Laparoscopic versus open stoma creation for fecal diversion

Abstract:

This study compared the results for laparoscopic and conventional laparotomy techniques of intestinal stoma creation. All patients who underwent only fecal diversion without any other abdominal procedures were included. Neither prior laparotomy, inflammatory bowel diseases, nor recurrent or metastatic carcinoma were absolut contraindications. Parameters evaluated included age, indications, previous abdominal surgery, operative time, time until stoma function, and the length of postoperative hospitalization. Patients were divided into two groups: laparoscopy and laparotomy. Between March 1993 and October 1996, 41 laparoscopic and 11 intestinal stomas by laparotomy were performed for fecal diversion. There were no significant differences between the 2 groups relative to mean age of patients or history of previous abdominal surgery. No significant differences in mean operation time were noted among patients with prior abdominal surgery: laparoscopy group. 98 min vs. laparotomy group, 95 min. Among patients without prior abdominal surgery, the mean operation time was: laparoscopy group, 78 min vs. laparotomy group, 63 min (p = NS). Morbidity rates were not statistically different between the 2 groups. Stomas began to function in the laparoscopic group earliet (2.3 days) than in the laparotomy group (4.5 days) (p<0.05). Similarly, the length of postoperative hospitalization was shorter in the laparoscopic group (5.3 days vs. 7.6 days, p<0.05). Interestingly, at a mean follow-up of 22 months, none of the patients in the laparoscopic group had stoma prolapse vs. 2 patients in the laparotomy group. Laparoscopic stoma construction was accomplished without significantly longer operative time or complications and was associated with earlier function and more rapid hospital discharge than were stomas created by laparotomy. Moreover, in this small group of patients at short follow-up, stoma prolapse has not been observed.