Kang Seng-Muk, Cho Jung Rae, Oh Heung-Kwon, Lee Eun-Ju, Kim Min Hyun, Kim Duck-Woo, Kang Sung-Bum
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Ann Coloproctol. 2020 Feb;36(1):17-21. doi: 10.3393/ac.2019.04.25. Epub 2020 Feb 29.
Single-port laparoscopic techniques can be optimized with confined incisions. This approach has an intraoperative advantage of excellent visualization of the correct intestinal segment for exteriorization, along with direct visual control of the extraction to avoid twisting. However, only a few studies have verified the efficacy of the technique. Thus, this study assessed the results of single-port laparoscopic stoma creation for fecal diversion, specifically focusing on feasibility, safety, and efficacy.
Patients who underwent single-incision enterostomy performed by a single surgeon were included. Data on demographics, indications for and chosen procedure, and operation results were retrospectively collected and analyzed.
Between April 2015 and January 2018, a total of 13 patients (8 males, 5 females) with a mean age of 57.7 years (range, 41-83 years) underwent single-port ileostomy creation. The most common reason for diversion was palliative ileostomy for colon obstruction or fistula from peritoneal malignancy (n = 12), followed by colonic fistula with necrotizing pancreatitis (n = 1). There were no cases of conversion to open or multiport laparoscopic surgery. The mean operative time was 54 minutes (range, 37-118 minutes), and the median length of hospital stay was 8 days (range, 2-211 days). A postoperative complication, aspiration pneumonia, was documented in 1 patient and treated conservatively. The mean duration of bowel movement was 0.7 days (range, 0-4 days). All stomas had good function, and there was no 30-day mortality.
Single-port laparoscopic ileostomy in patients with a palliative setting could be a safe and feasible option for fecal diversion.
单孔腹腔镜技术可通过有限的切口进行优化。这种方法在术中具有优势，能够清晰地看到用于外置的正确肠段，同时在提取过程中可直接进行视觉控制以避免扭转。然而，仅有少数研究证实了该技术的有效性。因此，本研究评估了单孔腹腔镜造口术用于粪便转流的结果，特别关注其可行性、安全性和有效性。
纳入由单一外科医生进行单切口肠造口术的患者。回顾性收集并分析患者的人口统计学数据、手术指征及所选手术方式、手术结果。
2015年4月至2018年1月，共有13例患者（8例男性，5例女性）接受了单孔回肠造口术，平均年龄为57.7岁（范围41 - 83岁）。转流的最常见原因是因结肠梗阻或腹膜恶性肿瘤所致瘘管而行姑息性回肠造口术（n = 12），其次是结肠瘘合并坏死性胰腺炎（n = 1）。没有转为开放手术或多孔腹腔镜手术的病例。平均手术时间为54分钟（范围37 - 118分钟），中位住院时间为8天（范围2 - 211天）。1例患者出现术后并发症——吸入性肺炎，经保守治疗。平均排便时间为0.7天（范围0 - 4天）。所有造口功能良好，无30天死亡率。
对于姑息性患者，单孔腹腔镜回肠造口术可能是粪便转流的一种安全可行的选择。
