Stapler-assisted stoma prolapse repair with real-time fluorescent angiography using indocyanine green
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Peter C. Ambe1 · Joseph Kankam2 · Konstantinos Zarras2 1
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Münster, Münster, Germany 2 Klinik für Viszeral- Minimal-Invasive und Onkologische Chirurgie, Marien Hospital Düsseldorf, Düsseldorf, Germany
Stapler-assisted stoma prolapse repair with real-time fluorescent angiography using indocyanine green A simple, safe, and fast solution to a frequent problem
Stoma prolapse is defined as an increase in the size of an ostomy after stoma maturation requiring a change in stoma dressing and/or surgical correction. Stoma prolapse is caused by an intussusception of a bowel segment protruding through the stoma orifice [1, 2]. Ostomy prolapse is a well-known long-term complication that has been reported in up to 11–25% of transverse loop colostomy
carriers [3, 4]. Although rarely observed in terminal ostomates, prolapse has been described in up to 11.8% of terminal colostomy carriers in long-term followup [5]. The cause of stoma prolapse is unclear. Obesity, increased intra-abdominal pressure, redundant proximal bowel segment, and a large abdominal wall opening have been discussed as possible risk factors for stoma prolapse [6]. Large stoma prolapses can be associated with patient distress. Although stoma
Fig. 1 8 Terminal transverse stoma prolapse
Fig. 2 8 Perfusion of the prolapsed bowel examined with near-infrared laser fluorescence angiography using indocyanine green
Background
function is usually not affected, bowel ischemia or strangulation may complicate stoma prolapse and surgical correction is thus usually indicated. Herein we present a simple, safe, and fast approach for correcting a prolapsed terminal ostomy. The patient was diagnosed with bowel obstruction due to advanced cancer of the sigmoid colon with hepatic metastasis and infiltration of the pelvic wall and the vascular bundle. A loop transverse colostomy was con-
coloproctology
Originalien
Fig. 4 8 Division of the prolapsed bowel along its length using a linear cutter to create two split segments
Fig. 5 8 Division of the prolapsed bowel along its length using a linear cutter to create two split segments
Fig. 3 8 Division of the prolapsed bowel along its length using a linear cutter to create two split segments
Fig. 7 8 Completion of stoma correction after over-sewing the staple lines
Fig. 6 8 Transverse resection of the split segments using a curved cutter (Contour)
coloproctology
Abstract · Zusammenfassung structed and palliative chemotherapy was initiated. Owing to intermittent prolapse, the loop transverse colostomy was converted to a terminal transverse colostomy with drainage of the distal colon via a mucous fistula. However, recurrent prolapse of the terminal colostomy occurred with associated problems with stoma care, so that a further surgical correction was indicated.
Surgical procedure Surgery was performed with the patient under general anesthesia. The perfusion of the prolapsed bowel segment (. Fig. 1) was examined using nearinfrared laser fluorescence
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