Reduced port colectomy through the stoma site following short term loop transversostomy for occlusive sigmoid cancer

A. Cristaudi, K. Galetti, R. Rosso, D. Christoforidis

Background

Left sided colon cancer occlusion is often associated with emergency laparotomy, prolonged periods of diverting stomas, higher morbidity and worse oncologic outcomes. We propose a 3 step treatment strategy during the same hospital admission using minimal invasive surgery that may minimize morbidity and duration of stoma and optimize oncologic management.

Methods

Three consecutive patients presenting at our emergency department with occlusive left sided colorectal cancer were managed with the following approach during the same hospital stay:

Step 1

Emergency loop transversostomy through a minilaparotomy in the right upper quadrant

Figure 1
Figure 2
Step 2

Clinical recovery of ileus, renutrition, oncological staging, complete colonoscopy through colostomy

Step 3

Same hospital stay colostomy closure and laparoscopic reduced port left colectomy: Single port access (GelPOINT®) through the stoma site + 1 additional 12mm trocar in right iliac fossa

Figure 3 and 4: Draping of abdomen for laparoscopy with additional draping for stoma closure surgery
Figure 4
Figure 5: Gelpoint through stoma site
Figure 6: Transverse colon anastomosis
Figure 7: Colorectal anastomosis
Figure 8: Final result

Results

  • Loop transversostomy was performed within 12h from admission in all patients

  • Oncologic staging, clinical recovery and colonic decompression was completed in all patients

  • At colonoscopy no synchronous lesion was found, but one adenoma (resected)

  • No conversion to laparotomy was necessary

  • Recovery was uneventful for all patients

Conclusion

Primary loop transversostomy followed by early stoma closure and reduced port colectomy through the stoma site during the same hospital admission, may be a valid approach for the management of occlusive left sided colorectal cancer.