Laparoscopically assisted trephine stoma formation.

Abstract

A trephined stoma allows a quick postoperative recovery when a concomitant laparotomy is not necessary. However, both colostomies and ileostomies are associated with a significant short- and long-term complication rate. Review of 25 conventional trephine colostomies showed a complication rate of 20% over 5 years (three hernias and three prolapses in five patients). A laparoscopically assisted method for trephine stoma formation is described that overcomes the disadvantages of the conventional trephine technique; namely the tendency to enlarge the trephine to mobilize the mesentery, leading to prolapse; tension on an inadequately mobilized mesentery, leading to retraction; and difficulties in the orientation of an end stoma. This method was used to fashion six colostomies and one ileostomy with no complications. There was a shorter convalescence and initial stoma care was easier. This procedure is preferred for temporary or permanent stoma formation when a laparotomy is not necessary because it allows a precise trephine mobilization of the mesentery and confirmation of orientation of the bowel.