Division of Colorectal Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
Dis Colon Rectum. 2011 Dec;54(12):1542-6. doi: 10.1097/DCR.0b013e31822b71eb.
Laparoscopic surgery has become a favorable alternative to conventional open surgery for the creation of intestinal stomas, and it offers many benefits including reduced postoperative pain, ileus, and hospital stay. Single-incision laparoscopic surgery has been described for many abdominal operations. It may offer better cosmetic outcomes and reduce incisional pain, adhesions, and recovery time.
In this study, we aimed to describe a novel technique of scarless single-incision laparoscopic loop ileostomy for fecal diversion and to report our experience with 8 patients who underwent this procedure within a 1-year period.
This study was designed as a retrospective case series.
This investigation was conducted at a single-institution, tertiary referral center.
Eight consecutive patients undergoing scarless single-incision laparoscopic loop ileostomy between August 2009 and August 2010 were included.
Scarless single-incision laparoscopic loop ileostomies were performed.
Among the outcomes measured were operation time, intraoperative blood loss, recovery of intestinal function, length of hospital stay, and surgical complications.
Seven patients underwent surgery for active Crohn's disease refractory to medical therapy. One patient underwent surgery for radiation-induced rectovesical fistula. Median surgery time was 76 minutes, and median intraoperative blood loss was 10 mL. Median length of postoperative hospitalization was 7 days. Of the 8 patients included in our series, 2 patients (25%) required reoperation for stoma ischemia because of vascular congestion that we attribute to a tight fascial opening or extensive bowel manipulation. Other surgical complications included nonoperative readmission for ileus and partial small-bowel obstruction (n = 2), anal dilation to evacuate an obstructed distal colon (n = 1), and peristomal cellulitis (n = 1).
This study was limited by its small sample size and its retrospective nature.
Scarless single-incision laparoscopic loop ileostomy is a feasible alternative to standard laparoscopy for fecal diversion. Surgeons attempting this technique should do so with caution, given the high stoma ischemia rate in our small case series.
腹腔镜手术已成为传统开腹手术创建肠造口术的一种有利替代方法，它具有许多优点，包括减少术后疼痛、肠梗阻和住院时间。单切口腹腔镜手术已被用于许多腹部手术。它可能提供更好的美容效果，并减少切口疼痛、粘连和恢复时间。
本研究旨在描述一种用于粪便转流的无痕单切口腹腔镜套叠回肠造口术的新方法，并报告我们在 1 年内对 8 例接受该手术的患者的经验。
本研究设计为回顾性病例系列。
本研究在一家单机构三级转诊中心进行。
8 例连续患者于 2009 年 8 月至 2010 年 8 月期间接受无痕单切口腹腔镜套叠回肠造口术。
进行无痕单切口腹腔镜套叠回肠造口术。
测量的结果包括手术时间、术中失血量、肠功能恢复、住院时间和手术并发症。
7 例患者因药物治疗无效的活动性克罗恩病而行手术。1 例患者因放射性直肠膀胱瘘而行手术。中位手术时间为 76 分钟，中位术中失血量为 10 毫升。中位术后住院时间为 7 天。在我们的系列中包括的 8 例患者中，2 例（25%）因血管充血导致的吻合口缺血需要再次手术，我们将其归因于筋膜开口过紧或广泛的肠管操作。其他手术并发症包括非手术再入院治疗肠梗阻和部分小肠梗阻（2 例）、为排空梗阻的远端结肠而行肛门扩张术（1 例）和造口周围蜂窝织炎（1 例）。
本研究受到其小样本量和回顾性性质的限制。
无痕单切口腹腔镜套叠回肠造口术是粪便转流的一种可行替代方法，与标准腹腔镜相比。鉴于我们小病例系列中吻合口缺血发生率较高，尝试该技术的外科医生应谨慎操作。
