Subperitoneal tunnel for iliac laparoscopic colostomy

Peristomial hernia is a very common complication in gastrointestinal surgery. Some degree of peristomial herniation has been claimed to be an almost inevitable complication of any ostomy formation. A stepwise approach to perform a subperitoneal tunnel iliac colostomy is presented in an attempt to prevent its development.

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Subperitoneal tunnel for iliac laparoscopic colostomy

Authors

J Leroy, J Marescaux

Abstract

Peristomial hernia is a very common complication in gastrointestinal surgery. Some degree of peristomial herniation has been claimed to be an almost inevitable complication of any ostomy formation. A stepwise approach to perform a subperitoneal tunnel iliac colostomy is presented in an attempt to prevent its development.

Classification

tips and tricks

Keywords

Laparoscopy, subperitoneal tunnel, iliac colostomy

Media type

Surgical video

Duration

01'40''

Publication

2008-11

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E-publication

WeBSurg.com, Nov 2008;8(11).
URL: http://www.websurg.com/doi-vd01en2428.htm

Subperitoneal tunnel for iliac laparoscopic colostomy

1. Introduction 00'21''

The purpose of this video is to show the subperitoneal tunnel created for a definitive left terminal colostomy as you can see in this schematic.

2. Subperitoneal tunnel creation 00'28''

This technique is recommended to prevent the risk of peristomial hernia. In the present case, the 10mm left flank trocar is removed. Through this incision site, we introduce a bougie (over 10mm in diameter) between the posterior aponeurosis and the peritoneum towards the lateral flank. Dissection is carried out bluntly until the lateral left colic dissection plane is reached. This achieves the creation of the subperitoneal tunnel.

3. Colon retraction subperitoneally 01'06''

Then the descending colon is grasped at its extremity by a Babcock forceps, and it is pulled through the subperitoneal tunnel before approximating the colon to the skin outside as done conventionally. Another benefit of this technique is that the risk of bowel obstruction is limited since there is no mesocolic defect.