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At least 271 records · Page 15Linked to original sources
PubMed1988

Surgical treatment of colostomy complications.

One hundred and twenty-three patients (M:F, 0.9:1; mean age 62 years) underwent 156 operations between 1954 and 1984 for correction of late colostomy complications (stenosis 65 patients, prolapse 16 patients, paracolostomy hernia 42 patients). Sixty-three per cent of patients eventually had a good result but in some up to 5 operations were necessary. Local excision of scar tissue at the mucocutaneous junction was associated with a 61 per cent (43/71) success rate for relief of colostomy stenosis. Where local fixation failed to prevent recurrent colostomy prolapse (13/20, 65 per cent of local fixation operations), colectomy and ileostomy was the most effective second procedure (2/3, 67 per cent success rate). Where local repair of a paracolostomy hernia failed (15/32, 47 per cent of local operations), resiting of the stoma to the umbilicus or right side of the abdomen produced better results (3/7, 43 per cent success rate) than resiting to another trephine on the left side of the abdomen (2/14, 14 per cent success rate).

Colostomy↗
PubMed1993

Multicentre study of a continent colostomy plug.

A multicentre clinical study was carried out to assess the performance of a new disposable device, the Conseal 1-Piece, for colostomy control and continence. Forty-three patients were studied; none had any complication at the stoma. The time elapsed since surgery and the condition of the stoma and surrounding skin were recorded. The new product was compared with the patients' usual colostomy bag, studying the following parameters: ease of application, reliability, leakage, confidence, ease of removal, adhesion and comfort. Thirty-seven patients completed the study. No complications arose, and complete faecal continence was obtained with 71.1 per cent of applications. The plug was kept in position for a mean of 11.5 h and a normal stoma bag was used for the remainder of the day. Of the 37 patients who completed the trial, 26 preferred the Conseal 1-Piece to a colostomy bag. In this preliminary study the device was easy to apply, involved no major complications and provided a high degree of continence. This product deserves further study because of its simplicity of use. However, research to improve the level of continence should continue.

Aged↗
PubMed1995

Primary anastomosis with transverse colostomy as an alternative to Hartmann's procedure.

Hartmann's procedure remains the favoured option in patients with acute left colonic and sigmoid disease, despite the well documented morbidity and mortality associated with reversal. In 40 patients with left colonic pathology, primary anastomosis was performed; 32 had a covering transverse colostomy. There were six hospital deaths, five in the transverse colostomy group. Closure was not attempted in seven of the 27 patients surviving with a colostomy (three refused, four had disseminated malignancy). In the 20 undergoing closure, there was no morbidity or mortality. With advances in intensive care, antibiotic therapy and anaesthesia, it is reasonable to consider alternatives to Hartmann's procedure, particularly when subsequent reconstruction is envisaged.

Adult↗
PubMed1995

Defunctioning colostomy for low anterior resection: a selective approach.

Seventy-seven consecutive low anterior resections of the rectum were performed with a selective approach to the use of a defunctioning colostomy. A defunctioning colostomy was performed in seven patients (9 per cent) where there was concern about the anastomosis due to difficult dissection (three), incomplete doughnuts (three) and tension on the anastomosis (one). The mean level of the tumour in the defunctioned group was 7.6 cm. Clinical anastomotic leakage occurred in two patients (3 per cent) in the non-defunctioned group, both of which were controlled with subsequent transverse colostomies. There were no perioperative deaths. Selective defunctioning of low colorectal anastomoses can produce low rates of anastomotic dehiscence while reducing the morbidity associated with a temporary stoma.

Adult↗
PubMed1996

Effect of different infusion regimens on colonic motility and efficacy of colostomy irrigation.

The colonic motility response and short-term clinical effectiveness of colonic irrigation was studied in five patients with an end-colostomy, each of whom was studied on up to six occasions, using volumes of 500 and 1500 ml water infused under gravity and over a period of 2.5 and 5 min with a pump. The median baseline colonic luminal pressure was 14 cmH2O and rose to 42 cmH2O with a 500-ml infusion, and to 74 cmH2O with a 1500-ml infusion. Irrigation induced high-pressure (over 200 cmH2O) propagated waves which caused the efflux of colonic contents. These were more numerous after a 1500- than a 500-ml infusion (median 4.5 versus 2.0 respectively). There was no difference between the two volumes infused in the incidence of colostomy break-through before subsequent irrigation. Colostomy irrigation with 500-1500 ml water appears to produce intracolonic pressure rises that are safe. These volumes can be infused rapidly under gravity alone.

Aged↗
PubMed1989

Proximal colostomy: still an effective emergency measure in obstructing carcinoma of the large bowel.

Large bowel obstruction constitutes an emergency abdominal condition and necessitates prompt surgical treatment. The optimal approach is still controversial as to whether to perform a diverting colostomy only or a tumor resection with or without primary anastomosis. Seventy-one elderly and high-risk patients were treated by proximal diverting colostomy through a right upper abdominal incision. The operative mortality was 8.5%, with an additional morbidity of 20.5%. Stomal complications appeared in 6.1% of the survivors. Seventy-five percent of surviving patients underwent successful resection and closure of colostomy within 3 months without additional mortality. Others were not operated because of metastatic disease or severe concomitant disease. We conclude that although primary resection should be attempted in good risk patients, for those patients who are elderly and at high risk, a simple life-saving procedure, such as fecal diversion, could alleviate obstructions with relatively low morbidity and mortality and improve the patient's prospects for subsequent definitive surgery.

Aged↗
PubMed1995

Acute obstruction from tumour in the left colon without spread. A randomized trial of emergency colostomy versus resection.

Staged resection (group T) versus acute resection (group R) for cure was compared in a randomized study of 121 patients presenting with signs of leftsided obstructive colorectal tumours during emergency surgery from 1978 to 1993. Patients with distant spread were excluded. Transverse colostomy was done in 58 and resection without immediate anastomosis in 56. Duration of emergency surgery was shorter, blood-transfusions less and wound infections less frequent in T compared to R, but postoperative mortality was similar (8 patients in each group). The diagnosis of tumour was wrong in 11 patients in T and 6 in R. The proportion of patients surviving the second stage curative resection in T without a permanent colostomy (32/35) was higher than after acute resection (36/50) in spite of 6 patients having anastomotic surgery (Coloshield) at the time of acute resection in R. Days spent in hospital were less in R. Overall recurrence rates and survival rates were similar in T and R. No major advantage besides shorter hospital stay could be demonstrated by acute resection without simultaneous anastomosis compared with the traditional three stage procedure, which on the other hand carried a much smaller risk of a permanent colostomy. The latter should therefore serve as a control in a prospective evaluation of emergency resection with simultaneous anastomosis.

Acute Disease↗
PubMed1993

Decrease in collagenous proteins and mechanical strength of distal colon after diverting colostomy in rats.

The effects of a diverting colostomy on weight, collagen content, and biomechanical strength of the left colon was investigated in rats. Female rats received either a diverting colostomy or a sham-operation and were killed randomly 1, 2, 4, or 12 weeks after surgery. The dry weight and hydroxyproline content of excluded colon decreased by 37% (P < 0.001, confidence limits (CL) = 21-53%) and 25% (P < 0.001, CL = 18-31%), respectively, after 4 weeks, and by 52% (P < 0.001, CL = 38-66%) and 40% (P < 0.001, CL = 27-53%), respectively, after 12 weeks compared to sham-operated rats. The breaking strength of the defunctioned colon decreased by 21% (P < 0.05, CL = 2-40%) after 4 weeks and by 25% after 12 weeks (P < 0.05, CL = 4-46%). The tensile strength of defunctioned colon (load per unit collagen) was reduced by 19% after 4 weeks (P < 0.05, CL = 6-32%). Proximal to the colostomy site we found no differences in the hydroxyproline content or biomechanical strength. In conclusion, defunctioning of the left colon in rats leads to deterioration in the biomechanical properties caused by a lesser content and a decreased quality in the collagen of the left colon.

Animals↗
PubMed1995

Influence of proximal end diverting colostomy on the healing of left-sided colonic anastomosis: an experimental study in rats.

The purpose of this study was to evaluate the healing of an experimental left-sided colonic anastomosis in rats protected by an end diverting proimal colostomy. The anastomoses were studied by radiological and biochemical examination and breaking strength was estimated. The results were compared with a non-operated group and with a group of rats having a non-defunctional anastomosis constructed in the same manner. In animals with an end diverting colostomy, anastomotic protein levels and enzymic activity were lower than in those with a colostomy, and the development of anastomotic strength was delayed compared with those not defunctioned.

Anastomosis, Surgical↗
PubMed1981

[Selective induction of tumors in Wistar rats with loop colostomy after administration of methyl-(acetoxymethyl)-nitrosamine (MAOMN) (author's transl)].

A single dose of 7 mg/kg methyl-(acetoxymethyl)-nitrosamine in Wistar rats with double loop colostomy induced adenomas, papillomas, and adenocarcinomas at the site of colostomy in 83% of the treated animals. The mean induction time was 320 days. The pronounced local effect as well as the high tumor yield are discussed in regard to the evident high epithelial sensitivity at the colostomy site.

Adenocarcinoma↗
PubMed1982

[Morbidity and mortality following intraperitoneal closure of transverse loop colostomy (author's transl)].

The postoperative course of 104 patients, who underwent closure of a transverse loop colostomy at the Surgical Department of the Teaching Hospital Herford between 1974 and 1980 after distal resection and anastomosis of the large bowel for neoplastic or diverticular disease has been reviewed in detail. The mortality was 0.9% and the morbidity rate was 25%, including 25% wound infections and 4.8% fecal fistulas. The highest complication rate was noted, when colostomies were closed during the first 6 weeks. Wound infections and fecal fistulae did not occur more frequently than in patients with diverticulitis. The intraperitoneal procedure of transverse loop colostomy closure can be recommended as to be straightforward and safe.

Adult↗
PubMed1994

Continent perineal colostomy by transposition of gracilis muscles. Technical remarks and results in 14 cases.

UNLABELLED: We herein present a study conducted on 14 patients presenting cancer of the lower rectum or of the anal canal (10 adenocarcinomas and 4 squamous-cell carcinomas) and submitted to the Miles abdominal perineal resection in which a new perineal sphincter was constructed. PURPOSE: The aim of this study was to evaluate the efficacy of this new perineal sphincter constructed by transposing the gracilis muscles around an orthotopic colostomy in the attempt to avoid a permanent abdominal colostomy. METHODS: In all cases both gracilis muscles were employed. The right one was placed along the posterior wall of the pelvis and fixed to the contralateral ischiatic tuberosity, creating a sling comparable to the levator ani muscles. The left gracilis was passed around the colon and attached to the ipsilateral or contralateral tuberosity according to its length, reconstructing a muscular ring. The entire procedure was performed in one step in nine cases and in more steps in the remaining five. RESULTS: Of the 14 operated patients, 2 died of vascular disease and 1 developed necrosis of the colonic stump which required reconversion to an abdominal colostomy. Of the remaining 11 patients available for long-term evaluations, 8 showed adequate stool control. The remaining three manifested an incomplete level of continence. During the three-year follow-up period, all patients were evaluated by clinical examination, defecography, endoluminal ultrasonography, nuclear magnetic resonance, CT scan, and endoluminal manometry. CONCLUSION: This neosphincter realizes an elastic stenosis responsible for an efficient level of continence. Best results are observed in the young and educated patients submitted to surgery in two steps. Contraindications to this surgery seem to be advanced cancer, old age, and obesity.

Adenocarcinoma↗
PubMed1991

Autotransplantation of the pylorus sphincter at the terminal abdominal colostomy. Experimental study in dogs.

A method for constructing a continent colostomy has been tried in dogs. The pylorus sphincter with blood supply by the left gastroepiploic vessels was transposed around or anastomosed to the terminal abdominal colostomy in five dogs. One dog had a colostomy without pylorus transplantation. Evaluation was by clinical (consistency and weight of fecal material and number of defecations per day), radiologic, and manometry studies. There was no difference in the clinical data. In all the dogs, the radiologic study demonstrated emptying of the contrast medium to the peristomal skin. By manometry one high-pressure zone was demonstrated, and, in all dogs with a transposed or anastomosed pyloric segment, the average resting pressure was superior to that of the control dog. However, the transposed pylorus sphincter alone was not sufficient to control continence.

Animals↗
PubMed1997

Bullous pemphigoid at colostomy site: report of a case.

PURPOSE: Pemphigoid is a well-recognized cutaneous lesion, occurring rarely in peristomal skin. We report the diagnosis and successful treatment of localized pemphigoid lesions adjacent to a colostomy. METHODS: We review the chart, immunofluorescence study, treatment, and follow-up of a patient with bullous lesions at a colostomy site. RESULT: Pemphigoid of the pericolostomy skin was diagnosed by immunofluorescence study and successfully treated with antibiotic. CONCLUSION: Diagnosis of bullous pemphigoid should be considered in the differential diagnosis of a bullous lesion adjacent to a colostomy site. Diagnosis is easily made, and treatment is simple and efficacious.

Aged↗
PubMed1992

Does a proximal colostomy affect colorectal anastomotic healing?

Fecal diversion has been implicated as an etiologic factor in anastomotic stenosis following colorectal surgery, particularly following the use of circular anastomotic stapling devices. However, experimental confirmation of the effects of fecal diversion on anastomotic healing is virtually nonexistent. The purpose of this study was to serially evaluate colorectal anastomotic healing with proximal colostomy (COL) and without it (CON; control) using two anastomotic techniques in a porcine model. Fifty-two (28 CON; 24 COL) mixed-breed female pigs had colorectal anastomoses using either a two-layer hand-sewn (HS) or an EEA (U.S. Surgical Corporation, Norwalk, CT) circular stapled (CS) technique. Anastomotic blood flow was measured using laser Doppler velocimetry (LDV). At second surgery (5, 11, 60, or 120 days postoperatively), the following data were collected: repeat LDV, gross and microscopic anastomotic inflammatory scores, anastomotic diameter, and bursting pressure. There were no significant differences in anastomotic blood flow (LDV), inflammatory scores, or incidence of leak or stenosis between the CON and COL groups or between anastomotic techniques. Bursting pressure was significantly lower for the COL group at day 11 but not any other postoperative day (POD). Proximal colostomy does not appear to exert adverse effects on colorectal anastomotic healing. The choice of colorectal anastomotic technique should not be influenced by the need for proximal colostomy.

Anastomosis, Surgical↗
PubMed2001

Chemical colostomy irrigation with glyceryl trinitrate solution.

PURPOSE: Colostomy irrigation may improve patient quality of life, but is time consuming. This study tests the hypothesis that irrigation with glyceryl trinitrate solution, by inducing gastrointestinal smooth muscle relaxation, may accelerate expulsion of stool by passive emptying, thereby reducing irrigation time. METHODS: Fifteen colostomy irrigators(with more than 3 years' experience) performed washout with tap water compared with water containing 0.025 mg/kg glyceryl trinitrate. Fluid inflow time, total washout time, and hemodynamic changes occurring during glyceryl trinitrate irrigation were documented by an independent observer. Subjects recorded episodes of fecal leakage and overall satisfaction on a visual analog scale. Cramps, headaches, and whether or not a stoma bag was used were expressed as a percentage of number of irrigations. Comparison of fluid inflow time, total washout time, leakage, and satisfaction was by Wilcoxon's signed-rank test and headaches, cramps, and stoma bag use was by McNemar's test. Pulse rate (paired t-test), systolic and diastolic blood pressures (Wilcoxon's test) at 20 and 240 minutes after washout with glyceryl trinitrate solution were compared with baseline. RESULTS: Fifteen patients (9 female), with a mean age of 53 (31-73) years, provided 30 sessions (15 with water and 15 with glyceryl trinitrate). Medians (interquartile ranges) for water vs. glyceryl trinitrate were fluid inflow time 7 (4-10) vs. 4, (3-5; P = 0.001); total washout time 40 (30-55) vs. 21, (15-24; P < 0.001); leakage 0 (0-1) vs. 0, (0-0; P = 0.02), satisfaction 10 (8-10) vs. 10 (9-10; P = 0.31). The number (percentage) of stoma bags, cramps, and headaches with water vs. glyceryl trinitrate were 7 (47 percent) vs. 7 (47 percent), P = 1; 1 (7 percent) vs. 14 (93 percent), P < 0.001; and 0(0 percent) vs. 14 (93 percent), P < 0.001, respectively. Changes in pulse (increase) and systolic and diastolic blood pressures (decrease) from baseline were maximal at 20 minutes (P < 0.001, P = 0.001, and P = 0.002, respectively) and had returned to baseline by 240 minutes (P = 0.52, P = 0.08, and P = 1, respectively). CONCLUSION: Glyceryl trinitrate solution significantly reduces colostomy irrigation time compared with the generally recommended tap water. Patients suffer fewer leakages and are highly satisfied, but side effects are potential drawbacks. Other colonoplegic agent solutions should now be evaluated.

Adult↗
PubMed1998

Colonoscopy-assisted colostomy--an alternative to laparotomy: report of two cases.

PURPOSE: The objective of this study was to evaluate the feasibility of performing fecal diversion with the help of a colonoscope without a concomitant laparotomy. METHODS: Colostomies were performed on two patients who needed fecal diversion and who would benefit from avoiding the morbidity of laparotomy. A colonoscope was used in each case to guide the surgeon in selecting the appropriate bowel segment. RESULTS: No complications related to the colostomy were noted in either patient. CONCLUSIONS: The technique of colonoscopy-assisted colostomy that we have described offers an acceptable method of creating a stoma without the need for laparotomy.

Aged↗
PubMed1992

Colostomy plug devices: a possible new approach to the problem of incontinence.

The authors report their experience in the use of the Conseal (Coloplast S.p.A., Bologna, Italy) Colostomy Plug, a new device for the regulation of continence in patients with colostomies. The devices were tested on 57 patients divided into two groups: Group A (36 patients) fit with a two-piece Conseal system and Group B (21 patients) fit with a one-piece Conseal system. All patients had the same colostomy type, and all were trained for self-irrigation. The objectives of this randomized, prospective study were to determine compliance with the different systems, to identify the advantages, and to verify the possible different applications among the population of irrigated patients. The following results were obtained. Regarding compliance: Group A's results were excellent in 22.2 percent and good in 52.7 percent of patients. Group B had better compliance than Group A (excellent in 66.6 percent and good in 19 percent of patients). Regarding controlled evacuation, continence time, and silent gas emission: in Group A, the device permitted controlled evacuations (23.8 percent of patients practicing daily washouts) with silent and odorless gas emission (100 percent of cases). In Group B, the results concerning improvement in continence were good (33.3 percent of patients) and excellent concerning the emission of flatus. Regarding the potential use of both systems in different groups of self-irrigated patients: the study has revealed the Conseal Uni-system as being ideal for patients with a well-constructed stoma, slight gas distention, and a better psychologic adaptability to larger-sized systems. In all other cases, the alternative two-piece system is more suitable, owing to the better safety it offers.

Adult↗