BACKGROUND: Laparoscopic surgery has become a favorable alternative to conventional open surgery for the creation of intestinal stomas, and it offers many benefits including reduced postoperative pain, ileus, and hospital stay. Single-incision laparoscopic surgery has been described for many abdominal operations. It may offer better cosmetic outcomes and reduce incisional pain, adhesions, and recovery time.
OBJECTIVE: In this study, we aimed to describe a novel technique of scarless single-incision laparoscopic loop ileostomy for fecal diversion and to report our experience with 8 patients who underwent this procedure within a 1-year period.
DESIGN: This study was designed as a retrospective case series.
SETTINGS: This investigation was conducted at a single-institution, tertiary referral center.
PATIENTS: Eight consecutive patients undergoing scarless single-incision laparoscopic loop ileostomy between August 2009 and August 2010 were included.
INTERVENTION: Scarless single-incision laparoscopic loop ileostomies were performed.
MAIN OUTCOME MEASURES: Among the outcomes measured were operation time, intraoperative blood loss, recovery of intestinal function, length of hospital stay, and surgical complications.
RESULTS: Seven patients underwent surgery for active Crohn's disease refractory to medical therapy. One patient underwent surgery for radiation-induced rectovesical fistula. Median surgery time was 76 minutes, and median intraoperative blood loss was 10 mL. Median length of postoperative hospitalization was 7 days. Of the 8 patients included in our series, 2 patients (25%) required reoperation for stoma ischemia because of vascular congestion that we attribute to a tight fascial opening or extensive bowel manipulation. Other surgical complications included nonoperative readmission for ileus and partial small-bowel obstruction (n = 2), anal dilation to evacuate an obstructed distal colon (n = 1), and peristomal cellulitis (n = 1).
LIMITATIONS: This study was limited by its small sample size and its retrospective nature.
CONCLUSION: Scarless single-incision laparoscopic loop ileostomy is a feasible alternative to standard laparoscopy for fecal diversion. Surgeons attempting this technique should do so with caution, given the high stoma ischemia rate in our small case series.
Division of Colorectal Surgery, Cedars Sinai Medical Center, Los Angeles, California
Financial Disclosures: None reported.
Correspondence: Phillip Fleshner, M.D., 8737 Beverly Blvd, Suite 101, Los Angeles, CA 90048. E-mail: Pfleshner@aol.com