Seminars in Surgical Oncology 10397 (1994)

Laparoscopy for Construction of Feeding Enteral Tubes and Diverting Stomas

TITUS D. DUNCAN, MD, FACS, AND EDWARD M. MASON, MD, FACS

From the Georgia Baptist Medical Center, Atlanta, Georgia

Laparoscopy has now assumed a new and important role in the treat- ment of malignant diseases. An important part of this role is the establishment of feeding enterostomies and stomas. This function is vital in both those patients who may not be candidates for curative therapy and those being staged for definitive therapy. @ 1994 Wiley-Liss. Inc.

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KEY WORDS: feeding enterostomies, colostomy

INTRODUCTION From its use to establish diagnoses to the resection

of malignancies, laparoscopy now is established as occupying an important niche in the treatment of ma- lignant processes.

An equally significant role of laparoscopy in the treatment of malignant diseases is developing feeding enterostomies and stomas.

DISCUSSION Feeding Enterai Tubes

Enteral feeding is the method of choice in the treat- ment of most illnesses. Laparoscopy may facilitate the placement of feeding tubes.

Once insufflation is obtained, trochars are intro- duced under direct vision to allow the small intestine to be inspected with the identification of the ligament of Trietz. The bowel is then run distally in the usual fashion for establishing a feeding jejunostomy. With the introduction of the feeding tube through a sepa- rate stab wound, a small enterotomy is made, the tube placed distally and secured with intracorporal sutur- ing. The bowel is attached to the anterior abdominal wall.

The advantage of this method is that it can be per- formed in conjunction with laparoscopy for establish- ing diagnosis and/or resectability. A disadvantage is the need for general anesthesia.

gone laparotomy for establishing a diverting colos- tomy.

Using laparoscopy, these patients may be explored for metastatic disease not previously noted, then to establish a colostomy. Trochar placement is made so as to allow the descending and sigmoid colon to be mobilized by severing the lateral attachments. With this mobilization, the colostomy site (previously marked by an enterostomal therapist) is removed and the bowel is brought to the outside. A rod is then placed beneath the loop to secure the bowel. Trans- verse colostomies and ileostomies can be constructed in a similar manner.

The advantages of this procedure are numerous. The patient can usually be discharged, following the procedure, within 48 hr, as ileus usually does not occur. Chemotherapy can be instituted at a much ear- lier time, in that there are no major incisions that must heal. Finally, by performing a laparoscopic colos- tomy, subsequent surgery is not complicated by adhe- sions. If the subsequent resection is to be done by laparoscopic assistance, simply dividing the loop with placement of the EEAB anvil (U.S. Surgical Corpora- tion, Norwalk, CT, USA) in the proximal segment prior to returning the bowel to the peritoneal cavity facilitates the anastomosis.

Diverting Stomas Large rectal tumors are treated by a combination of

preoperative chemoradiation therapy. In the Of

obstructing tumors, previously a patient has under- Address reprint requests to Edward M. Mason, M.D., 315 Boule- vard, N.E., Suite 500, Atlanta, GA 30312-1266.

0 1994 Wiley-Liss, Inc.