Skip to main content
Log in

Dual endoscopic-assisted endoluminal colostomy reversal: A feasibility study

  • Original article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background: Emergent colostomies are associated with increased morbidity related to second closure operations. The purpose of this canine pilot study was to create a minimally invasive procedure that would reduce the time interval and morbidity involved with colostomy reversals after left colon end colostomies. Methods: Six mongrel dogs underwent modified laparoscopic Hartmann’s procedures in which the stapled end of the rectal stump was approximated to the left colon proximal to the stoma. After 1 week, they underwent an endoluminal colostomy reversal with a computer-mediated, circular stapling device and varying anvil insertion methods. Variables recorded included anvil insertion technique and feasibility, OR time, complications, and number of days to first meal and bowel movement. A contrast enema performed 1 week post colostomy reversal ruled out anastomosis leaks and stenosis. The dogs were euthanized and subjected to necropsy. Results: Of four anvil insertion techniques tested, the most feasible employed a large-bore needle to perforate through the stapled end of the Hartmann pouch into the lumen of the left colon. Simultaneous endoluminal views of the rectal stump with a sigmoidoscope and the left colon lumen with an endoscope permitted a controlled and safe needle puncture. Through the needle, a guide wire was inserted to withdraw the anvil via the colostomy into place. A transanally inserted stapler was then married to the anvil under fluoroscopic guidance, thus completing the anastomosis. The colostomy was then taken down and transected at the level of the colocolostomy. Average operating time was 126 min (range 90–180), diet was tolerated within 1.5 days, and average number of days to first bowel movement was 2.5. The absence of stenosis, leaks, and inadvertent visceral injuries confirmed feasibility. Conclusions: In this canine model, a dual endoscopic-assisted colostomy reversal with a computer-mediated, circular stapling device is feasible. Using this technique, colostomy reversals can possibly be performed 1 week post-colostomy without entering the peritoneal cavity, thus reducing the number of invasive operations and subsequent morbidity required to manage emergent colon perforations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9

Similar content being viewed by others

References

  1. CA Anderson DL Fowler S White N Wintz (1993) ArticleTitleLaparoscopic colostomy closure. Surg Laparosc Endosc 3 69–72 Occurrence Handle10.1016/0962-8924(93)90065-9 Occurrence Handle1:CAS:528:DyaK3sXitlSksbs%3D Occurrence Handle8258079

    Article  CAS  PubMed  Google Scholar 

  2. JD Berne GC Velmahos LS Chan JA Asensio D Demetriades (1998) ArticleTitleThe high morbidity of colostomy closure after trauma: Further support for the primary repair of colon injuries. Surgery 123 157–164 Occurrence Handle10.1067/msy.1998.84178 Occurrence Handle1:STN:280:DyaK1c7kt1Cjsg%3D%3D Occurrence Handle9481401

    Article  CAS  PubMed  Google Scholar 

  3. H Cantele A Mendez J Leyba (2001) ArticleTitleColostomy closure using local anesthesia. Surg Today 31 678–680 Occurrence Handle10.1007/s005950170069 Occurrence Handle1:STN:280:DC%2BD3MvmsFOltQ%3D%3D Occurrence Handle11510602

    Article  CAS  PubMed  Google Scholar 

  4. FJ Criado TH Wilson (1981) ArticleTitleTechnique for re-establishing continuity after the Hartmann procedure. Ann Surg 47 366–367 Occurrence Handle1:STN:280:Bi6B1c%2Fhs1Q%3D

    CAS  Google Scholar 

  5. D Demetriades A Pezikis J Melissas D Parekh G Pickles (1988) ArticleTitleFactors influencing the morbidity of colostomy closure. Am J Surg 155 594–596 Occurrence Handle1:STN:280:BieC1c7jvVM%3D Occurrence Handle3354784

    CAS  PubMed  Google Scholar 

  6. DC Desai EJ Brennan JF Reilly RD Smink (1998) ArticleTitleUtility of the Hartmann procedure. Am J Surg 175 152–154 Occurrence Handle10.1016/S0002-9610(97)00272-9 Occurrence Handle1:STN:280:DyaK1c7nsFamtw%3D%3D Occurrence Handle9515534

    Article  CAS  PubMed  Google Scholar 

  7. RJ Detry PJ Kestens (1981) ArticleTitleColorectal anastomoses with the EEA stapler. World J Surg 5 739–742 Occurrence Handle1:STN:280:Bi2C3s7htFU%3D Occurrence Handle7331369

    CAS  PubMed  Google Scholar 

  8. SG Ghorra TP Rzeczycki R Natarajan VE Pricolo (1991) ArticleTitleColostomy closure: impact of preoperative risk factors on morbidity. Am Surg 65 266–269

    Google Scholar 

  9. JC Goligher (1979) ArticleTitleUse of circular stapling gun with peranal insertion of ano-rectal purse-string suture for construction of very low colorectal or colo-anal anastomosis. Br J Surg 66 501 Occurrence Handle1:STN:280:CSaB3szmtVw%3D Occurrence Handle380738

    CAS  PubMed  Google Scholar 

  10. H Hartmann (1923) ArticleTitle. Congres Francais de Chir 30 411–414

    Google Scholar 

  11. JC Holland DC Winter D Richardson (2002) ArticleTitleLaparoscopically assisted reversal of Hartmann’s procedure revisited. Surg Laparosc Endosc Percutan Tech 12 291–294 Occurrence Handle10.1097/00129689-200208000-00020 Occurrence Handle12193830

    Article  PubMed  Google Scholar 

  12. DA Khoury DE Beck FG Opelka TC Hicks AE Timmcke JB Gathright (1996) ArticleTitleColostomy closure: Ochsner clinic experience. Dis Colon Rectum 39 605–609 Occurrence Handle1:STN:280:BymB2cbgs1w%3D Occurrence Handle8646942

    CAS  PubMed  Google Scholar 

  13. EC Lee JJ Murray JA Coller PL Roberts DJ Jr Schoetz (1997) ArticleTitleIntraoperative colonic lavage in nonelective surgery for diverticular disease. Dis Colon Rectum 40 669–674

    Google Scholar 

  14. FC Nance (1979) ArticleTitleNew techniques of gastro-intestinal anastomosis with the EEA stapler. Ann Surg 189 587 Occurrence Handle1:STN:280:CSaC1cnjs1w%3D Occurrence Handle443911

    CAS  PubMed  Google Scholar 

  15. DM Pittman LE Smith (1985) ArticleTitleComplications of colostomy closure. Dis Colon Rectum 28 836–843 Occurrence Handle1:STN:280:BimD38bnvVw%3D Occurrence Handle4053895

    CAS  PubMed  Google Scholar 

  16. ML Prasad RK Pearl H Abcarian (1984) ArticleTitle“End-loop” colostomy. Surg Gynecol Obstet 158 380–382 Occurrence Handle1:STN:280:BiuC2s3mtlE%3D Occurrence Handle6369585

    CAS  PubMed  Google Scholar 

  17. MM Ravitch FM Steichen (1979) ArticleTitleA stapling instrument for end-to-end inverting anastomosis in the gastrointestinal tract. Ann Surg 189 791 Occurrence Handle1:STN:280:CSaB3cfhvFw%3D Occurrence Handle453950

    CAS  PubMed  Google Scholar 

  18. AM Roe S Prabhu A Ali C Brown AJM Brodribb (1991) ArticleTitleReversal of Hartmann’s procedure: timing and operative technique. Br J Surg 78 1167–1170 Occurrence Handle1:STN:280:By2D28bltlc%3D Occurrence Handle1958975

    CAS  PubMed  Google Scholar 

  19. MK Schilling CA Maurer O Kollmar MW Buchler (2001) ArticleTitlePrimary vs secondary anastomosis after sigmoid colon resection for perforated diverticulitis (Hinchey stage III and IV): a prospective outcome and cost analysis. Dis Colon Rectum 44 699–705 Occurrence Handle1:STN:280:DC%2BD3M3msVehtw%3D%3D Occurrence Handle11357032

    CAS  PubMed  Google Scholar 

  20. J Varnell LB Pemberton (1981) ArticleTitleRisk factors in colostomy closure. Surgery 89 683–686 Occurrence Handle1:STN:280:Bi6B38nmtFc%3D Occurrence Handle7245028

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded in part by a research grant from the Minimally Invasive Surgery Center of Mount Sinai School of Medicine which is supported by Tyco Health, Karl Storz Endoscopy of America, and Power Med Inc. We are grateful both to Nancy Heim for her artwork and to Ed Wierzbicki for his proctoring.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. Gagner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jacob, B., Gagner, M., Hung, T. et al. Dual endoscopic-assisted endoluminal colostomy reversal: A feasibility study . Surg Endosc 18, 433–439 (2004). https://doi.org/10.1007/s00464-003-8914-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-003-8914-2

Keywords

Navigation