Laparoscopically assisted trephine stoma formation.
A trephined stoma allows a quick postoperative recovery when a concomitant laparotomy is not necessary. However, both colostomies and ileostomies are associated with a significant short- and long-term complication rate. Review of 25 conventional trephine colostomies showed a complication rate of 20% over 5 years (three hernias and three prolapses in five patients). A laparoscopically assisted method for trephine stoma formation is described that overcomes the disadvantages of the conventional trephine technique; namely the tendency to enlarge the trephine to mobilize the mesentery, leading to prolapse; tension on an inadequately mobilized mesentery, leading to retraction; and difficulties in the orientation of an end stoma. This method was used to fashion six colostomies and one ileostomy with no complications. There was a shorter convalescence and initial stoma care was easier. This procedure is preferred for temporary or permanent stoma formation when a laparotomy is not necessary because it allows a precise trephine mobilization of the mesentery and confirmation of orientation of the bowel.
Neath General Hospital, South Wales, U.K.
S U
SU
Kini
Y
Y
Perston
A G
AG
Radcliffe
D000714:Anastomosis, Surgical; D003125:Colostomy / Q000295:instrumentation / Q000379:methods; D005069:Evaluation Studies as Topic; D006801:Humans; D007081:Ileostomy / Q000295:instrumentation / Q000379:methods; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D010030:Ostomy / Q000379:methods*; D011183:Postoperative Complications / Q000503:physiopathology; D011379:Prognosis