E R Stephenson1, O Ilahi, W A Koltun. 1. Department of Surgery, Pennsylvania State University, College of Medicine, Hershey, USA.
Abstract
UNLABELLED: Stoma creation often involves a separate laparotomy incision. Recently, laparoscopy was suggested to minimize the morbidity associated with conventional open stomal techniques. We describe and evaluate a technique of stoma creation done directly through the stoma site, avoiding both laparotomy and laparoscopy. METHODS: Charts of 36 patients who underwent attempted stoma creation using this closed technique were retrospectively reviewed. RESULTS: A total of 32 patients had stomas successfully created in this fashion (closed group); although four patients failed and required laparotomy (open group), there was an overall success rate of 89 percent. Blood loss (17 +/- 5 vs. 350 +/- 130 ml; P < .001), operative time (52 +/- 8 vs. 169 +/- 35 minutes; P < 0.001), and complications (3/32 vs. 4/4; P < 0.001) favored the closed group. No factors, including diagnosis, obesity, or previous abdominal surgery were identified that contraindicated use of the closed technique. CONCLUSIONS: Stomas can be safely made in a high proportion of patients without the need for laparotomy or laparoscopy. Failure of the closed technique identifies a group of patients who have a high associated operative time, blood loss, and morbidity when laparotomy is used for stoma creation and in whom laparoscopic procedures may improve results.
UNLABELLED: Stoma creation often involves a separate laparotomy incision. Recently, laparoscopy was suggested to minimize the morbidity associated with conventional open stomal techniques. We describe and evaluate a technique of stoma creation done directly through the stoma site, avoiding both laparotomy and laparoscopy. METHODS: Charts of 36 patients who underwent attempted stoma creation using this closed technique were retrospectively reviewed. RESULTS: A total of 32 patients had stomas successfully created in this fashion (closed group); although four patients failed and required laparotomy (open group), there was an overall success rate of 89 percent. Blood loss (17 +/- 5 vs. 350 +/- 130 ml; P < .001), operative time (52 +/- 8 vs. 169 +/- 35 minutes; P < 0.001), and complications (3/32 vs. 4/4; P < 0.001) favored the closed group. No factors, including diagnosis, obesity, or previous abdominal surgery were identified that contraindicated use of the closed technique. CONCLUSIONS: Stomas can be safely made in a high proportion of patients without the need for laparotomy or laparoscopy. Failure of the closed technique identifies a group of patients who have a high associated operative time, blood loss, and morbidity when laparotomy is used for stoma creation and in whom laparoscopic procedures may improve results.
Authors: H Scheidbach; H Ptok; D Schubert; D Kose; O Hügel; I Gastinger; F Köckerling; H Lippert Journal: Langenbecks Arch Surg Date: 2007-08-10 Impact factor: 3.445
Authors: Seung-Seop Yeom; Chan Wook Kim; Sung Woo Jung; Se Heon Oh; Jong Lyul Lee; Yong Sik Yoon; In Ja Park; Seok-Byung Lim; Chang Sik Yu; Jin Cheon Kim Journal: Ann Coloproctol Date: 2018-04-30