Laparoscopic-assisted continent stoma procedures: our new standard.

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.