Day-case closure of ileostomy: feasible, safe and efficient

Area of Science:

• Surgical Gastroenterology
• Minimally Invasive Surgery
• Patient Pathway Optimization

Background:

• Loop ileostomy closure is a common surgical procedure with significant inpatient resource utilization.
• Previous protocols have reduced length of stay, but same-day discharge remains an area for improvement.
• Standard loop ileostomy closure in the UK involves a median 5-day inpatient stay.

Purpose of the Study:

• To evaluate the feasibility, safety, and efficiency of a day-case surgical pathway for loop ileostomy closure.
• To assess patient outcomes and complications associated with same-day discharge following loop ileostomy closure.

Main Methods:

• Implementation of a specific patient pathway for day-case loop ileostomy closure adhering to British Association of Day Surgery guidelines.
• Inclusion criteria focused on patients without specific comorbidities or social care needs; exclusion criteria included prior chemoradiotherapy.
• Post-discharge follow-up involved telephone calls at 24 and 72 hours, with a 24-h emergency contact and routine outpatient appointment.

Main Results:

• Fifteen patients underwent day-case loop ileostomy closure, with a median age of 67 years.
• All patients were discharged on the day of surgery with no surgical complications reported.
• One readmission occurred due to a urinary tract infection; median follow-up was 4 months.

Conclusions:

• Day-case loop ileostomy closure is a feasible, safe, and efficient approach for selected patients.
• This protocol has the potential to significantly reduce inpatient bed days, saving an average of five days per patient.
• The protocol is planned for standardization within the institution for suitable candidates.