Beyond the stoma: Exteriorized ileal loop without ostomy as a simple, feasible alternative to defunctioning loop ileostomy

A defunctioning loop ileostomy is widely used to protect distal bowel repair and anastomoses, but is associated with significant stoma-related morbidity and the obvious need for a second procedure for closure. We therefore evaluated the creation of an unopened exteriorized (covering) ileal loop without ostomy as a simple, feasible alternative. In our prospective interventional study, 26 patients undergoing emergency surgery for ileal perforation or distal intestinal obstruction underwent this procedure, with an option for bedside conversion to ileostomy if required. Stoma conversion was required in only four patients, while the remainder avoided ileostomy and underwent loop repositioning without complication. This technique appears simple and safe, avoids stoma-related morbidity, and eliminates the need for a second surgery in the majority of patients.