“Incisionless” colostomy creation: A case series

V. Melkonian, L. de la Torre, J. Ketzer, V. Rodriguez, A. Pena, A. Bischoff
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Abstract

Introduction

The advent of laparoscopic and robotic surgery has revolutionized many operations throughout the surgical world, leading to smaller incisions, reduced post-operative pain, shorter hospital stays, and accelerated post-surgical recovery. However, these advancements come with drawbacks such as limited accessibility, high costs, and sometimes the requirement of multiple incisions. We present an alternative approach for an open “incisionless” colostomy, using an intra-rectal Foley catheter to help identify the descending colon.

Case series

Two patients underwent colostomy creation utilizing this minimally invasive open technique. The technique involves placement of a 24-french Foley catheter intra-rectally prior to prepping and draping the patient, making a circular incision, generally less than 3 cm in diameter over the left lower quadrant where the ostomy will be matured, and identifying of the colostomy limb through palpation of the intra-rectal catheter. This technique was utilized in two patients with minimal previous abdominal surgery and a normal or low body mass index. The first patient was 16-year-old male who had suffered a spinal cord injury, which was complicated by neurogenic bowel. He had considerable difficulties in emptying his colon appropriately, refused utilizing an enema regimen, and requested a permanent stoma. The second patient was a 10-year-old male with developmental delays, and severe idiopathic constipation refractory to medical intervention. In this case the patient's family requested a permanent stoma.

Conclusions

The open “incisionless” minimally invasive approach to colostomy creation provides an alternative approach to laparoscopic methods, with the benefit of minimal trauma to the abdominal wall and absence of a post-operative incision other than the colostomy itself.

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"无切口 "结肠造口术:病例系列
导言腹腔镜手术和机器人手术的出现彻底改变了外科界的许多手术,使手术切口更小、术后疼痛减轻、住院时间缩短、术后恢复加快。然而,这些进步也带来了一些缺点,如手术的可及性有限、费用高昂,有时还需要多个切口。我们介绍了一种 "无切口 "开放式结肠造口术的替代方法,使用直肠内 Foley 导管帮助确定降结肠。该技术包括在为患者做好准备和铺上敷料之前,在直肠内放置一根 24 法分的 Foley 导管,在造口成熟的左下腹部切开一个直径一般小于 3 厘米的环形切口,并通过直肠内导管的触诊确定结肠造口肢体。有两名患者曾做过腹部手术,体重指数正常或偏低,他们都采用了这种技术。第一位患者是一名 16 岁的男性,曾因脊髓损伤而并发神经源性肠病。他在适当排空结肠方面有相当大的困难,拒绝使用灌肠疗法,并要求永久性造口。第二名患者是一名 10 岁的男性,发育迟缓,有严重的特发性便秘,药物治疗无效。结论开放式 "无切口 "微创结肠造口术提供了一种替代腹腔镜方法的方法,其优点是对腹壁的创伤最小,术后除结肠造口本身外没有其他切口。
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来源期刊
CiteScore
0.60
自引率
25.00%
发文量
348
审稿时长
15 days
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