Laparoscopic Stomas: The Preferred Approach
Abstracts
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Purpose: The use of the laparoscope for intestinal surgery has been somewhat controversial. We outline a technique of laparoscopic stoma formation and review its indications and outcomes. Methods: A retrospective review of a two institution series of laparoscopic stomas over a 5-year period. Indications, return of bowel function, length of stay, and complications were reviewed. Results: 64 patients underwent attempted laparoscopic stoma formation, with 59 successfully completed. There were 5 conversions to open procedures. 16 loop sigmoid colostomies, 15 loop ileostomies, 6 loop transverse colostomies, 19 end sigmoid colostomies, and 3 end ileostomies were created laparoscopically. Indications included colorectal malignancies (21), decubitus ulcers (15), fistulas (11), anal Crohn's (7), incontinence (7), necrotizing perineal infections (2), sigmoid volvulous (1). 2 patients required local revision secondary to obstruction at the level of the stoma outlet. No other significant complications occurred. Median length of stay was 5 days and median return of bowel function was 1 day. Conclusions: Stoma formation is a clear indication for laparoscopic intestinal surgery. It is safe, easily accomplished, and allows for adhesiolysis and assurance of proper limb orientation. It should be the preferred technique for stoma creation. |
