Urology · 1999
Laparoscopic-assisted continent stoma procedures: our new standard.
Клиническое исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Cadeddu J A, Docimo S G
Аннотация
OBJECTIVES: To compare standard surgery to laparoscopic-assisted surgery for the creation of continent stomas. Creation of an antegrade continent enema (ACE) and/or continent urinary (CU) stoma using the appendix may require a generous midline incision. A laparoscopic-assisted technique to reduce morbidity and improve cosmesis has been described for urologic reconstruction.
METHODS: Between February 1996 and November 1998, 11 laparoscopic-assisted ACE and/or CU stomas were created. A 10-mm umbilical port and two 5-mm ports were used. The cecum, appendix, and ileum were delivered into the pelvis by laparoscopically mobilizing the ascending colon and hepatic flexure. Through a Pfannenstiel or small midline incision, 1 or 2 stomas were constructed in a standard fashion using the appendix and, when necessary, a segment of ileum or sigmoid colon. We compared these 11 cases with a cohort of 5 standard open cases performed during the same period. A midline incision was used in the open cases that extended above the umbilicus. Perioperative data and morbidity were compared. Patients undergoing simultaneous enterocystoplasty were excluded from both groups.
RESULTS: The patients who underwent laparoscopic-assisted surgery (two CU, four ACE, five ACE plus CU) had a mean operative time of 6.1 hours, resumed a regular diet at 2.3 days, and had a mean hospital stay of 4.1 days. The patients who underwent the open procedure (three ACE plus CU, two ACE) averaged an equivalent operative time, but took longer to resume a regular diet (5.6 days; P <0.05) and had a longer mean hospital stay (7.4 days; P <0.05). There were no differences in perioperative complications.
CONCLUSIONS: Laparoscopic-assisted creation of continent stomas resulted in a significantly more rapid recovery, with no increase in operative time. In addition, it resulted in a vastly improved cosmetic appearance.
METHODS: Between February 1996 and November 1998, 11 laparoscopic-assisted ACE and/or CU stomas were created. A 10-mm umbilical port and two 5-mm ports were used. The cecum, appendix, and ileum were delivered into the pelvis by laparoscopically mobilizing the ascending colon and hepatic flexure. Through a Pfannenstiel or small midline incision, 1 or 2 stomas were constructed in a standard fashion using the appendix and, when necessary, a segment of ileum or sigmoid colon. We compared these 11 cases with a cohort of 5 standard open cases performed during the same period. A midline incision was used in the open cases that extended above the umbilicus. Perioperative data and morbidity were compared. Patients undergoing simultaneous enterocystoplasty were excluded from both groups.
RESULTS: The patients who underwent laparoscopic-assisted surgery (two CU, four ACE, five ACE plus CU) had a mean operative time of 6.1 hours, resumed a regular diet at 2.3 days, and had a mean hospital stay of 4.1 days. The patients who underwent the open procedure (three ACE plus CU, two ACE) averaged an equivalent operative time, but took longer to resume a regular diet (5.6 days; P <0.05) and had a longer mean hospital stay (7.4 days; P <0.05). There were no differences in perioperative complications.
CONCLUSIONS: Laparoscopic-assisted creation of continent stomas resulted in a significantly more rapid recovery, with no increase in operative time. In addition, it resulted in a vastly improved cosmetic appearance.