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PubMed1988

[Ileostomy versus colostomy as temporary deviation stoma in relation to stoma closure].

Between January 1, 1982 and June 30, 1987 a total of 122 patients suffering colorectal cancer (n = 88) or diverticulitis of the colon (n = 24) underwent surgery for construction of a transient defunctioning stoma. Closure of the stomata was performed in 71 of the 79 ileostomies (89.9%) and in 36 of the 43 colostomies (83.7%). Regarding sex, age and primary surgical treatment both patient groups were very well comparable. However there were clear differences with regard to closure of the stomatas: Complications following closure occurred in 22.5% of the ileostomies but only in 5.6% of the colostomies. Also lethality was markedly increased following closure of the ileostomies (5.6%) as compared to closure of the colostomies (0%). These results show that ileostomy is a technically complicated procedure and the indication for a transient ileostomy therefore should be made carefully.

Colorectal Neoplasms↗
PubMed1985

A simplified technique for a totally diverting transverse loop colostomy and distal irrigation.

This technique of totally diverting loop colostomy may be performed as an independent procedure or with exploratory laparotomy and surgical treatment on the distal part of the colon. Either a transverse or sigmoid loop colostomy can be used for diversion without the risk of fecal contamination of the peritoneal cavity, particularly when working with unprepared intestine. When distal irrigation is desired to purge the intestine of fecal material, either intraoperatively or as part of a subsequent intestinal preparation, it can easily be accomplished by placing an irrigating catheter distal to the staple line. In addition, the use of a small rubber suspension bar facilitates application of standard colostomy appliances for the stoma.

Colostomy↗
PubMed1984

[Unopened colostomy, a protective procedure for high risk colorectal anastomosis].

The classical "protective colostomy" upstream of a high risk colo-rectal anastomosis is not fully effective and requires subsequent reconstructive surgery. For these reasons, it is little used to date. Unopened colostomy provides complete obturation above the anastomosis and therefore effective protection. When no anastomotic fistula develops, the colostomy loop is re-entered on the 8th postoperative day. In case of fistula, it is opened and becomes functional. The procedure is easy to perform and well accepted by the patient. It increases surgical safety and shortens the duration of stay in hospital.

Colon↗
PubMed1984

A preliminary report on the intracolonic bypass as an alternative to a temporary colostomy.

Anastomotic leakage remains the most important cause of morbidity and mortality in colonic operations, and the considerable complication rate accompanying the construction and closure of colostomy to prevent this has prompted an experimental study designed to protect the colonic anastomosis and dehiscence by an intraluminal bypass graft. To accomplish this, a specially prepared soft tube conducts the fecal flow and gastrointestinal secretions from the proximal part of the colon to the distal part of the colon or rectum, preventing any contact with the anastomotic site. Even in the face of surgically created gross colonic anastomotic dehiscences, these dehiscences have progressed to complete healing. The graft is expelled spontaneously after a varying time. A clinical study was therefore instituted. In ten patients in whom temporary colostomies would have been performed with or without a resection at the time, a one stage primary resection and anastomosis with the insertion of an intracolonic bypass graft was carried out. Preliminary clinical results indicate that one procedure could obviate the necessity for construction and subsequent closure of a temporary colostomy avoiding the morbidity and mortality and the considerable economic implications associated with these procedures. Clinical results have paralleled the experimental one. Since this article was accepted for publication, another 25 patients have undergone an intracolonic bypass procedure. Results have paralleled the previous ones except for one patient with fecal impaction at the fifth postoperative week. The separated tube formed part of the impacted fecal mass.

Animals↗
PubMed1982

Early closure of transverse loop colostomies.

A transverse loop colostomy was constructed in 60 patients at the time of primary elective surgery and the stoma was then resected within one month under antibiotic cover. There was a single death unrelated to operation. Four patients developed faecal leakage, 1 became obstructed, and 6 had infected wounds. With the exception of colostomy closure following sutured coloanal anastomosis a transverse loop colostomy can be closed within one month of construction with acceptable morbidity.

Adult↗
PubMed1980

[Results of periodic irrigation in rehabilitation of colostomy patients].

The Authors report their experience about 152 patients examined between 1976-1979 in the Aistom Centre of the Institute of "Semeiotica Chirurgica" at the University of Trieste. 98 patients irrigated their colostomies, while 57 patients were excluded in consequence of general or local counterindications. 92% of the irrigating patients gained fecal continence, but 1/4 of them use the colostomy bag to obtain full control of gas and odors. No cases of colonic perforation, bleeding or severe dermatitis were observed. The follow-up shows that most of the irrigating patients undergo less serious psychological problems and usually have easier social lives. It is opinion of the Authors that the results of colonic irrigation are better than natural evacuation. Irrigation should be therefore considered the best method of choice for the management of permanent colostomies.

Aged↗
PubMed1995

Treatment of war injuries to the colon: primary resection and anastomosis without relieving colostomy.

Fourteen casualties with penetrating injuries to the colon caused by firearms in combat zones have been treated according to the principles accepted today for the treatment of such injuries acquired in civilian violence. The patients were treated by primary resection of the injured part of the intestine, without relieving colostomy, providing that the time interval between the moment of injury and admittance to the hospital was less than six hours. Ten patients fulfilled this criterion, while three patients with prolonged time intervals were treated by resection and colostomy, and one by exteriorization. Overall mortality was 14.3%, and correlated to the injury severity score. Complications related to colon surgery occurred in one patient (7%). Primary resection without relieving colostomy for the colon injuries caused by firearms is a safe procedure providing that the time interval between wounding and surgery does not exceed six hours.

Anastomosis, Surgical↗
PubMed1995

Troublesome colostomies and urinary stomas treated with suction-assisted lipectomy.

OBJECTIVE: To investigate the effectiveness of liposuction as treatment in troublesome colostomies and urinary stomas in selected patients. DESIGN: Open clinical study. SETTING: University hospital, Norway. SUBJECTS: 8 consecutive patients with colostomies (n = 2) or urinary stomas (n = 6) who required treatment with liposuction above or around the stoma, mainly for leakage. INTERVENTIONS: Syringe-assisted liposuction under local anaesthesia. MAIN OUTCOME MEASURES: Change in stoma function, particularly reduction in the incidence of leakage, and by the patients' satisfaction graded according to a four point scale. RESULTS: All patients noted considerable improvements in stoma function, or abdominal contour, or both. CONCLUSION: Troublesome colostomies and urinary stomas can in selected patients be successfully treated with liposuction above or around the stoma.

Adult↗
PubMed1994

[Treatment of endoscopic colonic perforations by anastomosis in non exclusive lateral colostomy].

The authors report two cases of colonic endoscopic perforation with peritonitis treated by minimal lateral colostomy. The evolution was favorable in this two cases with spontaneous closure of colostomy. We intended to remind the usefulness of this old and simple technique sometimes omitted in the therapeutic armentorium of the iatrogenic colic perforation, especially from endoscopic origin. Thus the risk of complications of an ideal surgery or the necessity of a second-time anastomosis after the initial colostomy can be avoided.

Adult↗
PubMed1994

Tampon occlusion of colostomy stoma during laparotomy.

A new technique for the occlusion of the colostomy stoma during colostomy takedown is prevented. Utilization of this technique prevents contamination and allows maintenance of colostomy length for anastomosis. It can be easily and safely performed.

Colostomy↗
PubMed1993

Laparoscopic colostomy closure.

Perforated sigmoid diverticulitis often results in the patient undergoing a sigmoid resection, closure of the rectal stump, and an end sigmoid colostomy. To reestablish intestinal continuity, the patient must undergo a second major intra-abdominal operation. We have developed a technique of laparoscopic colostomy closure to reestablish intestinal continuity and have used it in two patients. Because of the reduced operative pain and shorter recovery period, this minimally invasive technique would be a better surgical alternative to colostomy closure.

Aged↗
PubMed1995

Laparoscopic creation of loop ileostomy and sigmoid colostomy.

OBJECTIVE: To evaluate the laparoscopic approach in the creation of loop ileostomies and sigmoid colostomies. DESIGN: Prospective open study. SETTING: University hospital, Sweden. SUBJECTS: Eighteen consecutive patients who needed faecal diversion. INTERVENTIONS: Laparoscopic loop ileostomy (n = 6) or sigmoid colostomy (n = 12). MAIN OUTCOME MEASURES: Mortality, morbidity, and duration of operation. RESULTS: There was no 30-day mortality, and no patients developed infections. The operating time (median 47 minutes, range 45-115 for ileostomies and 50, range 42-102 for colostomies) was comparable to open surgery. Two operations had to be converted to open procedures because of dense adhesions. Postoperative paralytic ileus was transient, and all patients started oral intake on the first postoperative day. CONCLUSIONS: The laparoscopic technique is easy to do, it takes no longer than open surgery, and it causes minimal trauma, allowing the patients to recover faster.

Adult↗
PubMed1997

[Ileostomy--cecal fistula--colostomy--which is the most suitable fecal diversion method with reference to technique, function, complications and reversal?].

In the literature the question as to what constitutes the most suitable faecal diversion procedure continues to be controversial. Between 1989 and 1994 at the Surgical Department of the University of Erlangen a total of 464 patients received intestinal stomas for a wide range of different indications. Of these procedures 41.6% (n = 193) were temporary diversion stomas (ileum n = 170, transverse colon n = 16, jejunum n = 4, sigmoid n = 2, ascending colon n = 1). Subsequently, 7.8% of the loop ileostomies and 9.7% of the loop colostomies needed revision for early or late complications. After reversal surgery none of the loop colostomies, but 2.5% of the loop ileostomies, developed complications needing operative treatment. On the basis of our own experience and the data reported in the literature it may be stated that both loop ileostomy and loop colostomy are effective faecal diversion procedures which, with appropriate bowel preparation and a meticulous surgical technique, can be reversed with a low incidence of complications. Both procedures, however, require careful preoperative planning, operative technique and care if complications are to be avoided. Used simply for the creation of a stoma, the laparoscopic approach offers certain advantages.

Cecostomy↗
PubMed1997

Classification of anorectal malformations--initial approach, diagnostic tests, and colostomy.

The optimal surgical care of patients with imperforate anus begins with appropriate decision making in the critical newborn period. In most cases the decision to create a colostomy should be delayed until the infant is 18 to 24 hours old. Except in cases of a rectoperineal fistula, most neonates are best treated with a completely divided left-lower-quadrant colostomy between the descending and sigmoid colons. Female patients with cloacal anomalies must be recognized at birth so that all urgent urologic evaluations can be performed. Hydrocolpos and obstructive uropathy are common in these neonates and warrant urgent decompression of the urinary tract with a vaginostomy and/or vesicostomy as well as a colostomy. Renal ultrasonography and voiding cystourethrography are mandatory for all patients regardless of the height of the defect. It is critical to discover the important precursors to renal insufficiency including renal agenesis, renal dysplasia, and vesicoureteral reflux in the neonate. The presence of these anomalies mandates early consultation with a pediatric urologist because the morbidity and mortality of these lesions often exceed those of the imperforate anus. Spinal cord anomalies are common and can be found even in patients who have normal plain films and low defects. Spinal ultrasonography or magnetic resonance imaging should be performed in all neonates to rule out occult spinal pathology such as tethered cord or lipoma of the cord. Efficacious and cost-effective care of patients with imperforate anus begins with a carefully thought out plan in the neonate. Optimal execution of the evaluation and surgical treatment at this phase sets the stage for the best possible outcome later in life.

Abnormalities, Multiple↗
PubMedDate not supplied

Colostomy: its place in the management of colorectal injuries in civilian practice.

The treatment of 23 patients who sustained colorectal perforating injuries over four year period were reviewed. Twelve out of 14 (85.7%) had excellent results with one stage (primary) closure while two patients (14%) died from complications of peritoneal sepsis and faecal fistula. The remaining nine patients were treated with colostomy. Only one developed wound sepsis not attributable to the colostomy. There were no deaths. The colostomy patients stayed in hospital, an average of 32 days as opposed to 15 days stay by those who had primary repair. It is concluded that primary closure is safe and cheap but the decision to do it must be taken in consideration to the environment in which one practices.

Abdominal Injuries↗
PubMed1997

Stapled colonic J-pouch-anal anastomosis without a diverting colostomy for rectal carcinoma.

PURPOSE: Colonic J-pouch reconstruction is designed to improve functional outcome of coloanal anastomosis. Most surgeons use a diverting colostomy to avoid severe pelvic sepsis caused by anastomotic breakdown. METHODS: We report the outcome of 30 consecutive patients with colonic J-pouch-anal anastomosis without a diverting colostomy performed between November 1992 and October 1993. All patients had carcinoma of the lower two-thirds of the rectum. Patients were seen every three months. Functional results were compared with those of 21 rectal cancer patients with straight coloanal anastomosis who underwent surgery in the same period and 20 normal patients. RESULTS: There were two anastomotic leakages and one postoperative death. After one year, patients with pouch anastomosis had significantly less frequency of defecation and rectal urgency compared with those with straight anastomosis (P < 0.01); 48 percent of patients with straight anastomosis had more than five bowel movements per day, whereas all patients with pouch anastomosis had five or less bowel movements per day. Manometric studies showed maximum tolerable volume was significantly higher in patients with pouch anastomosis (81 vs. 152 ml; P < 0.01). CONCLUSIONS: Stapled colonic J-pouch-anal anastomosis without a diverting colostomy is a reliable procedure that provides good, long-term functional results.

Adult↗
PubMed2005

Risk of emergency colectomy and colostomy in patients with diverticular disease.

HYPOTHESIS: Patients with diverticulitis are at a lifetime risk for emergency colectomy and colostomy. Age and recurrence characteristics can serve to predict the risk for these adverse outcomes. DESIGN: Time-to-event analysis and logistic regression were used to determine the risk of emergency colectomy/colostomy. SETTING AND PATIENTS: A retrospective cohort study using a statewide administrative database and identifying all patients hospitalized nonelectively for diverticulitis (1987-2001). MAIN OUTCOME MEASURE: Emergency colectomy and/or colostomy in patients treated nonsurgically after a first episode of acute diverticulitis. RESULTS: A total of 25 058 patients (mean age [ +/- SD], 69 [16] years, 60% female) were hospitalized for an initial episode of diverticulitis. Of the 20 136 patients treated without initial operation, 19% had recurrences, with younger patients (<50 years) more likely to have a recurrence than older patients (27% vs 17%, P<.001). While only 5.5% of patients had recurrent hospitalizations during which an emergency colectomy/colostomy was performed, it occurred more commonly in younger patients (7.5% vs 5%, P<.001). The adjusted hazard ratio for emergency colectomy/colostomy in younger patients was 39% higher than in older patients (hazard ratio, 1.39; 95% confidence interval, 1.21-1.62). Among all patients, the adjusted hazard ratio for emergency colectomy/colostomy was 2.2 times higher with each subsequent admission (hazard ratio, 2.2; 95% confidence interval, 2.1-2.2). The predicted probability of emergency colectomy/colostomy was highest in younger patients with multiple rehospitalizations. CONCLUSIONS: Age and number of recurrent events were associated with the risk of emergency colectomy/colostomy after successful nonoperative management in patients with diverticulitis. Individualization of recommendations regarding elective colectomy based on these factors may be more appropriate than the application of previously published strategies.

Adult↗
PubMed1981

Enterorectal and colorectal anastomosis. Evaluation of techniques including midtransverse or left-sided colon tube colostomy and pelvic drainage.

One-stage rectal anastomoses performed in 235 patients by one surgeon were studied. Of numerous techniques used to reduce anastomotic leakage, active suction drainage to remove presacral-space fluid accumulation was the most effective. Leakage developed in 11 (6.9%) of 160 patients whose conditions were managed without suction drainage or transverse or descending colon tube colostomy. In only one (1.1%) of 89 patients treated by one or both modalities did a leak develop. Seventy-two patients receiving suction drainage or both modalities had no leakage. Recorded suction drainage amounts and absence of leakage in these 72 patients support the contention that infected presacral accumulations of fluid are the most important cause of postoperative anastomotic dehiscence after rectal anastomosis. In 71 patients receiving tube colostomy, the tube site closed spontaneously following tube removal. No deaths from leakage occurred in either group.

Aged↗