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PubMed1989

[Colostomy patients--well cared for, if counseled. Experiences of a colostomy counselling center].

The postoperative care of stoma patients concerns the surgeon, the nurse, the relatives as well as the family doctor. In past years, specialized stomatherapy services became more important, and they represent a real necessity for the patients, according to our own experience. We plead for a broad stoma patient care including stomatherapy services in all cases, either during hospitalization or as an out-patient service after having left hospital.

Adult↗
PubMed1998

The high morbidity of colostomy closure after trauma: further support for the primary repair of colon injuries.

BACKGROUND: We examined the recent experience of a large urban trauma center to identify overall morbidity and factors predictive of outcome in patients undergoing colostomy closure after trauma. METHODS: We did a retrospective analysis of 40 patients who underwent colostomy closure after trauma at our institution between January 1992 and August 1996. RESULTS: The mechanism of injury was a gunshot wound in 30 patients (75%), a motor vehicle accident in 6 (15%), a stab wound in 3 (7.5%), and a rectal foreign body in 1 (2.5%). Loop colostomies were performed in 28 patients (70%) and end colostomies were performed in 12 patients (30%). Mean time until colostomy closure was 8 months (range, 0.5 to 28 months). Five patients underwent same admission colostomy closure (SACC). Contrast enemas were performed in 36 patients and found to be abnormal in 2 (6%) patients who were found during planning for SACC to have leaks from rectal trauma at 12 and 19 days after injury. Sixteen complications occurred in 12 patients (30%). Intraoperative complications occurred in two patients (5%) who sustained small and large bowel enterotomies. There were 4 major complications (1 fecal fistula, 1 anastomotic stricture, and 2 small bowel obstructions) in 3 patients (7.5%) and 10 minor complications (25%), 7 prolonged ileus and 3 superficial wound infections. Morbidity was significantly higher for patients whose initial injury involved the colon (11 of 20; 55%) as compared with those whose injury involved the rectum (2 of 16; 12.5%). The demographic, injury, and operative characteristics in the 12 patients with complications and the 28 patients without complications were compared to identify predictors of morbidity. The presence of a colon injury (RR = 7.70; p = 0.009) was a statistically significant predictor of morbidity after colostomy closure. The presence of an initial rectal injury, in contrast, was a predictor of low morbidity after closure (RR = 0.22; p = 0.024). No statistically significant differences were found with respect to age, gender, mode of injury, colostomy type, type of repair, need for laparotomy, or right- versus left-sided colostomy. Clinical trends were noted in five groups in whom the relative risk was greater than 2.0: age older than 30 versus less than 30 years (RR = 2.71; p = 0.079), end versus loop colostomy (RR = 2.33; p = 0.130), operative time greater than 2 versus less than 2 hours RR = 2.80; p = 0.141), estimated blood loss greater than 150 versus less than 150 cc (RR = 2.77; p = 0.079), and right- versus left-sided colostomy (RR = 2.00; p = 0.211). Patients with complications had significantly longer mean operative times (3.84 versus 2.46 hours; p = 0.02), higher mean blood loss (468 versus 142 cc; p = 0.006), and longer mean time until closure (11.3 versus 6.33 months; p = 0.02). CONCLUSIONS: Colostomy closure after trauma remains associated with significant morbidity. The patients in whom a colon injury was the indication for initial colostomy experienced high morbidity (55%) after subsequent closure. Patients who had a colostomy for rectal injury had a low morbidity after closure (6.25%). Intraoperative difficulties (longer operative times, higher blood loss) and long delays until colostomy closure increase complication rates. Timely closure may improve outcome after operation for bowel continuity restoration. Morbidity associated with colostomy closure should be considered additional evidence for performing primary repair of colonic injuries. Because the morbidity of colostomy closure after rectal injuries is low, proximal colostomy for extraperitoneal rectal injuries should remain the treatment of choice.

Adult↗
PubMed1996

A comparison of end and loop colostomy for fecal diversion in gynecologic patients with colonic fistulas.

OBJECTIVE: The purpose of this study was to evaluate the early morbidity, stomal complications, and overall survival rate of gynecologic oncology patients treated with end or loop colostomy for management of colonic fistula. METHODS: Seventy-five women with fistulas undergoing fecal diversion procedures from 1983 to 1993 were identified. Information relevant to tumor history, type of fistula, operative procedure, complications, and outcome was extracted from the medical records. RESULTS: A recto- or sigmoid-vaginal fistula was present in 55 patients. The remaining 20 patients had either a colonic fistula involving the bladder, uterus, or skin or multiple fistulas. In 66 (88%) patients, the pelvis had been irradiated. Loop colostomy was performed in 47 (63%) patients and end colostomy in 28 (37%) of patients. Cancer was present in 31 (66%) of 47 patients undergoing loop colostomy compared with 12 (43%) of 28 patients undergoing end colostomy (P = 0.05). No significant differences were detected with regard to age at cancer diagnosis or age at the time of colostomy, body habitus, medical condition, type of cancer, history of pelvic irradiation, or incidence of multiple or complex fistulas. Median operative time was increased by 1 hr and median blood loss from 50 to 200 ml with end colostomy. No significant advantage of loop colostomy over end colostomy was detected in the incidence of acute morbidity or hospital stay. Early stomal complications occurred in 8 patients, 7 of whom had loop colostomy (P = 0.25). Delayed complications (prolapse, retraction, stool per vagina, or fistula) following loop colostomies occurred more frequently than following end colostomy: 12 (26%) of 47 compared with 2 (7%) of 28 (P = 0.05), respectively. Five loop stomas were later converted to end stomas. In addition only one of four attempted loop colostomy closures was successful. Overall survival in both groups of patients was similar. CONCLUSION: There were no statistically significant differences between patients treated with loop or end colostomy with regard to early morbidity or survival. The early and frequent occurrences of stomal complications after loop colostomy overshadow the clinically minor advantages of this method of fecal diversion. Although loop colostomy was performed more often in this setting, these data do not support its routine use for the management of gynecologic oncology patients with fistulas.

Colonic Diseases↗
PubMed2001

Colostomy for anorectal anomalies: high incidence of complications.

PURPOSE: The aim of this study was to characterize the type and incidence of complications related to colostomy formation in newborn infants with anorectal anomalies. METHODS: The authors reviewed a 5-year (1994 to 1999) experience of a single institution in the management of neonates with high and intermediate anorectal anomalies who required colostomy at birth. Patients with colostomy still in place have been excluded from the study to maximize the chances of detecting colostomy-related complications. RESULTS: There were 80 neonates with anorectal malformations, of whom, 49 (31 boys and 18 girls) were included in the study. The site of colostomy was sigmoid colon (n = 32), transverse colon (n = 7), and descending colon (n = 10). Thirty-nine colostomies were loop, and the remaining 7 were divided. The median birth weight was 2.96 kg (range, 1.46 to 3.88). The age at colostomy formation was 2 days (range, 1 to 210). Mechanical complications related to colostomy formation were observed in 16 infants (32%) with 3 infants having more than 1 mechanical complication. These included prolapse in 8 (50%), intestinal obstruction (adhesions, intussusception, and volvulus) in 7 (44%), and skin dehiscence in 3 (19%). One neonate had necrotizing enterocolitis (NEC) after colostomy formation. Urinary tract infection was observed after colostomy in 14 infants (29%). The incidence of urinary tract infection was not higher in infants who had loop colostomy (11 of 39, 28%) compared with infants who had divided colostomy (3 of 10, 30%). There were no differences in the incidence of colostomy-related complications and urinary tract infection between male and female infants. There were no deaths in this series. CONCLUSIONS: Formation of colostomy for anorectal anomalies should not be considered a minor procedure. In our experience the incidence of complications after colostomy formation is high. The incidence of urinary tract infections does not seem to be affected by the type of colostomy performed.

Age Factors↗
PubMed1989

The true cost of protective loop colostomy.

Transverse loop colostomies are commonly used to "protect" low colorectal anastomoses after anterior resection for rectal carcinoma. However, anastomotic leaks occur despite proximal decompression. We studied 61 consecutive patients who underwent anterior resection to evaluate the cost of loop colostomy as reflected by morbidity, mortality, and length of post-operative hospital stay. Colostomy patients had significantly greater blood loss (736 vs. 500 ml, p = 0.004), more blood transfusions (1.55 units vs. 0.41 units, p less than 0.001), and longer operations (238 vs. 193 min, p = 0.005). They were also older (68 vs. 65, p = 0.13), had lesions closer to the anal verge (10.2 vs. 11.4 cm, p = 0.07), and had more infectious complications (13.6% vs. 2.6%, 0.05 less than p less than 0.1) than patients without colostomies. Colostomy was not related to sex or stage. There were no anastomotic leaks among those with colostomies and only one among those without colostomies; there were no associated mortalities. Patients with colostomies stayed an additional 10 days, on average, when readmitted for colostomy closure. The 22 patients who received loop colostomies had postoperative stays averaging one-third longer than patients without colostomies (16 vs. 12 days, p = 0.004). In both groups, the 8th postoperative day was the mean for resumption of a regular diet; all patients were eating a regular diet by the 12th postoperative day. The delay in discharging colostomy patients was due to the additional time necessary for patients to learn to change their appliance and irrigate their stoma. Proximal diverting colostomies may more than double the total dollar cost of anterior resection, although DRG reimbursement is the same with or without a colostomy. This additional cost could be reduced by initiating ostomy teaching in the preoperative period and by reducing the use of unnecessary colostomies.

Adenocarcinoma↗