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Minimal anatomical disruption in stoma formation: the lateral rectus abdominis positioned stoma (LRAPS)
B M Stephenson1, M D Evans, J Hilton
1Department of General & Colorectal Surgery, Royal Gwent Hospital, Newport, South Wales, UK. brian.stephenson@gwent.wales.nhs.uk
Aim:
Parastomal hernias are difficult to manage and recent attention has focused on their prevention including the use of prophylactic mesh at the time of initial surgery.
Method:
A novel 'anatomical' approach to stoma formation, the lateral rectus abdominis positioned stoma (LRAPS), involving minimal anterior abdominal wall disruption is described.
Results:
LRAPS was carried out electively (n = 25) or as an emergency (n = 4) for benign or malignant pathology. Twenty-two had a midline laparotomy and all types of stomas were fashioned. There were two early and three later deaths from advanced malignancy. No parastomal hernias have been detected at a mean follow-up of 13 (range 7-18) months and none detected by CT scanning in 20 of 24 patients with colorectal cancer at a mean follow-up of 14 (range 10-18) months.
Conclusion:
LRAPS reduces the incidence of early stomal herniation.
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