New “sutureless” technique of ileostomy and colostomy

Abstract

e15132 Purpose: Purpose is to prevent infection and subsequent complications following construction of either an Ileostomy or a colostomy in an elective or emergency operation. Technique is based on delayed-primary wound healing and established principles of basic sciences. Methods: Discovered by serendipity in 1986 during an Ileostomy, procedure was used for all stomata. Stomal (proximal) end of bowel (small/large) was left obstructed with staples and brought out at proposed site of stoma. Mesenteric corner was brought above skin opening. A cone was formed by lifting anti-mesenteric corner of bowel as apex of the stoma by pulling anti-mesenteric surface of bowel. Length of the stoma was determined by thickness of the abdominal wall. Serosa was sutured circumferentially to a round opening in rectus sheath starting below the mesenteric corner leaving an arc to accommodate the mesenteric vessels. This neutralized pulling effect of peristalsis on mesenteric corner of stoma and protects mesentery under skin reducing the chances of thrombosis of mesenteric vessels. Stoma was covered in OR using an appliance with transparent pouch. Obstructed stoma prevented immediate contamination of stomal and main wounds by feces. Postoperatively, serosal surface was covered by angiogenesis, making the stomal wound refractory to infection. When peristalsis returned, bulging stoma was opened using electro-cautery as a bedside procedure. Mucosal cuff protrudes and everts on angiogenesis over a single layer of serosa. Cuff progresses with peristalsis and grafts over a bed of granulation tissue. Margins of cuff adhere with dermis of skin opening completing self-maturation of stoma. Absence of sutures reduced tissue trauma and eliminated foreign body reaction resulting in better wound healing. This new scientific technique was named “DELAYED-PRIMARY SELF-MATURATION (DPSM)”. Results: 63 Colostomies and 17 Ileostomies were performed using DPSM. Infection in stomal and/or main wound was prevented. Subsequent complications were prevented. Conclusions: DPSM prevents infection and complications associated with Ileostomy and Colostomy operations. It is technically easier and more scientific than a conventional stoma. This technique is recommended for all cases requiring end/loop, temporary/permanent types of intestinal stomas. No significant financial relationships to disclose.