Laparoscopic or trephine faecal diversion: is there a preferred approach and why?
- Resource Type
- Authors
- Brian M Stephenson; K. D. Vellacott; E. S. McKain; Keshav Swarnkar; S. Jugool
- Source
- Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 7(2)
- Subject
- Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Regional anaesthesia
Malignancy
Stoma
Laparotomy
Colostomy
medicine
Humans
Laparoscopy
Aged
Aged, 80 and over
medicine.diagnostic_test
business.industry
General surgery
Disease progression
Gastroenterology
Surgical Stomas
Middle Aged
medicine.disease
Surgery
Treatment Outcome
Trephine
Female
business
- Language
- ISSN
- 1462-8910
Background Faecal diversion is often indicated in perineal sepsis and in the palliation of advanced ano-rectal malignancy. This can be performed open or laparoscopically. The aim of this study was to assess the outcome of these two approaches to stoma creation. Methods Prospective evaluation of laparoscopic or ‘trephine’ stoma creation in 49 consecutive unselected patients. Results Eighteen (37%) patients (median age 68 years) underwent a laparoscopic approach in which there were no conversions. One patient required a laparotomy for stoma mal-orientation and there were two (11%) deaths. Thirty-one patients (median age 70 years) had a trephine stoma formed with two (6%) conversions but no deaths. Thirteen (42%) of these patients had surgery performed under regional anaesthesia. There was no difference in the hospital stay between the two groups and at a mean follow-up of 16 months, 20 (41%) patients had died mainly from disease progression. Conclusion Both approaches to faecal diversion give adequate results in the short term. Laparoscopic techniques should be reserved for fitter patients as a trephine stoma can be performed under regional anaesthesia.