JOURNAL ARTICLE
RESEARCH SUPPORT, NON-U.S. GOV'T
Add like
Add dislike
Add to saved papers

Laparoscopic creation of stomas.

Surgical Endoscopy 1997 January
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.

Full text links

We have located links that may give you full text access.
Can't access the paper?
Try logging in through your university/institutional subscription. For a smoother one-click institutional access experience, please use our mobile app.

For the best experience, use the Read mobile app

Mobile app image

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app

All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

By using this service, you agree to our terms of use and privacy policy.

Your Privacy Choices Toggle icon

You can now claim free CME credits for this literature searchClaim now

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app