Extracorporeal staple technique: an alternative approach to the treatment of critical colostomy stenosis.

Abstract

We describe an extracorporeal staple technique used to treat severe colostomy stenosis under analgo-sedation, thus avoiding relaparotomy. The surgery is performed under short-term sedation. The orifice of the stoma is widened and overgrowing skin is excised. The volume and diameter of the stoma are assessed. The anvil of a circular stapler device is inserted into the lumen of the colostomy. First bowel layers and then skin are closed with purse-string sutures. One firing of the stapler is used to reshape the stoma. The procedure takes around 20–30 min. One circular stapler is used. The patient can be discharged the same day or a day after surgery. No complications were noted in operated patients. At 6- and 12-month follow-ups, a slight narrowing of the colostomy was visible, but no recurrence of the stricture was noted. The described technique is an interesting, easy and safe alternative to previous methods of treatment for stenosed end-colostomy. Importantly, it is an extra-abdominal procedure and may be offered to patients with a history of multiple abdominal operations or with serious coexisting medical conditions in the one-day surgery setting.

Outpatient treatment for colostomy stenosis; report of 3 cases

“…We proposed the daily placement of a baby pacifier to our patients, but the stenosis worsened. If the colostomy is temporary, then the reversal of the stoma with colonic anastomosis is chosen, but when the stoma is permanent, there is a need to perform colostomy again as a formal surgical procedure in the operating room, either manually or with a circular stapler [8] , [9] .…”

Z-plastika gydant ženklią kolostomos stenozę

“…Small number of patients in published series is not sufcient to give insight in the advantages of the extraabdominal procedure including Z-plasty [5][6][7].…”

“…Z-plasty technique does not require hospitalization, can be performed on a daily basis, is cost-effective and most important, do not expose patients on risk for intraperitoneal operations [5,7,8].…”

“…Bowel was freed on the facial level, following with double classical Z-plasty incision of the skin and bowel on both sides of the stoma and Z-plasy creation of the new stoma [7]. No antibiotic prophylaxis was used prior or after the surgical treatment.…”

“…Different surgical techniques are used in treatment of severe stenosis resulted from end-colostomy: local excision of the scar tissue at the mucocutaneus junction or translocation and creation of the new stoma [4]. Extra-abdominal procedures such Z-plasty, W-plasty and extracorporeal staple technique were easy surgical procedures which eliminate a need for stoma dislocation and possibility for intraperitoneal complications [5][6][7].…”