STOMA CREATION THROUGH THE STOMA SITE - A RAPID, SAFE TECHNIQUE

Stoma creation often involves a separate laparotomy incision. Recently , laparoscopy was suggested to minimize the morbidity associated with conventional open stomal techniques. We describe and evaluate a techni que of stoma creation done directly through the stoma site, avoiding b oth laparotomy and laparoscopy. METHODS: Charts of 36 patients who und erwent attempted stoma creation using this closed technique were retro spectively reviewed. RESULTS: A total of 32 patients had stomas succes sfully created in this fashion (closed group); although four patients failed and required laparotomy (open group), there was an overall succ ess rate of 89 percent. Blood loss (17 +/- 5 vs. 350 +/- 130 ml; P < . 001), operative time (52 +/- 8 vs. 169 +/- 35 minutes; P < 0.001), and complications (3/32 vs. 4/4; P < 0.001) favored the closed group. No factors, including diagnosis, obesity, or previous abdominal surgery w ere identified that contraindicated use of the closed technique. CONCL USIONS: Stomas can be safely made in a high proportion of patients wit hout the need for laparotomy or laparoscopy. Failure of the closed tec hnique identifies a group of patients who have a high associated opera tive time, blood loss, and morbidity when laparotomy is used for stoma creation and in whom laparoscopic procedures may improve results.