Shintaro Akamoto1, Yuma Fukumoto1, Yusuke Konishi1, Kazuhiko Nakagawa1, Tetsuji Fukuhara1, Kazuyasu Kobayashi1, Toshihito Hanaoka1, Yasuyuki Suzuki2. 1Sumitomo Besshi Hospital, 2Kagawa University
Background: Although the use of defunctioning ileostomy is a common practice in colorectal surgery, stoma obstruction is sometimes encountered by surgeons, especially after laparoscopic surgery.
Purpose: The aim of this study was to assess the risk of stoma obstruction.
Methods:
1) We retrospectively reviewed all patients who underwent colorectal resection and defunctioning ileostomy between April 2008 and March 2014 in Kagawa University Hospital. A round incision 20 mm in diameter was made in all patients at a preoperatively marked site on the skin.The factors affecting stoma obstruction were analyzed.
2) We prospectively analyzed the clinical data of patients who underwent skin extension by laparoscopic pneumoperitoneum between April 2016 and September 2016 in Sumitomo Besshi Hospital. A circular mark was made on the abdomen using a metallic pipe 19 mm in diameterwith the pneumoperitoneum at 10 mmHg according to the principles of stoma site marking. After degassing, the diameter of the marking was measured.
Results:
1) Forty-five patients underwent defunctioning ileostomy during the study period. Patients were divided into an obstruction group (n = 6) and a non-obstruction group (n = 39). All stoma obstructions were treated conservatively and there was no surgically treated case. Age (P = 0.751), sex (P = 0.752), operative time (P = 0.726), intraoperative bleeding (P = 0.249), postoperative complications (P = 0.352), and the use of antidiarrheal drugs (P = 0.482) were not associated with stoma obstruction. The percentage undergoing laparoscopic surgery in the obstruction group was higher than in the non-obstruction group (obstruction group: lap/open = 6/0 vs the non-obstruction group: lap/open = 16/23, P = 0.009).
2) Twenty-nine patients underwent circular marking. The marking diameter under pneumoperitoneum significantly decreased by 19.1% after degassing (under pneumoperitoneum: 19.5 ± 0.6 vs after degassing: 17.7 ± 1.0, P < 0.001). The patients whose marking diameter decreased 3 mm or more were defined as group A (n = 7) and those that decreased less than 3 mm were defined as group B (n = 22). There was no significant difference in age (P = 0.683), sex (P = 0.667), height (P = 0.231), weight (P = 0.346), or BMI (P = 0.628) between the groups.
Conclusion: Laparoscopic defunctioning ileostomy carries a risk of stoma obstruction. Pneumoperitoneum makes the incision seem larger than expected. We should pay attention to making the skin and fascial incision larger under pneumoperitoneum to prevent stoma obstruction.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79106
Program Number: P244
Presentation Session: Poster (Non CME)
Presentation Type: Poster
