Minimal anatomical disruption in stoma formation: the lateral rectus abdominis positioned stoma (LRAPS)

Abstract

Aim: Parastomal hernias are difficult to manage and recent attention has focused on their prevention including the use of prophylactic mesh at the time of initial surgery.

Method: A novel 'anatomical' approach to stoma formation, the lateral rectus abdominis positioned stoma (LRAPS), involving minimal anterior abdominal wall disruption is described.

Results: LRAPS was carried out electively (n = 25) or as an emergency (n = 4) for benign or malignant pathology. Twenty-two had a midline laparotomy and all types of stomas were fashioned. There were two early and three later deaths from advanced malignancy. No parastomal hernias have been detected at a mean follow-up of 13 (range 7-18) months and none detected by CT scanning in 20 of 24 patients with colorectal cancer at a mean follow-up of 14 (range 10-18) months.

Conclusion: LRAPS reduces the incidence of early stomal herniation.