Laparoscopic Stoma Formation

BACKGROUND: Laparoscopic stoma formation has gained wide acceptance as an alternative to open abdominal surgery. Although laparoscopic stoma formation has a low morbidity, complications have been reported. Contributing factors to these complications are twisting of the bowel, maturing the wrong limb, or both of these. In this report, we describe a simple technique that can reduce these complications. METHODS: The bowel segment to be exteriorized is grasped with a locking nontraumatic, nonrotating grasper. After the orientation of the bowel is verified, the surgeon ties the handle of the instrument to the trocar by using a cotton umbilical tape. The trocar and the instrument become one working unit, and if the umbilical tape is wrapped around the shaft of the instrument, then the bowel is twisted. It is easy to untwist it by aligning the umbilical tape with the shaft of the instrument. To mature the stoma, the umbilical tape is removed and the grasper is unlocked. CONCLUSION: Laparoscopic stoma is an effective treatment for several benign and malignant disorders, and in general has a low morbidity. Our report describes a simple technique that can reduce the rare but significant postoperative stoma or small bowel obstruction.