Colostomy creation for fecal diversion: Early experience utilizing single incision laparoscopic surgery.

Clarence Clark, MD, FACS, Darryl Knight, MD, Carl Lokko, MD, Travelyan Walker, MD

Morehouse School of Medicine

OBJECTIVE:
Laparoscopic multi-port stoma creation has shown to be safe and feasible with low morbidity. Few reports have been published, however, on the use of single incision laparoscopic (SIL) surgery for the creation of diverting colostomies. Here, we report our early experience of SIL colostomy for fecal diversion at a large urban county hospital.

METHODS:
The colostomy site is marked preoperatively by an Enterostomal therapy nurse. A 3cm stoma incision is made at this site with a longitudinal fascial incision. A small Applied Medical Alexis Wound Protector (Applied Medical, Rancho Santa Margarita, CA) is inserted followed by a SILS™ Port Multiple Instrument Access Port (Covidien, Inc., Norwalk, CT). Mobilization of the left and sigmoid colons is accomplished with a Ligasure AdvanceTM (Covidien, Inc., Norwalk, CT) along the lateral peritoneal reflection. The sigmoid is then guided through the wound protector with laparoscopic graspers preserving the colon orientation. A standard loop colostomy is matured over a bar after removing the wound protector.

RESULTS:
Four SIL diverting colostomies were performed at our institution by a single surgeon (CEC). There were 3 males and 1 female with ages ranging from 34-50. The average BMI was 24.9. Indications included non-healing Stage 4 sacral decubitus ulcer in a quadriplegic patient with fecal incontinence, Stage III rectal cancer with perirectal and seminal vesicle abscesses, extensive necrotizing squamous cell cancer of anus with perirectal abscesses, and refractory Crohn’s disease with complex perianal fistula-in-ano, anal fissure, and rectovaginal fistula. There were no conversions or additional ports needed. Patients were transitioned to an enteral diet (3 regular and one jejunostomy tube feeds) on postoperative day 1. The average time to return of bowel function was 2 days with either flatus or BM. The average operative time was 106 minutes. The average length of stay was 3.7 days for 3 of the patients with the fourth remaining as an inpatient due to placement (quadriplegic). There were no complications or deaths.

CONCLUSION:
The use of SIL technique for colostomy formation is feasible. This technique provides fecal diversion for a wide range of rectal disorders with ease of bowel orientation, no additional incisions, and early return of bowel function.


Session: Poster Presentation

Program Number: P073

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