33 Reducing occurrence of prolapse and parastomal hernia in end colostomy: a novel technique
Charlotte Holbrook, Joeseph Curry
Great Ormond Street Hospital, London, United Kingdom

Abstract

Aim
Colostomy is sometimes required when managing children with intractable constipation. In a systematic review of published studies of children having this procedure, prolapse was a common problem (19%). We describe a novel technique for creating colostomy aiming to reduce prolapse and parastomal hernia.

Method
Retrospective case note review of patients between 2012 and 2018 undergoing the following procedure: The abdomen is opened via lower midline incision. The sigmoid colon is delivered, divided using a linear stapler and the distal stump staple line oversewn with prolene. The opening for the stoma is created in left iliac fossa; a disc of skin and fat is excised to expose the fascia, then the rectus is split and the peritoneum opened. The stapled proximal sigmoid is brought through opening and the bowel secured to fascial layer using 8X 3/0 vicryl sutures circumferentially (Figure 1). The midline wound is closed and the incision covered with skin glue. Then the proximal sigmoid is resected to open the stoma and achieve appropriate length and the colostomy formed by suturing colonic mucosa to skin circumferentially with 3/0 vicryl.

Results
17 patients were identified. Mean age at operation was 9.5years (range 1.2 to 17.3). Indications were refractory constipation secondary to dysmotility (13), anorectal malformation (2), perineal congenital melanocytic naevus (1). One (Rett syndrome) had colostomy to prevent recurrent UTI. Evidence of wound infection was apparent in 2 postoperatively. One required readmission for poor stoma output which responded to laxatives. At a median follow up of 3.1years (range 0.1 to 5.6), 10 children still have colostomy. One has been closed. 5 have subsequently required ileostomy. One stoma was revised due to granulomas and pain.

Conclusion
In this series, our novel technique has prevented the occurrence of prolapse and parastomal hernia.  Other complications have been minimal.

Figure 1: Intraoperative image