Faculty Collaboration Database

Laparoscopic techniques for fecal diversion. Dis Colon Rectum 1996 Mar;39(3):285-8

Date

03/01/1996

Pubmed ID

8603549

DOI

10.1007/BF02049469

Scopus ID

2-s2.0-0029878861 (requires institutional sign-in at Scopus site)   74 Citations

Abstract

UNLABELLED: Although the role of laparoscopic techniques in performing major colorectal resections is unclear, laparoscopy may be well suited for fecal diversion procedures because no resection and minimal tissue dissection is required.

PURPOSE: This report reviews our initial experience with laparoscopic stoma procedures to assess safety and efficacy.

METHODS: Using a simple two-cannula technique, 24 such procedures (16 loop ileostomies, 6 end sigmoid colostomies, 1 transverse, and 1 sigmoid loop colostomy) were attempted. Indications for diversion were rectovaginal fistula (7), perianal sepsis (7), incontinence (4), advanced rectal or colon carcinoma (4), and complicated pelvic infection (2). There were 15 females and 9 males with a median age of 44 (range, 25-88) years.

RESULTS: Median operative time was 60 (range, 20-120) minutes, and median blood loss was 50 (range, 0-150) ml. There were no intraoperative complications. One case was converted to a laparotomy because of dense adhesions. Median time to passage of both flatus and stool was one (range, 1-3) day for ileostomy patients, two (range, 2-4) for flatus, and 3 (range, 2-6) days for stool after colostomy. Median time to discharge was 6 (range, 2-28) days and was often delayed by the primary disease process or ostomy teaching. One major postoperative complication, a pulmonary embolism, occurred eight days after operation in a patient with near obstructing, widely metastatic colon carcinoma. This patient later died of pulmonary failure. All stomas have functioned well, with no revisions required.

CONCLUSIONS: Laparoscopic fecal diversion procedures can be performed safely, simply, and effectively. Apparent advantages over standard techniques are avoidance of a laparotomy, while maintaining the ability to precisely identify and orient the pertinent bowel segment and rapid return of bowel function.

Author List

Ludwig KA, Milsom JW, Garcia-Ruiz A, Fazio VW

Author

Kirk A. Ludwig MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Blood Loss, Surgical
Colostomy
Female
Humans
Ileostomy
Laparoscopes
Laparoscopy
Length of Stay
Male
Middle Aged
Prospective Studies
Time Factors
Treatment Outcome