Minimal anatomical disruption in stoma formation: the lateral rectus abdominis positioned stoma (LRAPS)

Abstract

LRAPS reduces the incidence of early stomal herniation.

Prevention and treatment of parastomal hernia: a position statement on behalf of the Association of Coloproctology of Great Britain and Ireland

“…The LRAPS was first described by Stephenson; this stoma trephine preserves the width of the rectus muscle and minimizes disruption of the layers of the abdominal wall. No PSH was demonstrated in a small series of 24 patients with a short‐term median follow‐up of 13 months (range 7–18 months) . A feasibility RCT of 56 patients in the PATRASTOM trial found no difference in PSHs between the transrectal and LRAPS approach.…”

Assessing the efficacy of lateral rectus abdominis positioned stoma (LRAPS) formation in the PATRASTOM trial

“…Indeed they state that positioning of the ileostomy trephine above the arcuate line was ‘ not always practicable ’. This, however, is an essential step in LRAPS formation and the site should almost be at the level of the umbilicus where the posterior rectus sheath is always present. Indeed, in over 20 years of raising stomas (LRAPS type from July 2007) neither my stomatherapists nor I have had complaints regarding the position (height) of a stoma, especially when patients know it is temporary.…”

Preventing or repairing ileal conduit herniation?

“…Parastomal herniation is an oft encountered problem when the trephine is raised through the belly of the rectus muscle, as is traditionally done and illustrated in the video. With this in mind, the lateral rectus abdominis positioned stoma (or LRAPS) technique to stoma formation was described, with the aim of minimizing abdominal wall disruption and subsequent hernia formation . Briefly, dissection employs horizontal (rather than cruciate) incisions in the sheaths above the arcuate line of Douglas, with the rectus muscle swept medially to accommodate the trephine.…”