The anastomotic stoma: a useful procedure in emergency bowel surgery

Abstract

In emergency surgery of the bowel a primary anastomosis may be risky. Discontinuing colostomies have the disadvantage that a secondary laparotomy is necessary to restore continuity. If sufficient bowel loop mobilization is possible, we prefer to perform an anastomotic stoma. After resection of the diseased bowel segment, we bring the proximal and distal loop together and proceed to the anastomosis of the posterior wall. The anterior wall of the anastomosis remains open and is then fixed to the abdominal wall as a stoma. So far, we have used this method in 91 patients. In 73 cases this technique was performed during emergency operations. No patient died as a result of complications of the method: 21 patients, however, died as a consequence of their primary disease. Bowel continuity could be restored in 78 cases. The anastomotic stoma protects the posterior wall from elevated pressure and allows daily control of the anastomosis. In the case of extraperitoneal closure, a secondary laparotomy for reconstruction of the continuity is not necessary. The anastomotic stoma can be performed in most regions of the small and large bowel.

Split stoma in resectional surgery of high‐risk patients with ileocolonic Crohn’s disease

“…A protecting defunctioning stoma has often been proposed or, in severely ill patients an approach has been advocated only to deviate the faecal stream followed by delayed resection and anastomosis [5–7,11,12]. An alternative in such a complex situation might be a split stoma with excision of the disease and exteriorization of both ends of the small bowel through a small common opening, followed by an anastomosis at some point in the future [13,14] when the general condition of the patient has improved, including the presumed healing capacity. The aim of the present study was to investigate whether a split stoma with a delayed anastomosis in high‐risk patients with ileocolonic CD resulted in fewer anastomotic complications and fewer associated risk factors.…”

Role of damage control enterostomy in management of children with peritonitis from acute intestinal disease

“…If an intestinal resection has been done, the posterior wall is anastomosed and the anterior walls exteriorised as a loop stoma. In one report of 91 patients including adults and children, [10] this method was effective. This method is thought to facilitate subsequent enterostomy closure by extraperitoneal approach.…”

Modification of end-loop ileostomy for the treatment of ischemic or radiation enteritis

“…The formation of such a stoma was simple and quick, with no risk of stenosis or kinking. We believe that the short duration of our technique is an important advantage since operative time is a critical factor in the survival of these patients (urgent cases, unstable patients, "damage control" in trauma) [6] . In addition, closure of the stoma can be performed easily and quickly under local anesthesia, by mobilizing the common limb from the abdominal wall and stapling it just below the fascia without entering the abdominal cavity.…”

“…These include patients with mesenteric ischemia, radiation induced stenosis or fistulas, bowel necrosis due to hernias or adhesions, intestinal trauma and necrotizing enterocolitis in children [6] .…”