Laparoscopic Versus Open Loop Ileostomy Reversal: Is there an Advantage to a Minimally Invasive Approach?

BACKGROUND: Ileostomy reversals are commonly performed procedures after colon and rectal operations. Laparoscopic ileostomy reversal (LIR) with lysis of adhesions has potential benefits over conventional open surgery. The aim of this study was to compare outcomes of laparoscopic and open ileostomy reversal. METHODS: 133 consecutive patients undergoing ileostomy reversal at our institution between June 2009 and August 2013 were analyzed using a retrospective database. The group comprised 53 laparoscopic cases and 80 open cases, performed by four surgeons at a single center. The data were analyzed for patient demographics, operative characteristics, postoperative outcomes, and 30-day morbidity and mortality. RESULTS: The two groups had comparable mean age, gender distribution, ASA scores, and BMI. The laparoscopic group had a significantly longer duration of surgery compared to the open reversal group (109 versus 93 min, p < 0.05). However, this group underwent more lysis of adhesions (60.4 % versus 26.3 %, p < 0.01) as well as concurrent stoma site mesh reinforcement (32.1 % versus 6.3 %, p < 0.01). In the laparoscopy group, 20.7 % of patients underwent intra-corporeal ileo-ileal anastomosis. There were no significant differences between the laparoscopic and open groups with regard to estimated blood loss (31 versus 40 ml, respectively) or mean length of stay (5.3 vs. 5.7 days, respectively). The rates of overall 30-day morbidity (16.9 % for laparoscopic vs. 21.3 % for open) as well as rates of specific complications were equivalent between groups. 30-day mortalities were not noted in either group. CONCLUSION: LIR is safe and effective with low perioperative morbidity and mortality. The use of laparoscopy as an option in terms of concomitant hernia repair and lysis of adhesions may be considered in selected patients.

Aphid transmission of Banana bunchy top virus to bananas after treatment with a bananacide.

Field and laboratory studies were conducted to determine the impact of using a herbicide as a bananacide on aphid transmission of Banana bunchy top virus (family Nanoviridae, genus Babuvirus, BBTV) to healthy banana (Musa spp.) plants. BBTV-infected banana plants in a commercial orchard were treated with Roundup Weathermax herbicide. Using polymerase chain reaction, the time after herbicide treatment that BBTV could no longer be detected in the infected plants was determined. The impact of the herbicide treatment on Pentalonia nigronervosa Coquerel (Hemiptera: Aphididae) virus acquisition and ability to inoculate healthy banana plants with BBTV also were determined. Generally, banana plants were dead beyond 42 d after herbicide injection (DAI), and BBTV was detected in a similar high percentage of treated plants from 0 up to 21 DAI. During two field trials, 0 and 32% of P. nigronervosa acquired the virus from treated plants at 42 DAI, respectively, but none successfully inoculated a healthy banana plant beyond 35 DAI. Finally, 22% of P. nigronervosa colonies collected directly from the pseudostem of injected plants at the final sample date (42 DAI) tested positive for BBTV and infected 9.5% of the healthy banana plants. The findings indicate that banana plants may remain a potential source of virus inoculum 6 wk after injection with a bananacide. The implications of these findings with respect to BBTV management are discussed.