Davidson Joseph, Healy Costa, Blackburn Simon C, Curry Joe
1 Department of Paediatric Surgery, Great Ormond Street Hospital for Children , London, United Kingdom .
2 Department of Stem Cells and Regenerative Medicine, Developmental Biology and Cancer, GOS-UCL Institute of Child Health , London, United Kingdom .
J Laparoendosc Adv Surg Tech A. 2018 Sep;28(9):1135-1138. doi: 10.1089/lap.2017.0730. Epub 2018 Apr 6.
Ileostomy prolapse has a cumulative risk of 11% and represents a significant complication with associated morbidity, which may result in multiple admissions and procedures requiring a general anesthetic. We have developed a laparoscopic technique for managing stoma prolapse-so-called laparoscopic enteropexy for prolapsing stoma (LEPS).
Retrospective analysis of a prospectively maintained departmental surgical logbook was performed alongside clinical case history review for patients undergoing LEPS. Primary outcome was defined as recurrent prolapse. Secondary outcomes were any postoperative complication or complication occurring at the time of stoma closure.
A total of 15 LEPS procedures were performed on 14 patients with stoma prolapse-13 were patients with ileostomy and 1 with a loop colostomy. Median operative time was 75 minutes (range 50-95). Median postoperative stay was 1 day (1-4 days). There was one return to theater for a small bowel intussusception on the second postoperative day wherein taking down of the bowel and repeat LEPS were necessary. There was one recurrence of prolapse in a separate patient (1/14 [7%]). Three patients have since had their stoma closed without complication.
We describe here the initial case series of our LEPS procedure for managing stoma prolapse. This is a reproducible and technically straightforward laparoscopic procedure with an excellent success rate in preventing further prolapse.
回肠造口脱垂的累积风险为11%，是一种伴有发病率的严重并发症，可能导致多次住院及需要全身麻醉的手术。我们开发了一种用于处理造口脱垂的腹腔镜技术——所谓的用于脱垂造口的腹腔镜肠固定术（LEPS）。
对前瞻性维护的科室手术日志进行回顾性分析，并对接受LEPS手术的患者进行临床病例史回顾。主要结局定义为复发性脱垂。次要结局为任何术后并发症或造口关闭时发生的并发症。
共对14例造口脱垂患者进行了15例LEPS手术——13例为回肠造口患者，1例为袢式结肠造口患者。中位手术时间为75分钟（范围50 - 95分钟）。中位术后住院时间为1天（1 - 4天）。有1例患者在术后第二天因小肠套叠返回手术室，需要切除肠管并再次进行LEPS手术。有1例患者出现脱垂复发（1/14 [7%]）。此后有3例患者成功关闭了造口，无并发症发生。
我们在此描述了我们用于处理造口脱垂的LEPS手术的初始病例系列。这是一种可重复且技术上简单的腹腔镜手术，在预防进一步脱垂方面成功率极高。
