Post-right hemicolectomy ileostomy and mucous fistula through single skin opening: comparative study with ileostomy and mucous fistula through two skin openings

Background
Right Hemicolectomy (RHC) is a common procedure for various right-sided colon pathologies; cancer colon or terminal ileum, perforated appendix with unhealthy cecal base, traumatic injuries and other less commonly indications. Ileo-colic anastomosis is the preferred next step following resection of the diseased segment, however, in certain situations, ileostomy (IL) and mucus fistula (MF) may be done due to excessive soiling or post-leakage of ileo-colic an astomosis or due to bad general condition of patient at this situation. Analternative approach can be done in such cases, which is the construction of aside-to side ileo-colic anastomosis which is then brought out in the right abdominal wall anastoma, so that reconstruction can be done with out midline laparotomy. Here, in our study we did a short term comparison between two groups of patients underwent ileosto my with mucousfistula. The first under went posterior wall anastomosis and the second without.
Aim of Study
Compare between Two groups of patients post RHC; one underwent IL&MF through single skin opening with posterior wall anastomosis and the other one did IL&MF through separate skin openings, regarding postoperative and restoration of continuity outcomes.
Patients and Methods
This is a retrospective cohort study. Data retrieved from the medical records of Ain Shams University Surgery Hospital medical records. Patients were divided into 2 groups according to the type of ileostomy and mucus fistula; Group A: underwent ileostomy and mucusfistula with posterior wall anastomosis. Group B: operated up on by ileostomy and mucus fistula without posterior wall anastomosis.
Results
Twenty-three patients underwent ileostomy and mucus fistula through single skin opening with posterior wall anastomosis, while 25 patients were through 2 skin openings without posterior wall anastomosis. No statistically significant difference between both groups regarding postoperative stoma-related complications. Restoration of continuity showed significantly more rate of wound infection in-case of ileostomy and mucus fistula through separate skin openings that’s attributed to midline laparotomy.
Conclusion
Ileostomy and mucus fistula through single skin opening with posterior wall anastomosis, is associated with similar complications rate to separate skin openings ileostomy and mucus fistula, however, its less risk of wound related SSI along with its ramifications as wound dehiscence and incisional hernia, due to avoidance of midline laparotomy when restoring bowel continuity is a worthy advantage.