V40 - Minimally Invasive Repair of Stoma Retraction and Prolapse Using a Non-Cutting Linear Stapler

CME Eligible

Purpose/Background: Stomal prolapse and retraction are significant complications after stoma creation, with reported rates of 5-10% and up to 14%, respectively. These issues can lead to acute morbidity including peristomal dermatitis, stoma incarceration, ischemia, and sepsis, and frequently necessitate surgical revision or complex stoma management strategies. Traditional revision techniques are frequently invasive and may be associated with significant risk. A stapler-based repair demonstrated in this video may offer a simpler, less traumatic alternative for stoma stabilization and complication prevention

Methods/Interventions: We evaluated a 58 year old female with Crohn's disease who previously had proctocolectomy with permanent end ileostomy and subsequently developed intermittent stoma retraction. We performed ileoscopy to ensure Crohn's flair was not responsible for retraction. Preoperatively we reviewed available CT imaging to identify the location of stoma mesentery to prevent stapling across it. Covidien TA linear stapler was prepared by removing the retaining pin driver and loaded with blue-load 3.8 mm staples. The ileal segment was externalized to a length of 3-4 cm above the skin surface. The stoma was then stabilized by applying the stapler in three equidistant locations around the circumference avoiding the mesenteric side. Stoma was checked for viability.

Results/Outcomes: Following revision with the TA stapler technique, the stoma was protruding 3-4 cm above the skin surface as desired, consistent with optimal stoma construction. The patient tolerated the procedure well and was discharged the same day with routine outpatient follow-up. Ongoing outpatient monitoring is being conducted to assess for long-term durability and complications.

Conclusion/Discussion: Stapler-based local revision for stomal prolapse or retraction offers several distinct advantages as an initial intervention. This technique is technically straightforward, reproducible, and can often be performed under mild sedation or local anesthesia, reducing perioperative risk and resource utilization. While more extensive surgical interventions may be necessary for refractory or anatomically complex cases, these approaches carry higher risks of complications, longer recovery times, and increased healthcare costs. Therefore, local stapler-based revision should be considered the ideal first step for stomal revision in suitable patients.