gms | German Medical Science

Objectives: Closure of a protective loop Ileostomy and Colostomy after a Hartmann procedure is usually performed with total closure of the wound. This frequent procedure still leads to significant postoperative morbidity, specially wound infection, dehiscense, and incisional hernia. Our group developed an alternative open technique for secondary wound healing. In this study, our new “VULKAN” technique for ostomy closure is presented with preliminary results of the clinical serie of 23 patients.

Methods: Patients with protective loop ileostomy for diverse indications and end colostomy after Hartmann procedure were selected for the study and prospectively documented. Morbid obesity and patients with coagulopathy were exclusion criteria. After a circular incision very close to the ostomy limits, the bowel was liberated by usual dissection. After stapled or manual sewed anastomosis, the fascia was closed. “VULKAN” technique is applied in 3 concentric circular purse-string suturing of subcutaneous tissue using absorbable suture., resulting in concentric stricture of the wound. No drainage is applied. Antibiotic prophylaxis is restricted only for one intraoperative single-shot.

Results: The procedure was successfully performed in all patients. Mean operative time for ostomy closure was 48 min. Postoperative stay was a mean of 6 days, after normalization of laboratory parameters. There were 3 postoperative wound infections, that were treated with local measures. One patient had an incisional hernia that was surgically treated. Cosmetic results after 3 months showed a resulting punctural wound similar to a laparoscopic trocar wound.

Conclusion: The new “VULKAN” technique for ileostomy and colostomy closure showed feasibility and safety in our preliminary series. Cosmetic results after complete wound healing appeared excellent, reducing the incision to a punctural scar. The method is now our first choice for non obese patients with ostomy closure indication.