LAUSR

Stenosis of the left end colostomy is a rare complication that occurs in 2–15% of all colostomies [1], mostly appearing within the first 5 years of its performance [2]. The cause of stenosis is usually ischemia, although infection and subsequent retraction can also develop stenosis [3]. It can be managed conservatively with dietary modifications and irrigations. Other management options are manual local dilations or the use of Hegar dilators; however, these options require numerous sessions and can lead to greater fibrosis [3]. When these interventions fail, local skin plasties can be used, which sometimes require laparotomies and transposition of the stoma to a more suitable location. Some of these techniques are the classic Z-plasty [4] or the more current W-plasty described by Beraldo et al. [1]. Due to these challenges and the lack of innovation in the last decade, we developed a modified version of the gunsight plasty [5], for the treatment of colostomy stenosis, which we called the Star-plasty. We present a 73-year-old woman with a history of Miles operation due to pT3N0 rectal adenocarcinoma 4 years ago. Since a year, she presented progressive stenosis of colostomy, refractory to Hegar dilators, which limit her quality of life. That is why we propose the realization of a Star-plasty. The Star-plasty technique is performed by drawing a fourpointed star centered on the stenotic stoma (Fig. 1). The stoma and most of the peristomal scar tissue will be removed without delving into the lateral subcutaneous tissue, except around the colon wall (Fig. 1). Adhesion dissection of the entire colon is performed until reaching the aponeurosis. The intraperitoneal colon is approached through the periostomal incision, although it can also be done through laparotomy or laparoscopy. After fully mobilizing the colon from all its adhesions, it will be divided into healthy tissue. Subsequently, the tips at the obtuse angles of the star are resected at the appropriate distance to determine the diameter of the new colostomy. The intradermal suture of the four arms of the star is started with polyglycol 3.0. resulting in a cross-shaped suture with a square in the middle. The new colostomy will be sutured to the edges of this square with seromuscular polyglycolic 3.0 stitches (Fig. 1). After 5 years post-surgery, patients have not developed new stenosis. The advantages of the Star-plasty technique are the resection of the peristomal retractable tissue and the ability to maintain the stoma in the same location. Furthermore, this technique allows us to adjust the size of the incision in the skin depending on the diameter of the colon lumen, resecting more or less of the obtuse tips of the star. Finally, with this technique, a flat skin surface is obtained, compared to the convexity of the Z-plasty, which facilitates the correct apposition of the colostomy bag to the skin. We consider that the Star-plasty is an easy, innovative, and effective technique that should be considered as an alternative management for the treatment of colostomy stenosis and its consequent improvement in the patient’s quality of life.