title: Laparoscopic-assisted colostomy in children.
abstract: BACKGROUND
  Colostomy morbidity has been reported to be as high as 50%. Laparoscopic-assisted colostomy (LAC) is associated with decreased colostomy complication. LAC is recommended for stoma formation in adults but has not been previously reported in children. In this paper, we report on our initial experience with LAC in children.
  
  
  METHODS
  Using a two- to four-port (3.5-mm) technique, LAC was performed in a female with an imperforate anus and 2 male patients with complicated Hirschsprung's disease (HD), respectively. Data collected included operative time, time to recover bowel function, and morbidity. Close follow-up was done until stoma closure.
  
  
  RESULTS
  The operative time was 144 minutes in the HD patients (including concomitant laparoscopic biopsies and a leveling colostomy) and 40 minutes in the imperforate anus patient. Median time to passage of both flatus and stool was 40 hours (range, 24-48). Time to commence feeds postop was 40 hours (range, 24-48). The median time of follow-up was 3 months (range, 2-9) until the stoma was taken down. No complications have occurred to date.
  
  
  CONCLUSIONS
  LAC is safe and easily performed in neonates and infants. It facilitates accurate stoma placement and orientation. It allows additional bowel mobilization, especially in HD. In accordance with the adult experience, LAC seems to obviate stoma-related complications. Encouraged by our initial low morbidity rate, a prospective evaluation of this technique is planned.
authors.affiliation: Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Claudio
authors.initials: C
authors.lastname: De Carli
authors.forename: Marcos
authors.initials: M
authors.lastname: Bettolli
authors.forename: Carl-Christian
authors.initials: CC
authors.lastname: Jackson
authors.forename: Brian
authors.initials: B
authors.lastname: Sweeney
authors.forename: Steven
authors.initials: S
authors.lastname: Rubin
mesh_terms: D001006:Anus, Imperforate / Q000601:surgery*; D003125:Colostomy / Q000379:methods*; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D010535:Laparoscopy; D008297:Male