Anderson D N, Driver C P, Park K G, Davidson A I, Keenan R A
Department of Colorectal Surgery, Aberdeen Royal Infirmary, Foresterhill, UK.
Int J Colorectal Dis. 1994 Aug;9(3):138-40. doi: 10.1007/BF00290190.
Turnbull's "loop" ileostomies is a routinely performed procedure in the management of a variety of colorectal problems. Mechanical and functional complications occur with both permanent and temporary ileostomies, however they are more common with the loop than with the end (Brooke) variety. With the advent of restorative proctocolectomy with pouch formation, and the documented benefit of simultaneous temporary faecal diversion, the incidence of such complications will rise. Bowel obstruction, requiring laparotomy in the interval before stoma closure, is more commonly associated with the loop ileostomy. A loop stoma is routinely brought out directly through the abdominal wall, with little or no fixation or closure of the lateral space. However, anti-mesenteric fixation, as described here, minimises the risk of volvulus by widening the attachment of the adjacent ileum to the parities, creating a broader fulcrum. Since adopting this simple technique, we report no complications in over 30 loop ileostomies, "fixed" by this technique and followed up for a minimum of 4 years. Where applicable, no difficulty was encountered with stoma closure, either by a transverse single layer serosubmucosal technique, or as a minimal resection with end to end anastomosis (sewn or stapled), following bowel mobilisation. This technique should minimise the frequency of obstructive events, and we recommend it's routine use.
特恩布尔“襻式”回肠造口术是处理各种结直肠问题时常规施行的手术。永久性和临时性回肠造口术都会出现机械性和功能性并发症，不过襻式造口术比端式（布鲁克式）造口术更易出现这些并发症。随着带贮袋的保留性直肠结肠切除术的出现，以及同期临时性粪便转流的已证实益处，此类并发症的发生率将会上升。在造口关闭前的间隔期需要剖腹手术的肠梗阻，更常与襻式回肠造口术相关。襻式造口通常直接经腹壁引出，外侧间隙很少或根本不固定或闭合。然而，如本文所述的系膜对侧固定，通过扩大相邻回肠与腹壁的附着，形成更宽的支点，将肠扭转风险降至最低。自从采用这种简单技术以来，我们报道采用该技术“固定”并随访至少4年的30余例襻式回肠造口术均无并发症。在适用的情况下，无论是采用横向单层浆肌层下技术，还是在肠管游离后进行端端吻合（缝合或吻合器吻合）的最小切除，造口关闭均未遇到困难。该技术应能减少梗阻事件的发生频率，我们建议常规使用。
