Diseases of the Colon & Rectum

, Volume 39, Issue 3, pp 285–288 | Cite as

Laparoscopic techniques for fecal diversion

  • Kirk A. Ludwig
  • Jeffrey W. Milsom
  • Antonio Garcia-Ruiz
  • Victor W. Fazio
Original Contributions
  • 43 Downloads

Abstract

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) days 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.

Key words

Laparoscopy Ileostomy Colostomy Laparoscopic surgery Fecal diversion Intestinal surgery 

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References

  1. 1.
    Senapati A, Phillips RK. The trephine colostomy: a permanent left iliac fossa end colostomy without recourse to laparotomy. Ann R Coll Surg Engl 1991;73:305–6.PubMedGoogle Scholar
  2. 2.
    Anderson ID, Hill J, Vohra R, Schofield PF, Kiff ES. An improved means of faecal diversion: the trephine stoma. Br J Surg 1992;79:1080–1.PubMedGoogle Scholar
  3. 3.
    Winkler MJ, Volpe PA. Loop transverse colostomy: the case against. Dis Colon Rectum 1982;25:321–6.PubMedGoogle Scholar
  4. 4.
    Wara P, Sorensen K, Berg V. Proximal fecal diversion: review of ten years' experience. Dis Colon Rectum 1981;24:114–9.PubMedGoogle Scholar
  5. 5.
    Goldsmith MF. Future surgery: minimal invasion. JAMA 1990;264:2723.CrossRefPubMedGoogle Scholar
  6. 6.
    Soper NJ, Brunt LM, Kerbl K. Laparoscopic general surgery. N Engl J Med 1994;330:409–19.CrossRefPubMedGoogle Scholar
  7. 7.
    Milsom JW, Lavery IC, Church JM, Stolfi VM, Fazio VW. Use of laparoscopic techniques in colorectal surgery: a preliminary study. Dis Colon Rectum 1994;37:215–8.CrossRefPubMedGoogle Scholar
  8. 8.
    American Society of Colon and Rectal Surgeons. Policy statement. Dis Colon Rectum 1992;35:5A.Google Scholar
  9. 9.
    Carlson MA, Frantzides CT. Complications of laparoscopic procedures. In: Frantzides CT, ed. Laparoscopic and thoracoscopic surgery. St. Louis: Mosby-Year Book, 1995:224–52.Google Scholar
  10. 10.
    Fasth S, Hulten L. Loop ileostomy: a superior diverting stoma in colorectal surgery. World J Surg 1984;8:401–407.CrossRefPubMedGoogle Scholar
  11. 11.
    Williams NS, Nasmyth DG, Jones D, Smith AH. Defunctioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy. Br J Surg 1986;73:566–70.PubMedGoogle Scholar
  12. 12.
    Fasth S, Hulten L, Palselius I. Loop ileostomy—an attractive alternative to a temporary transverse colostomy. Acta Chir Scand 1980;146:203–7.PubMedGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1996

Authors and Affiliations

  • Kirk A. Ludwig
    • 1
  • Jeffrey W. Milsom
    • 1
  • Antonio Garcia-Ruiz
    • 1
  • Victor W. Fazio
    • 1
  1. 1.Department of Colorectal SurgeryThe Cleveland Clinic FoundationCleveland

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