Impact of suturing of stoma edges directly to skin without peritoneal fixation

Abstract

Introduction: Enterostomies are one of the common surgical procedures performed in a general surgery unit. Enterostomies are fixed to the peritoneum/abdominal wall, before being sutured to the skin. This results in prolongation of operative time and dense adhesions between the bowel wall and the abdomen at the site of stoma. This is a comparative study between the commonly followed methods of maturation with our method of direct suturing of the stoma to the skin. Materials and Methods: A prospective randomized study to compare the traditional method of maturation of stoma with direct suturing of the stoma edges to the skin without a peritoneal fixation was carried out in a tertiary health-care hospital. Results: Skin complications and stomal prolapse were the most common type of complication seen. Most of the stoma-related complications were managed conservatively. There was no difference in stoma-related complications between the two methods of stoma construction in our study. However, during stoma closure, dense adhesions were seen in 90% of cases in Group A (peritoneal hitch) as compared to 7% in Group B (direct skin fixation). There was a significantly high 16.7% incidence of iatrogenic perforation of bowel in Group A during stoma closure. Conclusions: Thus, additional rectus and/or peritoneum fixation does not add any benefit in preventing stoma-related complications over intestinal stomas, which are constructed with fixation only to skin. In the group, where the stoma was fixed to abdominal wall, the higher incidence of dense adhesions between the stoma and the abdominal wall resulted in longer operative time during stoma closure and increased risk of iatrogenic bowel trauma.