Improved stabilization of conventional (Brooke) ileostomies with the stapler technique.
The rate of functional complications of conventional (Brooke) ileostomy is high and endangers the complete postoperative rehabilitation of the patients. About half of these complications (retraction with/without stenosis, intermittent recession, and prolapse) occur within the classical prominent stoma and are caused by displacement of the serosa surfaces. We have stabilized conventional ileostomies in 39 patients with rows of staples placed paramesenterially and longitudinally. The ileum was everted in the classical way in the primary construction of ileostomies in 19 patients. On the other hand, in 11 patients the prominence of the stoma was established by pulling the ileum out through the previously plane-sutured stoma. In addition, 9 patients with ileostomies which were not primarily stabilized were corrected with the stapler technique to treat complications. With follow-up ranging from 0.2 years to 4.2 years, there have been no complications due to sliding of the nipple in these 39 patients. In contrast, there were complications in 37% of 38 patients with non-stabilized ileostomies with follow-up to the second postoperative year. It was more easily reproducible, more exact, and less traumatic to create the stoma prominence by pulling the intestine out from a primarily plane stoma than with classical eversion. With use of the stapler in repairing complications, local ileostomy constructions were no longer required in every second patient. Consequently, a Brooke ileostomy can be constructed more easily with the stapler technique, ensuring long-term function or restoration of function.
Ecker
K W
KW
Surgery Division, University of the Saarland, Homburg, Federal Republic of Germany.
Schmid
T
T
Xu
H S
HS
Feifel
G
G
D006801:Humans; D007081:Ileostomy / Q000009:adverse effects / Q000379:methods*; D007082:Ileum / Q000473:pathology; D013528:Surgical Staplers; D016896:Treatment Outcome