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PubMed1985

Irrigation management of sigmoid colostomy.

Questionnaires were sent to 270 patients who had undergone abdominoperineal resection and sigmoid colostomy at the Mayo Clinic, Rochester, Minn, during the ten years from 1972 to 1982; 223 patients returned their questionnaires with evaluable data. Sixty percent of the patients were continent with irrigation, and 22% were incontinent with irrigation. Eighteen percent had discontinued irrigation for various reasons. The proportion continent was higher in women, younger patients, and previously constipated patients. A poorly constructed colostomy may cause acute angle, parastoma hernia, stomal prolapse, or stenosis and thus be the cause of failure of irrigation.

Colon, Sigmoid↗
PubMed2004

Quality of life after rectal resection for cancer, with or without permanent colostomy.

BACKGROUND: For almost one hundred years abdominoperineal excision has been the standard treatment of choice for rectal cancer. With advances in the techniques for rectal resection and anastomosis, anterior resection with preservation of the sphincter function has become the preferred treatment for rectal cancers, except for those cancers very close to the anal sphincter. The main reason for this has been the conviction that the quality of life for patients with a colostomy after abdominoperineal excision was poorer than for patients undergoing a sphincter-preserving technique. However, patients having sphincter-preserving operations may experience symptoms affecting their quality of life that are different from those withstoma-patients. OBJECTIVES: To compare the quality of life in rectal cancer patients with or without permanent colostomy. SEARCH STRATEGY: We searched PubMed, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Colorectal Cancer Group's specialised register. Abstracts books from major gastroenterological and colorectal congresses were searched. Reference lists of the selected articles were scrutinized. SELECTION CRITERIA: All controlled clinical trials and observational studies in which quality of life was measured in patients with rectal cancer having either abdominoperineal excision or low anterior resection, using a validated quality of life instrument, were considered. DATA COLLECTION AND ANALYSIS: One reviewer (JP) checked the titles and abstracts identified from the databases and hand search. Full text copies of all studies of possible relevance were obtained. The reviewer decided which studies met the inclusion criteria. Both reviewers independently extracted data. If information was insufficient the original author was contacted to obtain missing data. Extracted data were crosschecked and discrepancies resolved by consensus. MAIN RESULTS: Twenty five potential studies were identified. Eight of these, all non-randomised and representing 620 participants, met the inclusion criteria. Four trials found that people undergoing abdominoperineal excision did not have poorer quality of life measures than patients undergoing anterior resection. One study found that a stoma only slightly affected the persons quality of life. Three studies found that patients receiving abdominoperineal excision had significantly poorer quality of life than after anterior resection. Due to heterogeneity, meta-analysis of the included studies was not possible. REVIEWERS' CONCLUSIONS: The studies included in this review do not allow firm conclusions as to the question of whether the quality of life of people after anterior resection is superior to that of people after abdominoperineal excision. The included studies challenged the assumption that anterior resection patients fare better.Larger, better designed and executed prospective studies are needed to answer this question.

Colostomy↗
PubMed2005

Quality of life after rectal resection for cancer, with or without permanent colostomy.

BACKGROUND: For almost one hundred years abdominoperineal excision has been the standard treatment of choice for rectal cancer. With advances in the techniques for rectal resection and anastomosis, anterior resection with preservation of the sphincter function has become the preferred treatment for rectal cancers, except for those cancers very close to the anal sphincter. The main reason for this has been the conviction that the quality of life for patients with a colostomy after abdominoperineal excision was poorer than for patients undergoing a sphincter-preserving technique. However, patients having sphincter-preserving operations may experience symptoms affecting their quality of life that are different from those with stoma-patients. OBJECTIVES: To compare the quality of life in rectal cancer patients with or without permanent colostomy. SEARCH STRATEGY: We searched PUBMED, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Colorectal Cancer Group's specialised register. Abstract books from major gastroenterological and colorectal congresses were searched. Reference lists of the selected articles were scrutinized. SELECTION CRITERIA: All controlled clinical trials and observational studies in which quality of life was measured in patients with rectal cancer having either abdominoperineal excision or low anterior resection, using a validated quality of life instrument, were considered. DATA COLLECTION AND ANALYSIS: One reviewer (JP) checked the titles and abstracts identified from the databases and hand search. Full text copies of all studies of possible relevance were obtained. The reviewer decided which studies met the inclusion criteria. Both reviewers independently extracted data. If information was insufficient the original author was contacted to obtain missing data. Extracted data were crosschecked and discrepancies resolved by consensus. MAIN RESULTS: Thirty potential studies were identified. Eleven of these, all non-randomised and representing 1412 participants met the inclusion criteria. Six trials found that people undergoing abdominoperineal excision did not have poorer quality of life measures than patients undergoing anterior resection. One study found that a stoma only slightly affected the person's quality of life. Four studies found that patients receiving abdominoperineal excision had significantly poorer quality of life than after anterior resection. Due to heterogeneity, meta-analysis of the included studies was not possible. AUTHORS' CONCLUSIONS: The studies included in this review do not allow firm conclusions as to the question of whether the quality of life of people after anterior resection is superior to that of people after abdominoperineal excision. The included studies challenged the assumption that anterior resection patients fare better.Larger, better designed and executed prospective studies are needed to answer this question.

Colostomy↗
PubMed1976

Rectal sphincter reconstruction in perineal colostomies after abdominoperineal resection for cancer.

A surgical technique is proposed for the reconstruction of the anal sphincter in perineal colostomies after abdominoperineal resection for cancer. The procedure, which employs the gracilis muscle for the sphincteric reconstruction is described and the operative results and complications are analysed in 24 patients submitted to this type of surgery. Of the 22 patients who were followed up, 17 had excellent or good results with retention of solid or soft stools. Three patients had poor results with no voluntary retention, while 2 others were partly incontinent of solid faeces. In this group of 5 patients, 3 had stenosis of the colostomy and 1 had no sensibility of impending defaecation.

Adenocarcinoma↗
PubMed1976

The results of colostomy closure.

Complications arouse in 93 (44 per cent) of 213 patients following the closure of a temporary colostomy. These complications include 1 death, 19 faecal fistulas, 3 large bowel obstructions and 24 incisional hernias. Complications were most commonly seen following closure of colostomies of the sigmoid colon, especially when such closure was undertaken between the fourth and twelfth weeks after definite surgery. It is concluded that still greater care is needed in both the operative technique and the preoperative care of these patients.

Abdomen↗
PubMed1979

Transcutaneous defunctioning colostomy.

The technique is described for constructing an occlusive tube colostomy which requires no second operative procedure for closure. The advantages of this method are discussed and it is recommended as a superior alternative to loop colostomy or caecostomy for defunctioning the unobstructed distal bowel.

Colostomy↗
PubMed1985

The management of colon injuries by primary repair or colostomy.

This retrospective study comprises 134 cases of penetrating colon injuries. In 92 cases the injury involved the left colon and in the remaining 42 the right colon. Death due to the colonic injury occurred in 1.5 per cent and the incidence of abdominal complications was 17.9 per cent. Patients treated by primary repair of the colon had less colon-related complications and a shorter hospital stay than patients treated by colostomy. Left and right colon injuries treated by primary repair had similar complication rates and hospital stay (P greater than 0.05). We believe that primary repair can safely be performed more frequently than is generally accepted. The site of colon injury, the presence of shock and the presence of multiple associated intra-abdominal injuries do not exclude primary repair. It is suggested that colostomy should be reserved for both left and right colon injuries with gross peritoneal contamination, extensive colonic damage, and large amount of hard faeces in the colon.

Adolescent↗
PubMed1986

On-table lavage to achieve safe restorative rectal and emergency left colonic resection without covering colostomy.

On table orthograde colonic lavage has been used in a nearly consecutive series of 122 cases of restorative rectal resection (16 for acutely obstructing rectosigmoid lesions), and in a further 4 cases of acutely obstructing left colonic carcinoma, with the aim of both achieving safer anastomoses in these adverse circumstances and avoiding a covering colostomy. The technique was found to be safe and to be effective, only five temporary colostomies being required for management of anastomotic leakage. The incidence of clinical anastomotic leakage was 4.8 per cent.

Adult↗
PubMed1992

Sitting a transverse colostomy.

Traditional teaching suggests that a transverse colostomy should be sited in the right upper quadrant. This study of 67 colostomies (26 right upper quadrant and 41 right iliac fossa) indicates that they should be placed in the optimum position for each patient, which is usually the right iliac fossa.

Colostomy↗
PubMed2003

Experimental model of continent colostomy using rectus abdominis neosphincteroplasty.

BACKGROUND: Use of dynamic myoplasty to create a continent stoma has produced promising results, but long-term stoma continence has not been achieved. The aim of the study was to establish and test a new model. METHODS: Three types of dynamic rectus abdominis sphincteroplasty around a colostomy and two conditioning protocols were tested in ten domestic pigs. Continence was assessed by means of conventional defaecography and neosphincter manometry after 8 and 12 weeks. The neosphincter muscle was studied histologically to assess the transformation of muscle type. RESULTS: Use of a distal rectus muscle sling surrounding the stoma by 270 degrees with a low-frequency conditioning protocol achieved a continent colostomy for more than 12 h on each of 5 consecutive days. The neosphincter had a 40-mm high-pressure segment with mean pressure of 74 (range 67-82) mmHg. The proportion of type I muscle fibres increased from 38 (range 32-42) to 74 (range 66-78) per cent after 12 weeks of conditioning. CONCLUSION: This pilot study demonstrated the feasibility of a continent stoma in an animal model with a dynamic rectus neosphincter. Long-term results should be confirmed in a larger series before use in humans can be considered.

Animals↗
PubMedDate not supplied

Perineal reconstruction with continent colostomy after the Miles operation.

Since the beginning of the century, different surgical procedures have been employed to create new anal sphincters for a continent perineal colostomy after abdominal perineal anorectal resection for cancer. After a detailed review of all the currently employed surgical procedures, the authors present their experience with 15 cases treated by transposition of the gracilis muscles to the perineum. More than 50% of the operated patients had good functional results with complete continence for solid stools and sufficient control of the stimulus. Poor results are related to surgical complications or unexpected postsurgical diseases and cancer recurrence or metastases. This surgical procedure seems to be an interesting possibility for selected patients in the case of a permanent abdominal incontinent colostomy after the Miles operation.

Aged↗
PubMed1992

A scintigraphic analysis of colonic movement in patients with colostomy: changes of colonic transit time after acquaintance with irrigation.

For the purpose of making a functional assessment of colostomy irrigation, eight patients were examined. Group A was composed of four patients whose experience of irrigation was less than one year. Group B was composed of four patients who had undergone irrigation for more than two years. The capacity of the remnant colon was determined by a barium enema. Next, 74 MBq of milking technetium 99 diethylene triamine penta-acetic acid (99mTc-DTPA) was instilled with a predetermined amount of water (37 degrees C). A dynamic scan was performed for 45 min. The mean evacuation time of Groups A and B were 6 min 56 s +/- 2 min 33 s and 13 min 27 s +/- 10 min 50 s, respectively. The mean half emptying time of Groups A and B were 142.5 s +/- 7.9 s and 309.0 s +/- 181.9 s. The results suggest that the remnant colon may be habituated with irrigation. Colostomy irrigation which uses a single instillation of a measured volume of tepid water is recommended.

Adult↗
PubMed1990

Perineal colostomy and electrostimulated gracilis "neosphincter" after abdomino-perineal resection of the colon and anorectum: a surgical experience and follow-up study in 47 cases.

A series of 47 patients undergoing abdomino-perineal resection of the distal colon and anorectum and construction of a continent perineal colostomy using electrostimulated gracilis muscle is described. External and implanted pulse generators have both been used. An analysis of complications and oncological data are reported. There was no operative mortality. The incidence of complications, divided into three classes, mild (62%), moderate (27%) and severe (11%), has not significantly altered the functional results, with the exception of early ischaemia of the colonic stump in two cases. During the first 22 cases, no preoperative oncological staging was performed. In the last 23 patients endorectal ultrasonography and CT scanning were carried out. Functional results were evaluated by electromanometry, electromyostimulation and dynamic defaecography. Clinical data assessed postoperatively showed good function in 65% of cases, fair in 22.5% and poor in 12.5%. The quality of life in 15 patients with a perineal colostomy and electrostimulated gracilis was significantly better than in 15 patients having an abdomino-perineal resection without gracilis plastic reconstruction.

Adult↗
PubMed1977

[Social medical aspects of patients with a permanent colostomy (author's transl)].

Problems of 39 patients with permanent colostomies/ileostomies are investigated one up to seven years after having got the anus praeternaturalis. The postoperative problems of everyday life are various and often serious, they are the more severe, the less patients had been informed preoperatively and the older the patients are. Younger and more intelligent patients integrate the colostomy easier and more quickly in their everyday life. Very useful for rehabilitation is the close contact between patient and the surgeon, respectively special colostomy-consulting hours.

Activities of Daily Living↗
PubMed1997

Abdominoperineal resection and perineal colostomy for low rectal cancer. The Lazaro da Silva technique.

PURPOSE: We sought to evaluate a new technique for creation of a continent perineal colostomy following abdominoperineal resection (APR) of the rectum for low rectal cancer. METHODS: Nine selected patients with low rectal cancer (two males; median age, 55.6 years; classified as Dukes A, 6 patients and as Dukes B, 3 patients) underwent APR. Following this, the original Lazaro da Silva technique was used as follows: 1) for performance of three circular myotomies in the distal sigmoid with a distance between each couple of no more than 8 cm; 2) repair of the myotomies, thus creating three circular colonic valves, the most distal of which remained extraperitoneally; 3) for construction of a perineal colostomy lying flush with the perineal skin; 4) after the patient starts consuming a regular diet, enemas through the perineal stoma are done, usually twice per week, to achieve defecation. Functional outcome was assessed by evaluation of bowel movements and neoanal continence. RESULTS: There were no deaths. From January 1994 until October 1995, no tumor recurrence has occurred, and fecal continence has been good. Four of the patients were able to defecate without enemas (2-4 times per week), and in five patients the self-administration of enemas (2-4 times a week) were necessary to accomplish defecation. CONCLUSION: Initial results with the Lazaro da Silva technique have been encouraging.

Abdomen↗
PubMed1990

Colostomy irrigation in the elderly. Effective recovery regardless of age.

One hundred forty elderly cancer outpatients with colostomy in the authors' rehabilitation department were included in an analysis of the feasibility, effectiveness, and safety of periodic irrigation of remaining colon with lukewarm tap water with the aim of regaining full continence. Sixteen patients did not have a sufficiently long remaining bowel (cecostomy, transverse colostomy) and 17 were considered unsuitable to learn the technique because of advanced neoplastic disease with poor life expectancy, intercurrent disease, or stomal problems. One hundred seven patients were proposed to perform the irrigation: 17 refused to do so with the remaining 90 able to learn the method without problems. Nearly all patients achieved full continence for at least 24 hours. Three patients refused to continue, and nine interrupted for minor complications. The median duration of irrigation in the whole group is 257 days (range, 1 to 2669 days): 32 patients have been irrigating from one to five years, and 9 patients for more than 5 years. Based on these results, we recommend irrigation as standard rehabilitative treatment for elderly patients.

Age Factors↗
PubMed2001

Surgical treatment of parastomal hernia complicating sigmoid colostomies.

PURPOSE: Parastomal hernia is a common late complication of colostomy. Surgical approach to the repair of parastomal hernia is controversial. Results of surgical treatment are disappointing. The aim of this study was to assess the outcome of surgical treatment of parastomal hernia. METHOD: This article reports a retrospective review of those patients who had undergone a surgical treatment of parastomal hernia complicating sigmoid colostomy. The indications, surgical procedures, complications, and outcome were carefully studied. RESULTS: There were 43 surgical treatments of parastomal hernia. Sixteen underwent simple local repair; 25 stomas were relocated, and 2 were locally repaired with mesh. Overall recurrence was 18 of 40 (45 percent). Recurrences for fascial repair and stoma relocation were 6 of 13 (46 percent) and 10 of 25 (40 percent), respectively. Stoma relocation could be accomplished without formal laparotomy in 19 of 25 cases. Incisional hernia occurred in only 2 of these 25 relocations. CONCLUSION: Fascial repair alone can be performed for symptomatic small hernias because of its advantage of minimal morbidity. Stoma relocation without formal laparotomy can be advocated for larger hernias. A combination of local resite together with mesh reinforcement may be the alternative for further improvement of results.

Aged↗
PubMed2000

Quality of life with a temporary stoma: ileostomy vs. colostomy.

PURPOSE: The hypothesis is that the impact of a temporary stoma on a patient's daily life is determined by complications and related stoma care problems. METHOD: A prospective clinical trial was performed, studying complications and social well-being of 37 patients with loop ileostomy and 39 patients with a loop colostomy (randomly assigned comparison). Patients were categorized according to degree of social restriction. The association between the degree of social restriction and the presence of stoma care problems and complications was assessed. Follow-up was scheduled every three months until the stoma was closed (94 percent). RESULTS: There is no relation between stoma type (ileostomy or colostomy) and degree of social restriction (chi-squared test, P = 0.42). The more stoma care problems or complications seen, the higher the degree of social restriction: significantly more stoma care problems were seen in the completely isolated group of patients when compared with the patients who were less socially restricted (Spearman correlation coefficient 1 = 0.35, P = 0.003). Especially stoma leakage, peristomal skin irritation, dietary prescriptions, retraction, and prolapse of the stoma have significant impact on the patient's daily life. CONCLUSION: Stoma surgery has a great influence on a patient's daily life. There is a clear relation between the number of stoma care problems and the degree of social restriction. Follow-up of stoma patients under close surveillance of stoma care nurse to minimize stoma care problems and a careful surgical technique are advocated for good stoma care.

Activities of Daily Living↗