Laparoscopic Colostomy in Gynecologic Cancer

Study Objective: The purpose of our study was to report on our case series of 7 patients with gynecologic cancer who underwent laparoscopic colostomy for elective fecal diversion. Our aim was to retrospectively estimate feasibility, safety, and efficacy of the laparoscopic approach in the setting of gynecologic malignancy, given the high incidence of earlier abdominal surgery and pelvic radiation treatment in this select population. Design: Retrospective chart review (Canadian Task Force classification I). Setting: University of Texas, M.D. Anderson Cancer Center. Patients: All patients with a history of gynecologic cancers who underwent laparoscopic colostomy during the study period. Interventions: We retrospectively reviewed all patients who underwent elective laparoscopic diverting colostomy in our department of gynecologic oncology. Surgical indications, medical history, operative and stomal complications, estimated blood loss, return of bowel function, and length of hospital stay were collected. Measurements and Main Results: Seven patients underwent laparoscopic colostomy during the study period. Six of these patients underwent an end descending colostomy, and 1 patient underwent a loop colostomy. Indications included rectovaginal fistula (n = 5), colonic/pelvic fistula (n = 1), or large bowel obstruction (n = 1). No intraoperative or postoperative complications occurred, nor did any conversions to laparotomy. The median blood loss was 50 mL (range 10-75). Median operative time was 102 minutes (range 69-159). Six (86%) patients had a history of pelvic radiation. In addition, 3 (43%) patients had a history of laparotomy. The median patient weight was 59.8 kg (range 47.1-82.2). The median time to tolerance of a regular diet was 2 days (range 1-3) and the median length of hospital stay was 3 days (range 2-4). No immediate or delayed stomal complications were noted with a median follow-up of 6 months (range 1-15). Conclusion: Laparoscopic colostomy in advanced gynecologic cancer may be a safe and feasible technique with minimal morbidity, rapid return of bowel function, and short hospital stay.