Laparoscopic-assisted continent stoma procedures: our new standard

Area of Science:

• Urology
• Minimally Invasive Surgery
• Surgical Reconstruction

Background:

• Continent stomas, including antegrade continent enema (ACE) and continent urinary (CU) stomas, are often created using the appendix.
• Traditional open surgery for these procedures may require extensive incisions, potentially increasing morbidity and impacting cosmesis.

Purpose of the Study:

• To compare the outcomes of laparoscopic-assisted surgery versus standard open surgery for the creation of continent stomas.
• To evaluate the impact of a laparoscopic approach on operative time, recovery, morbidity, and cosmetic appearance.

Main Methods:

• A cohort of 11 patients underwent laparoscopic-assisted ACE and/or CU stoma creation using umbilical and smaller ports.
• The ascending colon and hepatic flexure were mobilized laparoscopically to deliver the cecum, appendix, and ileum.
• Stomas were constructed through a small incision, and outcomes were compared to 5 standard open cases with larger midline incisions.

Main Results:

• Laparoscopic-assisted surgery patients had a mean operative time of 6.1 hours, resumed a regular diet in 2.3 days, and had a mean hospital stay of 4.1 days.
• Open surgery patients had similar operative times but longer recovery periods (5.6 days to resume diet) and significantly longer hospital stays (7.4 days).
• No significant differences in perioperative complications were observed between the two groups.

Conclusions:

• Laparoscopic-assisted continent stoma creation leads to a significantly faster patient recovery.
• This technique achieves comparable operative times to open surgery while improving cosmetic outcomes.
• The minimally invasive approach offers a favorable alternative for ACE and/or CU stoma creation.