Use of Sodium Hyaluronate/Carboxymethylcellulose Bioresorbable Membrane in Loop Ileostomy Construction Facilitates Stoma Closure

INTRODUCTION

The creation of a loop ileostomy is often a necessary adjunct to surgical procedures for low rectal cancers and inflammatory bowel disease. Several authors have advocated temporary fecal diversion to reduce clinically significant anastomotic dehiscence and to ameliorate the septic consequences of leakage from low pelvic bowel anastomosis^{1, 6} After a variable time interval and assessment of anastomotic integrity by water-soluble contrast enema, intestinal continuity can typically be restored with mobilization of the ileostomy through a limited peristomal incision. In our practice, closure of loop ileostomies is typically performed 5-8 weeks after the index operation for patients who are not undergoing postoperative chemotherapy. Dissection through a limited incision may be impaired due to adhesion formation at or below the fascial level, resulting in longer operating times and an increased potential for bowel injury.

We have adopted a technique of wrapping the loop of small intestine with an antiadhesion barrier film—sodium hyaluronate/carboxymethylcellulose (SH/CMC) bioresorbable membrane—before its delivery through the abdominal wall for stoma maturation. As SH/CMC has been demonstrated in previous studies to reduce postoperative adhesion development, we hypothesized that the use of SH/CMC would significantly decrease the operating time necessary for ileostomy closure with no effect on infectious complications or other patient morbidities^{7, 9}

METHODS

Following Ochsner Clinic Foundation Institutional Review Board approval, all patients who underwent loop ileostomy creation and closure at a single tertiary care institution (Ochsner Clinic Foundation, New Orleans, LA) between September 1999 and December 2011 were identified by Current Procedural Terminology (CPT) coding data. A retrospective analysis was performed, with abstraction of data pertaining to patient age, sex, primary diagnosis, operative times, staff surgeon, time interval between surgeries, postoperative morbidity, and whether an SH/CMC wrap was utilized in ileostomy formation.

All surgeries were performed by 6 board-certified colon and rectal surgeons and either colon and rectal surgery residents or general surgery chief residents. Loop ileostomy creation with SH/CMC wrap was performed using a standard 5 × 6-inch sheet of SH/CMC bioresorbable membrane (Seprafilm, Genzyme Corporation). After creation of the stoma opening and prior to delivery of the small intestine through the abdominal wall, SH/CMC was placed on the serosal surface of the chosen portion of bowel, and gentle pressure was applied using a dry laparotomy pad to...