Enterostomy based on abdominal wall tension and fascial locking: a theory of preventing stoma complications and parahernia.
10.3760/cma.j.cn441530-20220307-00088
- Author:
Lin WANG
1
;
Yu Zhou ZHAO
2
;
Yong Bin DING
3
;
Jia Gang HAN
4
;
Jun Jun MA
5
;
Yong You WU
6
;
Xin WANG
7
;
Teng Hui MA
8
;
Jie ZHANG
1
;
Zi Yu LI
1
;
Zhao De BU
1
;
Xiang Qian SU
1
;
Aiwen WU
1
Author Information
1. Gastrointestinal Cancer Center, Unit III, Peking University Cancer Hospital &Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China.
2. Department of General Surgery, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China.
3. Department of General Surgery, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.
4. Department of General Surgery, Beijing Chaoyang Hosptial, Capital Medical University, Beijing 100020, China.
5. Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine/Shanghai Clinical Medical Center for Minimally Invasive Surgery, Shanghai 200025, China.
6. Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
7. Department of General Surgery, Peking University First Hospital, Beijing 100034, China.
8. Department of Colorectal Surgery, Division of Radiation Enterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangdong Institute of Gastroenterology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.
- Publication Type:Journal Article
- MeSH:
Humans;
Abdominal Wall/surgery*;
Surgical Stomas/adverse effects*;
Enterostomy;
Incisional Hernia;
Fascia
- From:
Chinese Journal of Gastrointestinal Surgery
2022;25(11):1025-1028
- CountryChina
- Language:Chinese
-
Abstract:
No consensus on standardized technique of enterostomy creation has been made meanwhile high heterogeneity of surgical procedure exists in 'stoma creation' chapters of textbooks or atlases of colorectal surgery. The present article reviews the anatomy of tendinous aponeurotic fibers which is crucial for abdominal wall tension and integrity. Through empirical practice we hypothesize a procedure of enterostomy creation basied on abdominal wall tension plus anchor suture for fascia fixation which could theoretically decrease short-term stoma complication rates and long-term parastomal hernia rates. Surgical techniques are as followed: (1) preoperative stoma site mark for de-functioning ileostomy should be positioned at the lateral border of rectus abdominis muscle (RAM) to decrease the difficulty of stoma reversal and for permanent colostomy should be placed overlying the RAM to promote adhesion; (2)Optimal circular removal or lineal opening of skin, and avoid dissection of subcutaneous tissue; (3) Lineal dissection of natural strong fascia (rectus sheath) at stoma site and blunt separation of muscular fibers. The tunnel of the fascia should be made with appropriate size without undue tension. To prevent the formation of dead space, additional suturing at fascia layer is unnecessary. (4) Anchor suture for fascia fixation at two ends of fascia opening could be considered to avoid delayed fascia disruption and parastomal hernia. (5) After pull-through of ileum or colon loop, 4-8 interrupted seromuscular sutures could be placed to attach loop to skin. For ileostomy, self-eversion of mucosa can be successful in vast majority of cases and a Brooke ileostomy is not necessary. The efficacy and safety of this procedure should be tested in future trials.
