title: Minimal anatomical disruption in stoma formation: the lateral rectus abdominis positioned stoma (LRAPS).
abstract: OBJECTIVE
  Parastomal hernias are difficult to manage and recent attention has focused on their prevention including the use of prophylactic mesh at the time of initial surgery.
  
  
  METHODS
  A novel 'anatomical' approach to stoma formation, the lateral rectus abdominis positioned stoma (LRAPS), involving minimal anterior abdominal wall disruption is described.
  
  
  RESULTS
  LRAPS was carried out electively (n = 25) or as an emergency (n = 4) for benign or malignant pathology. Twenty-two had a midline laparotomy and all types of stomas were fashioned. There were two early and three later deaths from advanced malignancy. No parastomal hernias have been detected at a mean follow-up of 13 (range 7-18) months and none detected by CT scanning in 20 of 24 patients with colorectal cancer at a mean follow-up of 14 (range 10-18) months.
  
  
  CONCLUSIONS
  LRAPS reduces the incidence of early stomal herniation.
authors.affiliation: Department of General & Colorectal Surgery, Royal Gwent Hospital, Newport, South Wales, UK. brian.stephenson@gwent.wales.nhs.uk
authors.forename: B M
authors.initials: BM
authors.lastname: Stephenson
authors.forename: M D
authors.initials: MD
authors.lastname: Evans
authors.forename: J
authors.initials: J
authors.lastname: Hilton
authors.forename: E S
authors.initials: ES
authors.lastname: McKain
authors.forename: G L
authors.initials: GL
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004766:Enterostomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D046449:Hernia, Abdominal / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D017568:Rectus Abdominis / Q000601:surgery*