Extraperitoneal staged stapling closure of the double-barreled stomas: a new modification of the old technique

Abstract

Introduction One distinct disadvantage of Paul Mikulicz double-barreled colostomy is the need to apply an enterotome to the stoma for several days to crush the intervening spur before the double-barreled colostomy is closed. A new modification of the old technique was applied to omit the usage of the enterotome and avoid the riskiest complications of colostomy closure. Aim The aim of this study was to evaluate the efficacy and safety of this new technique, staged stapling closure of the double-barreled stomas, to publicize its use for all temporary stomas. Patients and methods Being a new technique, only 20 patients were included in this study. They all were old patients of both sexes. This new technique is accomplished in three stages: stage I is to perform the original double-barreled enterostomy in its native manner, stage II: 1 week later after in the outpatient clinic without the need for anesthesia, sterilization, or bowel preparation, where the spur between the two limbs of the enterostomy is divided using GIA stapler, and stage III: where 2 weeks later, under local or spinal anesthesia, extraperitoneal closure of the stoma was done with double-layer sutures. Results This study was carried out between November 2018 and January 2020 on 20 patients, aged 64–86 years, comprising 12 males and eight females. Only one (5/%) case was complicated with leakage and wound gaping. She had another trial of closure 2 weeks later, which succeeded. At the end, all patients were discharged home, with open bowel, normal defecation, and surgically stable. There was no mortality throughout our study. Conclusion Extraperitoneal staged stapling closure of the double-barreled enterostomy is a safe and easy technique to close temporary stomas with no need for another laparotomy and without the risk of peritonitis or obstruction.