Evaluation of the Outcome of Local Surgery for Stomal Prolapse

Abstract

We reviewed the results of local surgical treatment of stoma prolapse, a long-term complication of stoma construction. Fifteen patients treated for stomal prolapse between 2009 and 2020 at the authors’ and affiliated hospitals were included in this study. The treatment comprised local laparotomic stomal reconstruction (LLSR) in nine patients and stapling repair (SR) in six. We compared and evaluated the clinical and surgical information and postoperative complications. Operation time was significantly shorter in the SR group than in the LLSR group: 20 and 53 min, respectively (p = 0.036). The duration of postoperative hospitalization was shorter in the SR group than in the LLSR group: 5.5 and 8 days, respectively; the difference was not significant (p = 0.088). No short-term complications were found in either group. Regarding long-term, postoperative complications, parastomal hernias developed after 2.5 years in one patient in the LLSR group and after 6 months in one patient in the SR group; both patients had histories of parastomal hernia surgery and had relatively high body mass indices. Local surgery for stomal prolapse was minimally invasive and performed safely. In patients with a history of surgery for parastomal hernia, attention must be paid to the potential of parastomal hernia developing as a postoperative complication.

Mid-term Efficacy of Local Repair Using Modified Altemeier Technique for Stomal Prolapse: A Case Series

“…Recently, another local repair method using a linear stapler was proposed, named “Phillips correction,” for prolapsed end ileostomy; in this method, a repeated procedure was successfully performed in a recurrent case [ 20 ]. Moreover, the median operative time was reportedly shorter in the stapler technique than in MAT (20-40 min [ 8 , 14 ] vs. 75.5 min in this study). One of the potential disadvantages of stapler devices is the increased surgical cost associated with the use of multiple firing.…”

“…For acute SP, the use of topical sugar may be effective when reducing the prolapsed intestine to avoid emergency surgery [ 19 ]. Redundant intestines can be shortened using Delorme’s technique [ 6 , 9 ] or resected using MAT [ 11 - 12 ] or stapler devices [ 5 , 7 - 8 , 14 , 17 - 18 , 20 ]. The mobile intestine can be fixed using button-pexy [ 21 ], endoscopic-assisted procedures [ 22 ], or laparoscopic enteropexy [ 23 ].…”

“…Koide et al demonstrated that there was only one recurrence among 24 patients who underwent local repair using linear staplers [ 14 ]. No recurrence has been previously reported using a similar technique [ 5 , 7 - 8 , 14 ]. Recently, another local repair method using a linear stapler was proposed, named “Phillips correction,” for prolapsed end ileostomy; in this method, a repeated procedure was successfully performed in a recurrent case [ 20 ].…”

“…One of the potential disadvantages of stapler devices is the increased surgical cost associated with the use of multiple firing. In some countries, the cost of staples is not covered by health insurance [ 7 - 8 , 12 , 14 , 17 - 18 ]. In general, local repair was associated with no or very low rates of postoperative complications in all studies [ 5 , 7 - 14 , 17 , 20 , 22 , 24 ], suggesting that surgery can be performed in a minimally invasive manner.…”

“…The surgical procedures include local repair, abdominal wall fixation, and stoma relocation. However, previous reports were mostly case reports or case series with a relatively small number of patients [5][6][7][8][9][10][11][12]; therefore, mid-or long-term results are lacking. In 2020, one of the largest case series (23 cases) was published, and the recurrence rate was > 40% after either local repair or laparotomy [13].…”