Colostomia Asistida por Endoscopia! Trabajo experimental en puercos

CONTROL ID: 2149552

PRESENTATION TYPE: Oral or e-Poster

TITLE: Endoscopic assisted colostomy with percutaneous colopexy: An experimental study.

AUTHORS: Bustamante L., L. A.2; Sulbaran N, M. N.1; Sakai, P.1; Moura, E. G.1;
Nahas, C.2; Marques, C. S.2; Sakai, C.1; Cecconello, I.2; Pinto, R. A.2; Nahas, S. C.2

INSTITUTIONS (ALL):
1. Endoscopy, Department of Gastroenterology, Surgical Division, University of São Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.
2. Coloproctology, Department of Gastroenterology, Surgical Division, University of São Paulo Medical School, Sao Paulo, Sao Paulo, Brazil.

PRESENTER: Leonardo Bustamante L.

ABSTRACT BODY:
Purpose : Indications for colostomy in colorectal diseases are obstruction of the large bowel, such as in cancer, diverticular disease in the acute phase, post–radiotherapy enteritis, complex perirectal fistulas, anorectal trauma and severe anal incontinence. Some critically ill patients cannot tolerate an exploratory laparotomy and laparoscopic assisted colostomy needs general anesthesia as well. The aim of this study is to evaluate the feasibility, safety and efficacy of performing colostomy under colonoscopic visualization and the use of colopexy without additional morbidity of abdominal exploration and general anesthesia in laboratory animals.

Methods : 5 pigs underwent endoscopic assisted colostomy with percutaneous colopexy. In the lithotomy position with legs open, all animals were submitted to tracheal intubation, mechanical ventilation, and maintained under general anesthesia. Transanal introduction to the descending colon with a gastroscope was performed, identification of the best site for transillumination of the abdominal wall, and puncture with the Loop Fixture II gastropexy kit ®. As a brief description, this device has two needles, one which has a suture inserted to immediately before the tip of the needle, and the other which has a suture-holding loop placed on it. Under endoscopic observation, the suture-holding needle was pushed down to form a loop for holding the suture. The suture was knotted against the abdominal wall to hold the colon to the parietal peritoneum. After that, a small disc of skin was removed proximal to the colopexy and a loop colostomy was performed in the anti-mesenteric wall. Animals were evaluated in post-operative days 1, 2, 5 and 7 for feeding acceptance and colostomy characteristics. On day 7 animals were performed full colonoscopy followed by exploratory laparotomy.

Results : Average procedure time was 27 (21-54) minutes. Animals were fed and were able to move the same day of procedure. Position of the colostomy, mucosa color, periostomal skin, and colostomy functioning were satisfactory in 4 animals. Retraction of colostomy was present in one pig without loss of function. The colonoscopy and laparotomy control on the seventh postoperative day revealed no abnormality. The only intraoperative complication was a bladder perforation successfully repaired through the colostomy incision.

Conclusions : Endoscopic assisted colostomy with percutaneous colopexy proves to be a safe and effective method with low morbidity for performing colostomy in experimental animals with probability of clinical application.