Trephine Stoma in High-Risk Patients: Feasibility and Short-Term Outcomes

Background/Objectives: In older patients undergoing abdominal surgery, perioperative risk is influenced not only by chronological age but also by frailty, comorbidity burden, and diminished physiological reserve. These factors may limit tolerance of conventional abdominal surgery and increase interest in less invasive surgical approaches in high-risk patients. The trephine approach provides limited surgical access without routine laparotomy, but evidence regarding its use in this population remains limited. This study evaluated the technical feasibility and short-term outcomes of the trephine approach in high-risk older patients. Methods: Patients aged ≥65 years who underwent stoma surgery using the trephine approach at a tertiary referral center between January 2016 and January 2026 were retrospectively reviewed. During the study period, 488 patients underwent stoma surgery; of these, 10 (2.0%) were managed using the trephine approach and formed the study cohort. We used preoperative CT for surgical planning in all cases, with intraoperative endoluminal guidance when required. We analyzed demographic, perioperative, and short-term outcome data descriptively. Results: The mean age was 77.9 ± 9.6 years. Median ASA physical status was 4, median Clinical Frailty Scale score was 5.5, and median Charlson Comorbidity Index was 5.5. Eight patients (80%) underwent emergency surgery. The planned procedure was completed without conversion to laparotomy in 9/10 patients (90%), and bowel resection was performed through the same incision in 4/10 (40%). Median operative time was 32.5 min, and median hospital stay was 5 days. Major complications occurred in 3/10 patients (30%), and 30-day mortality was 2/10 (20%). Conclusions: In this small retrospective series of high-risk older patients, the trephine approach was technically achievable in most cases when used with preoperative CT-based planning and, when needed, intraoperative endoluminal guidance. These findings provide preliminary descriptive evidence regarding the feasibility of this approach in a highly selected clinical setting. Given the small sample size, lack of a comparator, and observed postoperative morbidity and mortality, no conclusions can be drawn about safety, comparative effectiveness, or patient-selection criteria.