Laparoscopic or trephine faecal diversion: is there a preferred approach and why?

Background: Faecal diversion is often indicated in perineal sepsis and in the palliation of advanced ano-rectal malignancy. This can be performed open or laparoscopically. The aim of this study was to assess the outcome of these two approaches to stoma creation.

Methods: Prospective evaluation of laparoscopic or 'trephine' stoma creation in 49 consecutive unselected patients.

Results: Eighteen (37%) patients (median age 68 years) underwent a laparoscopic approach in which there were no conversions. One patient required a laparotomy for stoma mal-orientation and there were two (11%) deaths. Thirty-one patients (median age 70 years) had a trephine stoma formed with two (6%) conversions but no deaths. Thirteen (42%) of these patients had surgery performed under regional anaesthesia. There was no difference in the hospital stay between the two groups and at a mean follow-up of 16 months, 20 (41%) patients had died mainly from disease progression.

Conclusion: Both approaches to faecal diversion give adequate results in the short term. Laparoscopic techniques should be reserved for fitter patients as a trephine stoma can be performed under regional anaesthesia.