Loss of intestine during stoma closure: an experimental model comparing laparoscopic and conventional techniques.
OBJECTIVE
This study compared laparoscopy-assisted stoma closure (Lap) with conventional closure (Co) to assess loss of intestine.


METHODS
Ileostomies (loop L; single S) were performed 5 cm proximal to the ileocecal junction through a right lower quadrant incision in forty 11-week-old Lewis rats (L = 20, S = 20). Stoma closure was performed 60 days later using laparoscopy (Lap) or conventional closure (Co) in 10 rats each, to give 4 groups, Lap-L, Lap-S, Co-L, and Co-S. End-to-end anastomosis was performed through the stoma site in all rats. Bowel resected from the skin to the anastomosis was termed resected unusable bowel (RUB) and measured blindly. Laparotomy was performed 30 days later to assess the status of the anastomosis and complications.


RESULTS
Average RUB with Lap was significantly shorter; Lap-L (17.8 mm) versus Co-L (23.8 mm), P = 0.002, and Lap-S (10.6 mm) versus Co-S (13.8 mm), P = 0.001. During Co, accidental full-thickness injury to underlying bowel during stoma take-down occurred in 3 Co-L and 2 Co-S rats. All Lap rats were uncomplicated. Average times taken until end of stoma take-down were 6.1 min for Lap-L (3.2 min for trocar insertion, 2.8 min for stoma take-down), 5.6 min for Lap-S (2.8 and 2.7 min), 6.3 min for Co-L (from first incision to stoma take-down), and 5.1 min for Co-S (P = NS). At laparotomy there was no evidence of complications such as wound infection, incisional hernia or anastomotic stenosis in any rat.


CONCLUSIONS
Our results suggest that laparoscopy-assisted stoma closure is safe and quick, and results in less loss of intestine during stoma closure.
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. go1993@hotmail.co.jp
Go
G
Miyano
Satoko
S
Ichikawa
Geoffrey J
GJ
Lane
Yoshifumi
Y
Kato
Tadaharu
T
Okazaki
Atsuyuki
A
Yamataka
D034861:Abdominal Wall / Q000601:surgery*; D000818:Animals; D004195:Disease Models, Animal; D007081:Ileostomy / Q000009:adverse effects*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D008297:Male; D051381:Rats; D011917:Rats, Inbred Lew; D012778:Short Bowel Syndrome / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome