Anterior rectus sheath fixation during ileostomy/ colostomy?
| Discussion in 'All Categories' started by Dr Alankrith Ramesh Kashyap - Jun 1st, 2023 10:57 pm. | |
Dr Alankrith Ramesh Kashyap
|
Good morning sir Is it necessary to fix the seromuscular layer of stoma to anterior rectus sheath before enterotomy during maturation of ileostomy or colostomy? There are different schools of thought... One says that rectus sheath fixation prevents paranormal herniation & retraction... Another says, that rectus sheath fixation causes dense adhesions & makes it difficult during stoma reversal leading to resection- anastomosis... What is the latest accepted guidelines ? Thank you sir |
|
re: Anterior rectus sheath fixation during ileostomy/ colostomy?
by Dr, Bhalla -
Jun 6th, 2023
3:38 pm
#1
|
|
|
Dr, Bhalla
|
The decision to fix the seromuscular layer of the stoma to the anterior rectus sheath before enterotomy during the maturation of ileostomy or colostomy can vary among surgeons, and there is no universally accepted guideline that applies to all cases. The choice depends on multiple factors, including the surgeon's experience, patient-specific considerations, and institutional practices. Some surgeons advocate for fixing the seromuscular layer to the anterior rectus sheath to prevent potential complications such as parastomal herniation and retraction. This fixation can provide additional support and stability to the stoma, reducing the risk of prolapse or herniation. On the other hand, some surgeons express concerns about the potential for dense adhesions resulting from rectus sheath fixation. These adhesions may make subsequent stoma reversal surgeries more challenging and potentially necessitate a resection-anastomosis procedure instead. Surgeons who follow this approach prioritize the ease of reversal and minimizing the risk of complications related to adhesions. Given the differing opinions and lack of a consensus guideline, it is essential for surgeons to consider the individual patient's characteristics, the specific stoma location, and the surgeon's expertise when making a decision. They should evaluate the potential benefits and risks of rectus sheath fixation on a case-by-case basis and discuss these considerations with the patient to reach an informed decision together. |
