Laparoscopic Enteropexy for Prolapsing Stoma: A Case Series Describing a Novel Technique

Davidson, Joseph; Healy, Costa; Blackburn, Simon; Curry, Joe

doi:10.1089/lap.2017.0730

Cited by 14 publications

(7 citation statements)

References 20 publications

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“…Such cases would certainly have benefitted from the laparoscopic enteropexy for prolapsing stoma (LEPS) described by Davidson et al but for the unavailability of the skills and equipment. 13 The morbidity of open surgery to correct such progressively enlarging prolapse is the reason surgeons in similar circumstances as ours prefer to manage conservatively. However, surgeons who have the resources for minimally invasive correction like the LEPS and other techniques will tend to explore those options.…”

Section: Discussionmentioning

confidence: 69%

Prolapse of colostomy in children; characteristics, predisposing factors and preventive measures in four health facilities in Southern Nigeria

Chinyeaka²

2019

ijmhs

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IntroductionThe protrusion of the bowel through the stoma in a colostomy is one of thecommon complications of colostomy. Though it rarely gets secondarilycomplicated, it causes significant morbidity by virtue of the increasing bowel massoutside. The predisposing factors and progression in children are not well reportedin our region.AimTo evaluate the characteristics and occurrence of colostomy prolapse in childrenand to identify any factors predisposing to this complication in our practice.Patients and MethodsThis is a five year prospective study of paediatric colostomy in the authors’ servicebetween March 2013 and April 2018. Patients were categorized into those thatdeveloped prolapse (Pro group), and those that did not (Non Pro group). Othervariables investigated were gender, age at creation of colostomy, indication, type,and duration of colostomy, presence of raised intra abdominal pressure. Statisticswas with SPSS 21.ResultsTwenty seven (28.4%) of 95 children who had colostomy during the study perioddeveloped prolapsed. Prolapse occurred more in patients who had their colostomyat a relatively older age. There was a positive association of prolapse andHirschsprungs disease but no association with the gender or duration of stoma.ConclusionColostomy prolapse is a common complication seen in our practice. Cases ofneglected Hirschsprungs disease in children have increased risk of thiscomplication. Extra caution is therefore needed in forming colostomy in this groupof patients.

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Section: Discussionmentioning

confidence: 69%

Prolapse of colostomy in children; characteristics, predisposing factors and preventive measures in four health facilities in Southern Nigeria

Chinyeaka²

2019

ijmhs

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“…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 ]. The space between the abdominal wall and intestine can be narrowed by local treatment using a mesh strip technique [ 24 ] or Thiersch’s technique [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

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

Tsujinaka¹,

Kakizawa²,

Hatsuzawa³

et al. 2022

Cureus

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Introduction: Stomal prolapse (SP) is characterized by full-thickness protrusion of the bowel through the stoma site. The surgical procedures for SP include local repair, abdominal wall fixation, and stoma relocation. However, previous reports were mostly case reports or case series with a small number of patients and lacked long-term results. A modified Altemeier technique (MAT) has been used for the local repair of SP in our institution, and this study aimed to evaluate its mid-term efficacy. Methods: We reviewed patients who underwent MAT for SP between August 2013 and December 2020. The variables included patient characteristics, type of stoma, indications of stoma creation, the time interval from stoma creation to prolapse, site of prolapse, reasons for SP surgery, perioperative variables, complications during SP surgery, and length of follow-up. Recurrence of SP was defined as the need for change in stoma care or re-protrusion of the stoma by more than 5 cm in length. Results: Ten patients were included in this study. The median age at the time of SP surgery was 71.5 years. The indications of stoma creation included unresectable or recurrent intra-abdominal malignancies in four patients, diverting ileostomy with rectal cancer surgery in two, transverse colon cancer in one, gastric and rectal cancer in one, rectovaginal fistula in one, and non-occlusive mesenteric ischemia in one. The median interval from stoma creation to prolapse was 2.5 months. Six patients underwent elective SP surgery, and four patients underwent emergency surgery for incarcerated prolapse. The median operative time was 75.5 min. Postoperative complications that included transient mucosal ischemia and subcutaneous abscess occurred in one patient. There were four recurrences (40%), and the median time interval from surgery to recurrence was 4.5 months. Two patients underwent repeated MAT, one of whom underwent stomal reversal with laparotomy for re-recurrence. The median follow-up duration was 19 months. Conclusion: MAT for SP is associated with a high recurrence rate in mid-term follow-up.

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“…2). Methods of fixing the mobile intestine include button-pexy fixation [40][41][42][43], techniques for suturing and fixing a stoma to the abdominal wall (conventional method) locally or by laparotomy [26], and laparoscopic fixation of a stoma to the abdominal wall [44] (Fig. 2).…”

Section: Classification Of Surgical Treatments According To Pathophys...mentioning

confidence: 99%

“…This method involves fixing the prolapsed-side intestine to the abdominal wall laparoscopically. Davidson et al [ 44 ] performed this procedure in 14 cases, and 1 case needed reoperation due to intussusception after the initial surgery. They reported one recurrence of stoma prolapse (1 of 14 cases), corresponding to a 7% recurrence rate ( Table 1 ).…”

Section: Present State Of Surgical Treatmentsmentioning

confidence: 99%

Prolapse of intestinal stoma

Maeda¹

2022

Ann Coloproctol

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Stoma prolapse can usually be managed conservatively by stoma care nurses. However, surgical management is considered when complications make traditional care difficult and/or stoma prolapse affects normal bowel function and induces incarceration. If the stoma functions as a fecal diversion, the prolapse is resolved by stoma reversal. Loop stoma prolapse reportedly occurs when increased intraabdominal pressure induces stoma prolapse by pushing the stoma up between the abdominal wall and the intestine, particularly in cases of redundant or mobile colon. Therefore, stoma prolapse repair aims to prevent or eliminate the space between the abdominal wall and the intestine, as well as the redundant or mobile intestine. Accordingly, surgical repair methods for stoma prolapse are classified into 3 types: methods to fix the intestine, methods to shorten the intestine, and methods to eliminate the space between the stoma and the abdominal wall around the stoma orifice. Additionally, the following surgical techniques at the time of stoma creation are reported to be effective in preventing stoma prolapse: an avoidance of excessive fascia incision, fixation of the stoma to the abdominal wall, an appropriate selection of the intestinal site for the stoma orifice to minimize the redundant intestine, and the use of an extraperitoneal route for stoma creation.

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Laparoscopic Enteropexy for Prolapsing Stoma: A Case Series Describing a Novel Technique

Abstract: We describe here the initial case series of our LEPS procedure for managing stoma prolapse. This is a reproducible and technically straightforward laparoscopic procedure with an excellent success rate in preventing further prolapse.

Cited by 14 publications

References 20 publications

Prolapse of colostomy in children; characteristics, predisposing factors and preventive measures in four health facilities in Southern Nigeria

Prolapse of colostomy in children; characteristics, predisposing factors and preventive measures in four health facilities in Southern Nigeria

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

Prolapse of intestinal stoma

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