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Laparoscopic-assisted colostomy in children
Claudio De Carli1, Marcos Bettolli, Carl-Christian Jackson
1Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Insights
Laparoscopic-assisted colostomy (LAC) is a safe and effective technique for children, reducing stoma complications. This initial pediatric experience shows promising results with no reported complications.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Gastrointestinal surgery
Background:
- Colostomy procedures carry a high morbidity risk, up to 50%.
- Laparoscopic-assisted colostomy (LAC) in adults is linked to fewer complications.
- LAC has not been previously documented in pediatric patients.
Purpose of the Study:
- To report the initial experience and outcomes of performing LAC in pediatric patients.
- To evaluate the safety and efficacy of LAC in neonates and infants.
Main Methods:
- LAC was performed using a two- to four-port (3.5-mm) technique.
- The study included a female infant with imperforate anus and two male infants with Hirschsprung's disease.
- Data collected included operative time, bowel function recovery, and morbidity, with close follow-up until stoma closure.
Main Results:
- Operative times were 144 minutes for Hirschsprung's disease patients and 40 minutes for the imperforate anus patient.
- Median time to flatus and stool passage was 40 hours; median time to commence feeds was 40 hours.
- No complications were reported during a median follow-up of 3 months.
Conclusions:
- Laparoscopic-assisted colostomy is safe and feasible in neonates and infants.
- LAC allows for precise stoma placement and orientation, with added benefits for bowel mobilization in Hirschsprung's disease.
- The technique appears to prevent stoma-related complications, warranting further prospective evaluation.
Introduction:
Colostomy morbidity has been reported to be as high as 50%. Laparoscopic-assisted colostomy (LAC) is associated with decreased colostomy complication. LAC is recommended for stoma formation in adults but has not been previously reported in children. In this paper, we report on our initial experience with LAC in children.
Materials And Methods:
Using a two- to four-port (3.5-mm) technique, LAC was performed in a female with an imperforate anus and 2 male patients with complicated Hirschsprung's disease (HD), respectively. Data collected included operative time, time to recover bowel function, and morbidity. Close follow-up was done until stoma closure.
Results:
The operative time was 144 minutes in the HD patients (including concomitant laparoscopic biopsies and a leveling colostomy) and 40 minutes in the imperforate anus patient. Median time to passage of both flatus and stool was 40 hours (range, 24-48). Time to commence feeds postop was 40 hours (range, 24-48). The median time of follow-up was 3 months (range, 2-9) until the stoma was taken down. No complications have occurred to date.
Conclusions:
LAC is safe and easily performed in neonates and infants. It facilitates accurate stoma placement and orientation. It allows additional bowel mobilization, especially in HD. In accordance with the adult experience, LAC seems to obviate stoma-related complications. Encouraged by our initial low morbidity rate, a prospective evaluation of this technique is planned.
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