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PubMedDate not supplied

Feasibility analysis of loop colostomy closure in patients under local anesthesia.

PURPOSE: To verify prospectively the practicability of performing loop colostomy closure under local anesthesia and sedation. METHODS: In this study, 21 patients underwent this operation. Lidocaine 2% and bupivacaine 0.5% were utilized. Pain was evaluated during the operation, on the first postoperative day and at hospital discharge. Intraoperative events, postoperative complications and the acceptability of this procedure were analyzed. RESULTS: The mean duration of the operation was 133 minutes (range: 85 to 290 minutes). The mean postoperative hospitalization was four days (range: one to twelve days). No patients died. Complications occurred in two patients (9.4%): abdominal wall hematoma and operative wound infection. With regard to pain severity, scores of less than or equal to three were indicated in the intraoperative evaluation by 80% of the patients (17/21) and on the first postoperative day by 85% (18/21). At hospital discharge, 95.2% of the patients (20/21) said they were in favor of the local anesthesia technique. CONCLUSION: Loop colostomy closure under local anesthesia and sedation is feasible, safe and acceptable to patients.

Adult↗
PubMed2000

[Contribution to the understanding of the sexuality of partners of people with permanent colostomy].

The general purpose of the present investigation was to describe the sexual interactions involving colostomized individuals, aiming at understanding this experience. The authors aimed also at identifying the mode regarding sexual procedures used by colostomized individuals and the possible effects of colostomy on these procedures. Therefore, a semi-structured interview, recorded or not, was applied to partners of colostomized subjects. The interviews were transcribed and analyzed according to the content analysis technique. Authors divided the results in 39 subcategories with 4.361 speech units that were gathered in three main categories. The category I "Precedence of the crisis" included 4 subcategories with 113 (36.67%) speech units. The category II "Crisis" comprised 17 subcategories with 1599 (36.67%) speech units and Category III "Crisis' Results" comprehended 18 subcategories with 2649 (60.74%) speech units. Data were validated by an expert on content analysis and the conclusion was that the main concern of health professionals is to keep subjects with a definitive colostomy alive, providing orientations focussing on the stoma, its care and gastrointestinal function. The speech of partners showed a clear presence of post-crisis results, representing a great danger to their general and sexual integrity and to their general and sexual adaptation on a short, medium and long-term basis.

Colostomy↗
PubMed2004

[Implementation and evaluation of a teaching plan for the auto-irrigation of colostomy: a case study].

With a view to describing and evaluating the implementation of a teaching plan for the auto-irrigation of colostomy and reporting on the perceptions of colostomized patients related to auto-irrigation, this case study was developed at the colostomy out-patient clinic of the Júlio Müller University Hospital, Cuiabá, Brazil, from February to March 1997. The teaching plan helped the patients to learn about the irrigation technique and social rehabilitation.

Colostomy↗
PubMed2002

Do we still need a permanent colostomy in XXI-st century?

The aim of this paper is to answer the question: do we still need a permanent colostomy and present the quality of life of patients operated on for rectal cancer. A comparative analysis of patients after abdomino-perineal resection of the rectum vs. patients after low anterior resection of the rectum with preservation of sphincters is presented. When assessing the quality of life of patients, the following issues were considered: a) function of the whole organism and general condition (physical function); b) psychological well-being (psychological function); c) professional activity, relations with relatives and friends, leisure activities (social function) and d) intimate relations (sexual function). In both groups of patients, both after abdomino-perineal resection of the rectum and after low-anterior resection, a significant deterioration in the quality of life was noted. In spite of a good general health condition in the majority of cases (over 60% in both groups), frequent are irregular stools and diarrhoea. Stomy patients complain about uncontrolled passing of gas and urologic problems, while patients with preserved sphincter complain about constipation. Stomy patients significantly more often suffer depression, loneliness and even despair due to low self-esteem and feeling of unfavourable change in body appearance. This feeling is present more often in younger patients and in women. Rectal cancer may cause social disfunction, like reluctance to resume professional activity after surgery, limitation of social contacts, change of model of rest and leisure activities towards more passive forms and forms which do not require the attendance of many people. These phenomena apply to both groups but are more prominent among stomy patients. As stomy patients are usually older, some of these alterations may be due to age. Sexual dysfunction is significantly more frequent in stomy patients. Age may be one of the causes thereof. These problems are significantly more frequent in males. In some cases of colorectal cancer, the best way of management is colostomy. Further studies are needed to elaborate more clear criteria for optimal management of patients with colorectal cancer.

Activities of Daily Living↗
PubMed1976

Colostomy irrigation: its role in improving the colostomate's quality of life.

The wider use of the irrigation technique for the management of the permanent colostomy has previously been advocated. The results of its use in a group of 10 colostomates followed more than two years is discussed. As more than half of these colostomates have been able to resume a normal life after beginning colostomy irrigation, a further plea is made for a better understanding of the technique and the advantages that it offers.

Colostomy↗
PubMed1999

[Treatment of parastomal colostomy hernia].

BACKGROUND: Parastomal hernias are the most common cause of in patients surgically with stomy reoperation treated. METHODS: Treatment of parastomal hernias has been faced through two kind of technics: the first one consisted in the translocation of colostomy, the second one was placing around the colostomic hole a marlex mesh which was inserted at muscular structure level. From January 1993 to May 1997 we treated 8 patients affected by paracolostomic hernia associated to laparocele. The laparocele was treated according Rives' technique with the prosthesis positioned in the properitoneal site. The parastomal hernia was treated with translocation of the colostomy in 3 cases; in the other patients a plastic surgery of the colostomic orifice was made using polypropylene little bandages in properitoneal site. RESULTS: In the postoperative period the complications concerned a single case of skin parcellar necrosis, that healed spontaneously with medications and a case of prolonged serous secretion the mean follow-up was 2 years from the wound. CONCLUSIONS: In our experience the use of marlex mesh may be effective in treatment of parastomal hernia only a patient treated with translocation of the stoma showed a recurrence of parastomal hernia. The positioning of the prosthesis at properitoneal level is subject to a lower incidence of recurrent parastomal hernia.

Aged↗
PubMed1975

Complications of closure of loop colostomy.

Among 71 patients undergoing loop colostomy closure, one complication or more developed after operation in 35. Most of the complications were not serious, but there were two anastomotic leaks and two patients died. Some of the complications may be prevented by avoiding the use of drains and by packing the skin and subcutaneous tissues open with Vaseline gauze. There does not appear to be any advantage in using antibiotics in preoperative bowel preparation. A one-layer intraperitoneal colostomy closure can be done safely but is frequently associated with minor complications.

Colonic Neoplasms↗
PubMed2000

[Continent colostomy and colon irrigation].

The authors have studied a functional activity of a continent colostomy at 20 patients, undergone an abdomeno-perineal extirpation of rectum and carried out periodic colonirrigations, during a period of 6 months. A conus type, closed irrigating system has been used. The degree of an incontinency at patients has been compared before and after the beginning of the colonirrigations. The irrigating procedures have reduced spontaneous defications at patients during a week 28 times and have improved the quality of life significantly. The application of colostomy bags has been restricted in 8 (40%) patients. An intraluminal ultrasonographic investigation has been done at 12 (60%) patients at the end of 6 month irrigating period. No changes of the ultrasonographic image of the precolostomic segment of colon has been observed.

Adult↗
PubMed2001

[Colostomy and ileostomy and their complications].

Establishment of an artificial intestinal outlet is even nowadays associated with a more than 50% postoperative morbidity. More frequent surgical complications are described in colostomies, patients with ileostomies are threatened more by a metabolic breakdown due to fluid loss via the stoma. This complication threatens patients with ileostomy not only in the early postoperative period but may represent also a long-term problem in particular in risk patients. The authors evaluated complications associated with establishment of an artificial outlet of the gut in 88 patients operated in 1999-2000. Complications were more frequently recorded in patients with colostomy, i.e. in 9.7%. In 80.8% patients with ileostomies fluid losses via the stoma exceeding 1000 ml/24 hours were observed. Early and systematic replacement of water and minerals prevented the development of serious metabolic and circulatory disorders. The authors consider a priority solution in particular in temporary derivation of the intestinal passage establishment of an ileostomy despite the risk of metabolic complications.

Adult↗
PubMed1975

[Continent colostomy through magnetic closure in animal experiments on dogs].

In dog experiments a continent colostomy be means of magnetic occlusion has been developed. Around a terminal anus praeter a silicon-coated ringmagnet was placed between muscular fascia and subcutaneous fascia. The colon was pulled through the lumen of the ring and sutured to the skin. There has been a primary wound healing. There was no leakage of gas and faeces beneath the magnetic cap, thus providing an excellent closure of the colostomy. After removal of the cap spontaneous defecation took place.

Animals↗
PubMed2002

[Laparoscopic colostomy].

The advantages of miniinvasive operations were proved in a number of surgical procedures. The objective of the authors was, based on their own experience with a group of 11 patients, to describe the procedure, discuss indications, contraindications and advantages of laparoscopically assisted colostomy. This procedure should become the method of choice in the majority of patients indicated for derivation colostomy.

Adult↗
PubMed1992

[Colostomy closure after Hartmann operation: functional results].

The "Hartmann operation" for complication of acute diverticulitis or obstruction of the rectosigmoid is a safe procedure with few complications. However, it needs a second operation to reconstruct the continuity of the intestinal tract with more difficulties. The goal of our report is to show the 30-day morbidity and the late sequelae after colostomy closure with special concern to the late anorectal function. We analyzed 43 patients who underwent colostomy closure after Hartmann's procedure between 1985 and 1990. We controlled personally 35 patients after 32 months (range: 5-64 months) concerning their bowel habits, anal sphincter function (digital measure) and endoscopic anastomosis diameter. There were no deaths, but there was a 9% perioperative morbidity (1 anastomotic leak, 1 anastomotic bleeding and 2 wound infections). In the further course 2/35 patients were incontinent for gas and liquid stool. Further 3 patients lost water after coughing and had a poor sphincter rest tone. Our results demonstrates a low 30-day morbidity after reversal of Hartmann's procedure. It needs further investigation to show, if a damaged sphincter muscle or a lower rectum capacity could be responsible for these results.

Adult↗
PubMed2005

[Laparoscopic colostomy, indications and technical notes].

The aim of this article was to review the main indications of laparoscopic colostomy. A series of 9 patients is reported, stressing the technical steps of laparoscopic colostomy. The laparoscopic approach in patients with unresectable colorectal cancer permit to avoidance mayor laparotomy. In conclusion this technique appears safe, feasible and effective.

Aged↗
PubMedDate not supplied

Colonic injuries (primary repair and proximal colostomy).

This paper compares the outcome of colonic injuries (primary repair and proximal colostomy) in 94 cases. It concludes that certain risk factors are of predictive value in case of colon injuries (eg, gross fecal contamination, more than two visceral injuries, more than four units of blood transfusion, and extensive colonic injuries) irrespective of type of operation performed. Primary repair is debatable; however, in the present antibiotic era, it is safe and less costly than the two-stage procedure of proximal colostomy with repair. Primary repair can be performed in almost all cases except in certain selected cases that are decided on the table, taking into account the above risks factors. Mortality in cases of colonic injuries is associated with risk factors rather than colonic injury itself.

Adult↗
PubMed2006

[Complications of the terminal colostomy and their treatment].

The authors describe a comparative analysis of results of surgical treatment of complications after using different variants of end terminal colostomy in 34 patients aged from 23 to 72 years with stenosing carcinoma of the sigmoid (in 19 patients) and dolichosigmoid (in 6 patients) complicated by acute intestinal obstruction, traumatic injuries of the colon (in 5 patients) and nonspecific ulcerative colitis (in 4 patients) complicated by perforation of the intestinal wall and peritonitis. It was found that using a modified variant of formation of end terminal flat colostomy and performing a controlled intra- and postoperative decompression and intraluminal lavage of the colon with the help of an original author's new model of the aspiration-lavage device allows the number of postcolostomy complications to be decreased and the nearest and long-term results of surgical treatment to be improved.

Adult↗
PubMed1992

Colonic pH: a comparison between patients with colostomies due to trauma and colorectal cancer.

Colonic pH is important in the regulation of colonic cell growth, control of absorption and secretion, and bile acid degradation, which may be a key step in the development of colon cancer. This study determined the mucosal, luminal, and fecal pH in right and left colons of otherwise healthy patients who underwent colostomies because of trauma. The pH was evaluated while patients consumed a western diet. In addition, the mucosal, luminal, and fecal pH in patients with colostomies carried out for colorectal cancer also was assessed. All patients were blacks--a low-risk group for colorectal cancer. The results showed that mucosal pH was alkaline (pH 8) and was similar on both sides of the colon of healthy colostomates and in colon cancer patients. Luminal pH (7.6) was the same in healthy right colostomates and cancer patients and was significantly lower that mucosal pH. Fecal pH was significantly lower in right colostomates (6.0) than in left (6.5), and in healthy right colostomates compared with colon cancer patients (6.6). In addition, fecal pH was significantly lower than mucosal and luminal pH.

Adult↗
PubMed1991

[The continent perineal colostomy after abdominoperineal resection of the rectum. A digital defecographic study].

For 10 years, in the Surgery Dept. of the University of Pisa, perineal colostomies have been performed on patients who had undergone abdominoperineal rectal amputation. The gracilis muscles of the thighs, transposed to the perineum, are used for building a continent muscular apparatus. Seventeen of 40 patients operated with this procedure have been submitted to defecographic studies, by means of digital fluoroscopic image acquisition. This modality allowed the visualization of anastomotic colon morphology as well as of the functionality of the transposed gracilis muscles during the various phases of defecography. The muscle surrounding the colostomy acts as a sphincter and relaxes only during evacuation; the one positioned as a sling acts as the normal puborectalis muscle. In two patients a perineocele was documented, causing problems in the evacuation phase, which were solved after surgical intervention.

Colostomy↗
PubMed1991

Extraperitoneal closure of colostomy in children.

In 12 children colostomy wound closure was undertaken with liberal extraperitoneal mobilisation of the bowel. In all the cases adequate length of the colonic loops could be achieved for resection of the colostomy and end to end anastomosis. There was only minor wound infection in 3 cases. There was no faecal fistula nor any postoperative intestinal obstruction.

Anal Canal↗