Trephine Transverse Colostomy Is Effective for Patients Who Have Previously Undergone Rectal Surgery

Abstract

PurposeColostomy creation is an essential procedure for colorectal surgeons, but the preferred method of colostomy varies by surgeon. We compared the outcomes of trephine colostomy creation with open those for the (laparotomy) and laparoscopic methods and evaluated appropriate indications for a trephine colostomy and the advantages of the technique.MethodsWe retrospectively evaluated 263 patients who had undergone colostomy creation by trephine, open and laparoscopic approaches between April 2006 and March 2016. We compared the clinical features and the operative and postoperative outcomes according to the approach used for stoma creation.ResultsOne hundred sixty-three patients (62%) underwent colostomy surgery for obstructive causes and 100 (38%) for fistulous problems. The mean operative time was significantly shorter with the trephine approach (trephine, 46.0 ± 1.9 minutes; open, 78.7 ± 3.9 minutes; laparoscopic, 63.5 ± 5.0 minutes; P < 0.001), as was the time to flatus (1.8 ± 0.1 days, 2.1 ± 0.1 days, 2.2 ± 0.3 days, P = 0.025). Postoperative complications (<30 days) were not different among the 3 approaches (trephine, 4.3%; open, 1.2%; laparoscopic, 0%; P = 0.828). In patients who underwent rectal surgery, a trephine colostomy was feasible for a diversion colostomy (P < 0.001).ConclusionThe trephine colostomy is safe and can be implemented quickly in various situations, and compared to other colostomy procedures, the patient’s recovery is faster. Previous laparotomy history was not a contraindication for a trephine colostomy, and a trephine transverse colostomy is feasible for patients who have undergone previous rectal surgery.

Minimally invasive colostomy with endoscopy as a novel technique for creation of a trephine stoma

“…Moreover, the procedure was successful in only four of the seven patients (57%) with a history of prior laparotomy. Overall, to summarize the previous studies, the rate of conversion to an open approach during the trephine stoma approach has been reported to be between 4.3 and 29.0% 5 , 12 – 15 .…”

“…The advantages of the trephine stoma procedure over an open surgical approach have previously been described. In a group of 263 patients who underwent transverse colon stoma creation, Yeom et al 12 compared outcomes between trephine (n = 161), open (n = 82), and laparoscopic (n = 20) procedures. The trephine procedure was associated with a shorter operative time (46.0 ± 1.9 min, 78.7 ± 3.9 min, and 63.5 ± 5.0 min, respectively, p < 0.001) and shorter time to flatus (1.8 ± 0.1 days, 2.1 ± 0.1 days, and 2.2 ± 0.3 days, respectively, p = 0.025), but with no difference in the length of hospital stay and rate of postoperative complications among the three procedures.…”

Non-operative management of gallstone sigmoid ileus in a patient with a prostatic cancer

“…It is associated with less operative time, limited skin incision and the ability to be performed under local or regional anaesthesia. However, this approach remains an unpopular option due to its technical difficulty, misidentification of the target organ and poor visualization of the operative field [ 10 , 16 ]. The debate continues as to whether to perform a single stage surgery in which you perform enterolithotomy, along with cholecystectomy and closure of the fistula, or to perform a two-stage procedure with initial enterolithotomy to manage the obstruction followed by interval management of the fistula along with cholecystectomy [ 8 ].…”

Comparison of blowhole colostomy and loop ostomy for palliation of acute malignant colonic obstruction

“…Ostomy for palliation can be performed in the sigmoid colon, transverse colon, cecum, or ileum [ 19 - 21 ]. The location of the stoma is chosen based on the site of obstruction and patient condition [ 4 , 11 - 14 , 17 , 18 , 20 - 24 ]. However, there is no general consensus with regard to the optimal type of stoma [ 4 , 13 , 18 - 21 , 25 , 26 ].…”