Laparoscopic creation of stomas |
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Authors: | L Oliveira P Reissman J Nogueras S D Wexner |
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Institution: | (1) Department of Colorectal Surgery, Cleveland Clinic Florida, 3000 West Cypress Creek Road, Ft. Lauderdale, FL 33309, USA, US |
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Abstract: | Background: Some indications for laparoscopic bowel surgery are still controversial. However, the use of laparoscopic techniques for
the treatment of benign disorders is less often challenged. Moreover, the morbidity of nonresectional procedures is less than
that encountered with resectional cases. Therefore, stoma creation seems ideally suited to laparoscopy. The aim of our study
was to assess the outcome of laparoscopic stoma creation.
Methods: All patients who underwent laparoscopic intestinal diversion were evaluated; parameters included age, gender, indication
for the procedure, history of previous surgery, operative time, length of hospitalization, recovery of bowel function, and
postoperative complications.
Results: Between March 1993 and January 1996, 32 patients of a mean age of 42.2 (range 19–72) years (14 males, 18 females) underwent
elective laparoscopic fecal diversion (25 loop ileostomy, four loop colostomy, three end colostomy). Indications for fecal
diversion were fecal incontinence (n= 11), Crohn's disease (n= 6), unresectable rectal cancer (n= 4), pouch vaginal fistula (n= 3), rectovaginal fistula (n= 2), colonic inertia (n= 2), radiation proctitis (n= 1), anal stenosis (n= 1), Kaposi's sarcoma of the rectum (n= 1), and tuberculous fistula (n= 1). Conversion was required in five patients (15.6%) due to the presence of adhesions (three), enterotomy (one), or colotomy
(one). All of these five patients had undergone previous abdominal surgery and were operated on early in our experience. Major
postoperative complications occurred in two patients (6%) and in both cases consisted of stoma outlet obstruction after construction
of a loop ileostomy. One of the two patients had undergone prior surgery. This patient required reoperation, at which time
a rotation of the terminal ileum at the stoma site was found. The other patient had a narrow fascial opening which was successfully
managed with 2 weeks of self-intubation of the stoma. The mean operative time was 76 (range 30–210) min; mean length of hospitalization
was 6.2 (range 2–13) days; stoma function started after a mean of 3.1 (range 1–6) days. Patients with previous abdominal surgery
had a longer mean operative time (14/32; 117 min) compared to patients who had no previous surgery (18/32; 55 min) (p < 0.0002). These longer operative times and hospital stay were attributable to extensive enterolysis, which was required
in some cases.
Conclusion: In conclusion, laparoscopic creation of intestinal stomas is safe, feasible, and effective. Although the length of the procedure
is longer in patients who have had prior surgery, previous surgery is not a contraindication, and even in these cases, a laparotomy
can be avoided in the majority of patients. Lastly, care must be taken to ensure adequate fascial opening and correct limb
orientation.
Received: 25 March 1996/Accepted: 21 May 1996 |
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Keywords: | : Bowel surgery — Laparoscopic intestinal diversion — stomas |
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