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PubMed1987

Colostomy.

The colostomy is the most commonly performed diversion of the fecal stream in the surgical management of colorectal carcinoma, diverticular disease, congenital birth defects, and trauma. The evolution of the colostomy has resulted in improved surgical techniques and a better quality of life for the patient. The clinician should be familiar with the indications for colostomy surgery, the different types of colostomies, preoperative and postoperative care, complications related to colostomy, and special diagnostic procedures required for follow-up care.

Colostomy↗
PubMed1993

[Pseudo-continent perineal colostomies after amputation of the rectum for cancer].

From February 1989 to February 1982, 23 pseudocontinent perineal colostomies (PC), performed after abdominoperineal excision for rectal carcinoma, were evaluated. Perineal colostomy was performed using a free autotransplant of smooth muscle, according to Schmidt, associated with colonic irrigations. This procedure was proposed to the younger and more alert patients without advanced rectal carcinoma. These 23 cases represented 35% of the rectal extirpations performed during the same period. Four patients did not accept a PC and preferred, after being fully informed about both types of colostomies, to have a classical iliac colostomy which they thought to be safer. The advantages of this procedure were mainly psychological, as the body scheme and corporeal image were not disturbed. Continence was evaluated in only 21 cases, because two patients had non-specific complications (necrosis of the colonic extremity, and colonic perforation due to enema material). Ten patients were incontinent to flatus, but did not have to wear a sanitary towel, while 11 patients had occasional, minor soiling, requiring the use of a sanitary towel. None of the patients had major incontinence requiring a secondary iliac colostomy. When asked what they thought of results, none said that they were dissatisfied. The degree of satisfaction was subjective and was not correlated with the quality of functional results as seven patients declared themselves satisfied although they had minor soiling, and conversely, two patients were not completely satisfied, even though they had no soiling. Six months after operation, the muscular transplanted ring had disappeared in half of the patients, but this did not seem to have any repercussion of the quality of functional results.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1998

[Incidence and prevalence of colostomies. The future of stoma societies. Results of a Côte-d'Or survey. Federation of Stoma Patients in France].

Few data are available in France about the impact of Ostomy Associations in the population of patients with permanent colostomy. The aim of this study was to assess the percentage of patients with permanent colostomy involved in local Ostomy Associations in a well-defined population (Côte-d'Or department, 493,931 inhabitants) in 1992. A minimum number of incident colostomy cases was computed using data from the Digestive Tract Tumor Registry in case of cancer and using the surgical reports from the University Hospital in case of benign disease. The maximum number of incident cases was computed using results from a survey conducted by the Public Administration (Social Security) during the same period. An interval of prevalent cases was assessed the number of collecting pouches based on sold during 1992 in the same area. A colostomy was set up in 37 to 84 patients. The number of prevalent cases was in a range of 274 to 410 patients. The corresponding percentages of Ostomy Associations members were included in a 8.3% to 19% range for incident cases and 9.5% to 19% for prevalent cases. These percentages are less than 30%, which is the presumed value previously evaluated in a survey conducted among physicians. As the incidence of colostomy cases continues to decline regularly, more effective methods must be developed to maintain a constant number of members.

Colostomy↗
PubMed1998

[Laparoscopic colostomy--experiences with inoperable ovarian and rectum carcinomas and rectovaginal fistulas].

Between August 1995 and July 1997 laparoscopic colostomy was successfully carried out in 10 patients with advanced ovarian cancer, inoperable carcinoma of the rectum or rectovaginal fistulae. There were no intraoperative or postoperative complications and postoperative recovery was rapid with all patients having function of the colostomy within 24 h and regaining their preoperative state of mobility on the second postoperative day. The laparoscopic approach allows the careful selection of the colostomy site, easy mobilisation of the colon causing only little disruption to the intestinal function and hence, improving postoperative recovery. From our experience, laparoscopic colostomy is a simple and safe operation in most cases and can be used as the preferred technique of intestinal diversion. The technical features of laparoscopic colostomy are described.

Aged↗
PubMed2001

Life table analysis of hernia following end colostomy construction.

OBJECTIVE: To study the long-term hernia rate and risk factors after end colostomy construction. PATIENTS AND METHODS: 86 patients with a permanent end colostomy constructed over 5 years were examined and interviewed. There were 35 men and the mean age was 56.5 (28-87) years. Risk factors which were analysed included emergency operation, age over 60 years, obesity, steroids, cancer, infection at the stoma site, smoking and chronic obstructive airways disease. RESULTS: Para-colostomy hernia occurred in 12/86 cases (13.9%). The cumulative recurrence rose with duration of follow up. Overall 10/45 patients (22%) over 60 years developed hernia vs. 2/41 patients (4.8%) less than 60 years (P=0.02). There were no other risk factors that correlated with para-colostomy hernia. CONCLUSIONS: These data indicate that the incidence of colostomy related hernia increases with follow up and is significantly higher in patients over the age of 60. Other risk factors, particularly obesity and coexisting cardiorespiratory disease, have no impact.

Journal Article↗
PubMedDate not supplied

Rectosigmoid resection without colostomy during primary cytoreductive surgery for ovarian carcinoma.

A nine year experience with rectosigmoid colectomy during primary cytoreductive surgery for epithelial ovarian cancer is reported. During the period 1979-1987, 20 patients underwent such resections with primary sutured end-to-end anastomosis without a protecting colostomy. Only one of these patients required a secondary colostomy. In a further five patients, anterior resection and reanastomosis was performed concomitant with additional bowel resections, again without diversion colostomy. Subsequent secondary colostomy for a recto-vaginal fistula was required in one. There were two post-operative deaths, both in the group who required bowel resections in addition to recto-sigmoid resection. Of the entire group of 25 patients, 12 (48%) are currently alive free of disease, with a median survival of 32 months. Excluding the two post-operative deaths (at 20 and 39 days), the median survival of the remaining 11 who subsequently died of recurrent disease, was 14 months. The Authors recommend that anterior resection with primary reanastomosis without a protecting colostomy, is performed during primary cytoreductive surgery for ovarian cancer in patients in whom such a procedure facilitates resection of all or nearly all their disease.

Anastomosis, Surgical↗
PubMed1986

De-functioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy.

Patients undergoing colorectal surgery who required a defunctioning stoma were randomly allocated to receive either a loop ileostomy (n = 23) or transverse loop colostomy (n = 24). Assessment was made during construction, immediately postoperatively, during the period of outpatient supervision and before and after stoma closure. The ileostomy was associated with significantly less odour than the colostomy (P less than 0.01) and required significantly less appliance changes (P less than 0.05). Furthermore eleven patients (58 per cent) with a colostomy experienced three or more problems with stoma management compared with only three patients (18 per cent) with an ileostomy (P less than 0.05). Wound infection was also significantly more common after closure of the colostomy compared with the ileostomy. Both types of stoma were demonstrated objectively to defunction the distal bowel almost completely. These results indicate that a loop ileostomy is the procedure of first choice when a stoma is needed to defunction the distal colorectum.

Adult↗
PubMed1988

Influence of proximal colostomy on the healing of a left colon anastomosis: an experimental study in the rat.

The healing of an experimental left colon anastomosis protected by a proximal diverting colostomy was studied in the rat. Collagen synthesis in the anastomotic area was measured by incorporation of [3H]proline. With a defunctioning proximal colostomy, the synthesis and accumulation of collagen in the anastomosis was diminished, and the anastomotic strength development delayed and reduced. The development of anastomotic strength seems to proceed according to the level of strain from intraluminal bulk. As the healing of the anastomosis protected by a diverting colostomy was uncomplicated, these findings should not contra-indicate the use of diverting colostomy.

Anastomosis, Surgical↗
PubMed2004

Diagnostic laparoscopy and diverting sigmoid loop colostomy in the management of civilian extraperitoneal rectal gunshot injuries.

BACKGROUND: This prospective study reviews the management of isolated civilian extraperitoneal rectal gunshot injuries using a protocol of diagnostic laparoscopy and abdominal wall trephine diverting loop colostomy, without laparotomy, distal rectal washout and presacral drainage. METHODS: Patients admitted to the trauma unit at Groote Schuur Hospital between January 2000 and December 2002 with a rectal injury were evaluated. A rectal injury was confirmed by digital rectal examination and proctosigmoidoscopy. Missile peritoneal violation was excluded by diagnostic laparoscopy. Normal laparoscopy was followed by creation of a diverting sigmoid loop colostomy through an abdominal wall trephine, without a laparotomy. No distal rectal washout or presacral drainage was performed. RESULTS: Of the 104 patients admitted with 106 rectal injuries, 20 (19.2 per cent) qualified for inclusion in the study. All had sustained low-velocity gunshot injuries of which 18 exhibited a transpelvic trajectory. Diagnostic laparoscopy was normal and a trephine diverting loop sigmoid colostomy was performed in all 20 patients. No pelvic sepsis occurred. Two patients developed rectocutaneous fistulas, both of which resolved without surgical treatment. Nineteen stomas have since been closed. CONCLUSION: Low-velocity gunshot injuries isolated to the extraperitoneal rectum can be managed safely by laparoscopic exclusion of intraperitoneal missile penetration and diverting sigmoid loop colostomy, without laparotomy, distal rectal washout or presacral drainage

Adolescent↗
PubMed1994

Laparoscopic descending colostomy in three patients with cervical carcinoma.

Three patients with cervical carcinoma underwent laparoscopic descending colostomy. The indications for colostomy included severe radiation proctitis, enterovaginal fistula secondary to progressive pelvic tumor, and large bowel obstruction from progressive pelvic tumor. Two patients were treated with laparoscopic descending end colostomy with creation of a Hartman's pouch, and the third patient underwent laparoscopic descending loop colostomy. The techniques utilized are discussed.

Colostomy↗
PubMed1986

The history of colostomy in childhood.

The idea of performing a colostomy in a child was first brought up by Littré in 1710. It lasted, however, 50 years until the first successful operation was published. Especially in the 19th century various ways to approach the colon have been practiced with frequently disappointing results (lumbar, inguinal approach). Only at the end of the century, colostomy was used as a guide for a pull-through operation. With improved surgical and anaesthesiological techniques, colostomy has gained more importance as a temporary measure in order to postpone definitive surgery. Various new techniques have been developed within the same time. In our days, colostomy is a safe procedure and has a more defined place in handling children with imperforate anus and Hirschsprung's disease.

Child↗
PubMed1985

[Is the protective colostomy in left-sided resections of the colorectum necessary?].

In a prospective clinical study 100 left-side colon and anterior rectum resections were performed without a protective colostomy under standardized conditions: Whole gut lavage, oral and systemic antibiotic prophylaxis, parenteral highcaloric nutrition perioperatively, anastomosing technique end to end, single layer, with atraumatic sutures (3 X 0 Vicryl, Dexon) or EEA stapler. A clinically relevant insufficiency of the anastomosis was seen in 4%, wound-healing impairment in 7%, only one patient died. Due to careful preparation and operation technique the frequency of septic complications and mortality nowadays is very low. On the other side a protective colostomy is afflicted with psychical problems to the patient, higher costs because of the longer period of hospitalization and a not unimportant number of complications of colostomy closure. Therefore we consider the routine usage of protective colostomy as not being necessary in elective colon and anterior rectum resections.

Adult↗
PubMed1988

Healing of a left colon anastomosis after early colostomy closure. An experimental study in the rat.

The healing of a standardized left colon anastomosis after early (7 days) closure of a concomitant proximal diverting colostomy was studied experimentally. Early closure of the diverting colostomy could be conducted safely by an intraperitoneal technique and the healing of the primary anastomosis was uncomplicated. Colostomy closure in the proliferative phase of wound healing resulted in development of anastomotic strength similar to colonic healing without faecal diversion. The anastomotic strength had doubled after three weeks. As compared to colostomy closure in the remodelling phase of anastomotic healing development of anastomotic strength was more rapid and without serious local complications.

Anastomosis, Surgical↗
PubMed1991

Continent colostomy by means of a new one-piece disposable device. Preliminary report.

A study was established concerning a continent colostomy system consisting of a new one-piece disposable plug. Twenty patients participated: 13 men and 7 women, who ranged in age from 35 to 87 years. All patients had an end colostomy located on the left lower quadrant. The colostomy age ranged from 2 months to 7 years. Of the 20 participants, 17 found the new procedure to be safer and more comfortable, as well as a considerable improvement for their quality of life. The other three patients found no advantage in its use. In no case was there any perception of local, secondary, or general adverse effects owing to its use. Taking into consideration that the use of this new device does not require any type of special conditioning, we consider that it can contribute to the better quality of life of a colostomy patient, the one best able to evaluate the worthiness of its use.

Adult↗
PubMed1993

Diversion colitis in patients scheduled for colostomy closure.

Despite recent work, diversion colitis remains poorly defined. Thirty-four patients, scheduled for colostomy closure, were prospectively evaluated with flexible sigmoidoscopy for diversion colitis. Biopsies and cultures were obtained if colitis was identified at endoscopy. All biopsy materials and cultures were consistent with inflammation only. The vast majority of patients were in good general health, and their colostomies were constructed as the result of trauma. Eight patients (24 percent) had normal-appearing colons at an average of 16.6 weeks following diversion. Twenty-six patients (76 percent) demonstrated mild to severe colitis at an average of 29.9 weeks following diversion. Three complications occurred in 22 patients after colostomy closure: two wound infections in patients with colitis and one in a patient with a normal colon. We conclude that diversion colitis in an otherwise individual constitutes no increased risk of infection following colostomy closure.

Adult↗
PubMed1995

Fluctuation of blood pressure and pulse rate during colostomy irrigation.

PURPOSE: The aim of this study was to determine the effects of colostomy irrigation on the vital signs of patients with left colostomy. METHODS: Twenty-two consecutive patients who underwent abdominoperineal resection for cancer of the lower rectum and had left lower quadrant end colostomy were included in this study. Subjective symptoms, blood pressure, and pulse rate during the first irrigation were investigated. RESULTS: Fluctuation of blood pressure during instillation was 8.0/8.5 mmHg (average) and 25.0/17.9 mmHg during evacuation. Fluctuation of pulse rate was 5.5 per minute (average) during instillation and 11.5 per minute during evacuation. The number of subjects who showed more than 20% fluctuation of systolic pressure was 12 (54.5 percent) and that of diastolic pressure was 14 (63.6 percent). One of 22 patients complained of illness during irrigation. CONCLUSION: Although colostomy irrigation showed no significant effects on vital signs in the majority of patients, it caused a significant reduction in both blood pressure and pulse rate in a small number of patients. Careful attention should be paid to vital signs considering the possibility of such effects, especially on the initial irrigation.

Aged↗
PubMed1996

Influence of colostomy on in vivo and in vitro permeability of the rat colon.

PURPOSE: Barrier properties of an isolated colon loop and the remnant colon in continuity with the gastrointestinal tract after colostomy were studied in the rat. METHODS: The in vivo absorption after colonic loop administration of the marker fluorescein sodium was measured as the urinary recovery. The in vitro permeability was measured in Ussing diffusion chambers as the transmucosal passage of [14C]mannitol and of human serum albumin in the isolated and the nonexcluded colonic segments and was compared with the corresponding colonic regions from sham-operated rats at 1 to 14 days after operation. RESULTS: Body weight gain of the rats decreased and diarrhea appeared from day 2 after colostomy. Histologic examination showed mucosal atrophy with decreased villus height in the isolated colonic loop and an increased villus height in the nonexcluded colon segment. Absorption of fluorescein sodium in the isolated loop was increased at 8 and 14 days. Moreover, permeability in the isolated loop was increased for both mannitol and human serum albumin from four days after colostomy compared with the corresponding colonic segments after the sham operation, whereas a decrease in the passage of mannitol was noted in the nonexcluded colon. CONCLUSIONS: Experimentally performed colostomy diversion in the rat induced alterations of the barrier function in both the isolated colonic loop and the nonexcluded colon in continuity with the fecal stream.

Animals↗
PubMed1997

Antiperistaltic transverse colostomy for massive bowel necrosis following surgery for an abdominal aortic aneurysm: report of a case.

We herein report the findings of a 72-year-old man with gangrenous multivisceral necrosis following an operation for abdominal aortic aneurysm. The region of necrosis, which accompanied infarction of the left kidney, included the entire ileum and the ascending, descending, and sigmoid colon. An end ileostomy and transverse colostomy were performed subsequent to massive bowel resection in a second operation. After the second operation, he was managed with total parenteral nutrition and recovered uneventfully except for end-jejunostomy syndrome. A third operation was performed to reconstruct the interrupted bowel. To minimize abandoned bowel, antiperistaltic transverse colostomy was used for jejunocolonal reconstruction. The antiperistaltic colostomy improved the symptoms of end-jejunostomy syndrome and normalized the patient's vitamin B12 and bile acid levels. An antiperistaltic colostomy is thus considered to be useful for preventing short bowel syndrome after a massive bowel resection.

Aged↗