“Incisionless” colostomy creation: A case series

The advent of laparoscopic and robotic surgery has revolutionized many operations throughout the surgical world, leading to smaller incisions, reduced post-operative pain, shorter hospital stays, and accelerated post-surgical recovery. However, these advancements come with drawbacks such as limited accessibility, high costs, and sometimes the requirement of multiple incisions. We present an alternative approach for an open “incisionless” colostomy, using an intra-rectal Foley catheter to help identify the descending colon. Two patients underwent colostomy creation utilizing this minimally invasive open technique. The technique involves placement of a 24-french Foley catheter intra-rectally prior to prepping and draping the patient, making a circular incision, generally less than 3 cm in diameter over the left lower quadrant where the ostomy will be matured, and identifying of the colostomy limb through palpation of the intra-rectal catheter. This technique was utilized in two patients with minimal previous abdominal surgery and a normal or low body mass index. The first patient was 16-year-old male who had suffered a spinal cord injury, which was complicated by neurogenic bowel. He had considerable difficulties in emptying his colon appropriately, refused utilizing an enema regimen, and requested a permanent stoma. The second patient was a 10-year-old male with developmental delays, and severe idiopathic constipation refractory to medical intervention. In this case the patient's family requested a permanent stoma. The open “incisionless” minimally invasive approach to colostomy creation provides an alternative approach to laparoscopic methods, with the benefit of minimal trauma to the abdominal wall and absence of a post-operative incision other than the colostomy itself.