1. Pre-operative :

   It was made by barium enema protocol and transanal endoscopy to rule out anastomotic leaks or strictures contraindicating stoma closure .

2. Surgical technique:

   • Peristomal incision with electrocautery
   • Release the handle of ileum
   • Anastomosis made the with the segment everted sutured by simple manual end to end 3/0 or mechanical side to side (surgeon's election).
   • Return the ileum into the abdominal cavity and the fascial defect is repaired with continuous polydioxanone 1/0 suture respecting 4:1 measurement rule.
   • The skin is sutured "purse string" style.

Post-Op

- Hospital discharge after verification of normal digestive transit

Abdominal Tomography 1 year after ileostomy closure

Contrast study is used to ensure the integrity of the distal anastomosis

All patients undergo a Blood Test study of C-reactive protein on day 4 by protocol within the unit before discharge.

Anastomotic leak rate , intestinal fistula , vesical fistula, peritonitis...

• This is a Clinical measure always supported by image tests.
• All the morbidity problems are reported independently.

Hemoperitoneum, abdominal hematoma,anastomotic bleeding ....

• This is a Clinical measure supported by image if necessary.
• All the morbidity problems are reported independently.
• The amount of blood loss won't be specified

acute myocardial infarction, angor pectoris , atrial fibrillation, acute pulmonary edema

• This is a Clinical measure supported by more specific tests if necessary.
• All the morbidity problems are reported independently.
• Cardiologist report will be required for including this items

Acute urinary retention, Acute renal failure, cystitis, pyelonephritis ...

• This is a Clinical measure supported by more specific tests if necessary.
• All the morbidity problems are reported independently.

Pneumonia, Atelectasis, Pulmonary embolism, Respiratory distress syndrome ...

• This is a Clinical measure always supported by image .
• All the morbidity problems are reported independently.

Deep venous thrombosis, phlebitis, thrombophlebitis, ...

• This is a Clinical measure supported by more specific test if necessary .
• All the morbidity problems are reported independently

Liver failure, gastrointestinal bleeding, severe malnutrition, ...

• This is a Clinical measure supported by blood test and further test if necessary
• All the morbidity problems are reported independently.

Disorientation, cerebral vascular accident, ...

• This is a Clinical measure.
• All the morbidity problems are reported independently.
• Neurologist report will be required beyond disorientation.

Superficial, deep, body-cavity

• This is a Clinical measure supported by image if necessary
• All the morbidity problems are reported independently

Hematoma, seroma, evisceration

• This is a Clinical measure
• All the morbidity problems are reported independently

Hospital stay since surgery is done