomes between open and laparoscopic procedures.

Among 118 patients, 58 underwent open and 60 underwent laparoscopic reversal. No differences were observed between groups in terms of age, gender, comorbidities, delay to surgery, blood loss, postoperative ileus, or time to first flatus. Median length of stay did not differ significantly (open: 3 days [2–4] vs laparoscopic: 2.2 days [2–3.2]; P = .2784). Operative time was significantly shorter for open procedures (77 minutes [65–92] vs 108 minutes [74.5–139]; P = .0013). Of the entire cohort, 11 patients developed ileus; these patients had a significantly longer median time to surgery (6.3 months vs 3.7 months; P = .0235).

“The only significant difference between open and laparoscopic closure was the length of surgery,” the study authors concluded. “Open surgery alone without diagnostic laparoscopy remains a safe alternative to routine laparoscopy in diverting loop ileostomy reversal.”

Reference:
Humphreys B, Willhite S, Venero A, Russ AJ, Rowe A, Low G. Retrospective review of open vs laparoscopic diverting loop ileostomy reversal. Presented at: American Society of Colon and Rectal Surgeons (ASCRS) Annual Scientific Meeting; May 10, 2025; San Diego, CA. https://ascrs25.eventscribe.net/agenda.asp?pfp=ePosters