Laparoscopy-assisted stoma closure

Abstract

Purpose: The aim of this study was to describe our improved technique for stoma closure, laparoscopy-assisted stoma closure (LASC).

Patients and methods: Eleven (11) children had LASC at our institute during 2005. Their ages at LASC ranged from 4 to 23 months and their body weight ranged from 3.4 to 10.0 kg. Under general anesthesia, a 5-mm trocar was inserted through an infraumbilical, left-lower, or upper quadrant incision, and laparoscopy was used to observe the bowels, the stoma, the line of separation, and any adhesions. Externally, an incision was made around the stoma circumferentially, and a pair of mosquito forceps was inserted into the abdomen along the attachment between the stoma and the abdominal wall where no intra-abdominal adhesions were present, and the tips of the mosquito forceps were used to free the stoma along the proposed line of separation. Electrocautery was used for hemostasis and for completing the separation. After the stoma was taken down, the bowel was anastomosed and the abdomen closed in layers.

Results: All stomas were taken down easily without any complications in all cases. The average time for each stomal separation, from incising around the stoma until the stoma was taken down, was 23.1 minutes (range, 17-42). Injury to the abdominal wall musculature was minimal. There was 1 case of postoperative small bowel obstruction and no wound infection or incisional herniation.

Conclusions: Although our experience is limited to only 11 patients, our LASC procedure appears to be an effective option for stoma closure.