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

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.