Laparoscopic ileostomy and colostomy

The technical features of laparoscopic ileostomy and colostomy are described. A diverting ileostomy or colostomy can be performed with minimal trauma by laparoscopic techniques. This is distinct from the complex laparoscopic and laparoscopic-assisted resections of small and large bowel. To date the technical features of creating a diverting ileostomy or colostomy have not been emphasized sufficiently. Standard laparoscopic techniques are used to create a pneumoperitoneum. After mobilization of the ileum or colon, a stoma is made on the abdominal wall. A trocar is introduced at the site where the stoma is located, thus reducing the technical problems associated with creating and maturing a stoma while the abdomen is insufflated. This approach obviates the need for a laparotomy while creating an ileostomy or colostomy. The technical features of creating a double-barrel ostomy, an end-ostomy with a stapled distal limb, and a loop ostomy are described. The postoperative recovery is prompt with a rapid return of intestinal function and early discharge from the hospital. Laparoscopic ileostomy and colostomy are straightforward procedures that reduce postoperative discomfort and ileus, and reduce the length of hospital stay.