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27.03.2023 | The Last Image
Less is more? Stoma prolapse repair by linear stapler
Erschienen in: Techniques in Coloproctology | Ausgabe 6/2023
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The ileal conduit remains one of the simplest, safest, and most common forms of urinary diversion after radical cystectomy [1]. Stoma complications (including parastomal hernia, stoma prolapse, stenosis, and retraction) are the most frequent indication for reoperation in these patients [2]. Stoma prolapse affects 1.5–8% of ileal conduits at a median time of 2 years after surgery [3]. Here we present a mini-invasive technique to treat stoma prolapse using a linear stapler (Fig. 1).
Fig. 1
Repair of a 7-cm stoma prolapse (a) by linear stapler in a 59-year-old male patient who underwent ileal conduit procedure by the Wallace technique (conjoined, refluxing, end-to-end ureteroenteric anastomosis) 1 year before admission. Four cardinal stitches are placed at the edge of the prolapse after complete eversion to allow adequate traction b. A Foley catheter is inserted through the conduit to ensure a safe distance between the mucocutaneous border and the ureteroenteric anastomosis (not shown). A 60-mm linear GIA stapler is inserted and fired at the 3 o’clock position (c). The same maneuver is carried out at the 9 o’clock position. Excision of the prolapse is completed by firing further two linear GIA staplers across the base bilaterally (dotted lines) securing a 1-cm margin from the mucocutaneous border d. The stoma is matured using adsorbable stitches (e)
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