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The common methods used to stabilize a loop colostomy can be fraught with patient dissatisfaction. Presented is an effective and convenient means of securing a loop colostomy by use of a skin bridge fixed by a single heavy suture.
In 34 patients with penetrating colon wounds which were considered to be liable to dehiscence, the sutured wounds were exteriorized. There were several 'high-risk' factors, i.e. operative delay of more than 6 hours after injury, faecal contamination of the peritoneal cavity, marked contusion of the bowel wall, and severe associated visceral haematoma which is deemed liable to infection. Additional considerations were thoraco-abdominal penetration and combined colonic and renal injuries. The operative technique is described in detail, and the morbidity of the procedure, which is low, is analysed. Comparison is made with a similar group of patients in whom colostomy was performed with subsequent closure. Exteriorization and closure of the penetrating colon wound appear significantly superior to colostomy in terms of mortality, septic complications and period of hospitalization.
An analysis of the complications occurring in permanent colostomies at Surgery Departments of Innsbruck University during the period between January 1969 and December 1977 showed that approximately 72% of all complications were primarily caused by operative shortcomings. It was therefore right and proper to investigate the causes of these operative shortcomings by means of physical considerations with the model and the preternatural anus and to analyse its most frequent complications in order to develop a colostomy technique which has so far turned out to be clinically successful in 32 controlled patients.
In 11 patients with a sigmoid end colostomy (and one additional patient with an end ileostomy), we examined the endoscopic and microscopic aspects of both the dysfunctioned bowel and the colon proximal to the colostomy. The latter showed in none of the cases signs of inflammation, while in 7 patients a remarkable or even severe colitis (mimicking ulcerative colitis) could be demonstrated endoscopically and/or histologically - irrespective to the duration of the dysfunction (one month up til 11 years). In the four patients with restoration of the intestinal continuity, macroscopic and microscopic findings of the rectal mucosa became normal as soon as two weeks after reoperation. We conclude, that the "dysfunctioned bowel-colitis" is somehow related to the mucosa's contact to the fecal stream.
2 groups of patients were given anterior rectal resections, one of the groups also receiving protective colostomy. Results show the usefulness of protective colostomy, not so much because it reduces the incidence of anastomotic dehiscence as because it minimizes the possible consequences of any such dehiscence.
The frequency and sites of carcinoma of the sigmoid colon and rectum are discussed. The complications associated with Dixon's anterior resection of the rectum are described, with particular reference to factors affecting cicatrisation of the colic anastomoses, followed by dehiscences and their degree of seriousness. A personal serier for the years 1969 to 1975 is presented and the advantages and disadvantages of derivative colostomy are explained. Comparison with similar series in which colostomy was or was not employed is used to elicit the reasons why it may be regarded as superfluous.
The cases of 49 patients on whom a primary temporary muco-cutaneous transversal colostomy were practiced for different pathologies, are presented and the results obtained analysed. From our point of view, certain technical aspects explain the excellent results obtained. Within these aspects we call to attention the place where the colostomy was practiced, divulsioning the rectum muscle, the total absence of colo-parietal fixation and the early removal of the glass rod-all of which as we see it, simplifies enormously the healing process of this type of ostomy, thus permitting the systematic use of local anaesthesia. This procedure allows this type of surgery to be practiced on ambulatory patients, reducing the operating costs.
A 28-year-old Pinto mare was evaluated for multiple recurrences of a perianal squamous cell carcinoma. Clinical signs included lethargy, inappetence, weight loss, dyschezia, and hematochezia. The tumor involved the proximal portion of the vulvar labia, the perineum, and the anus, and there was a rectal fistula just left of the anus. Permanent end-on colostomy without further treatment of the carcinoma was the management option chosen. The colostomy functioned satisfactorily, and the mare's condition was stable for the next 14 months. Recurrence of lethargy and inappetence and development of weakness eventually necessitated euthanasia.
BACKGROUND: Management of civilian colonic trauma remains controversial. AIM: To determine prognostic factors in patients with civilian colonic trauma undergoing different modes of therapy. METHODS: Sixty-five patients with colonic injuries were retrospectively analyzed. RESULTS: Right and left colon injuries were present in 30 and 35 cases respectively. Colon-related complications occurred in 27.7%. One death (1.5%) was directly due to colonic injuries. Left sided colon injuries led to a higher incidence of complications and longer duration of hospital stay; a higher number of complications occurred in relation to colostomy than primary closure. CONCLUSIONS: Primary repair can be done in more cases than is routinely done. The presence of multiple abdominal injuries or shock does not exclude primary repair. The site of injury may affect the outcome, but does not exclude primary repair. Gross fecal contamination, extensive colonic damage and type of feces in affected colon should be considered as indications favoring colostomy.
A prospective, controlled, clinical study was conducted to evaluate the effect of skin barriers and adhesives on the incidence of peristomal skin irritation. Colostomy patients eligible to participate were randomly assigned one of two sets of 10 one-piece pouching systems. At mid-study, after using the first 10 pouches, patients were allocated 10 pouches from the alternate pouching system. Each pouching system was worn for a maximum of 24 hours. One-hundred twelve patients were enrolled in the study. At baseline, 8 percent of patients had some erythema. At the end of the study period, 26 percent of patients exhibited signs of skin irritation. Patients were significantly more likely to develop skin irritation following use of the Karaya-based barrier than following use of the pectin-based barrier product (Wilcoxon Rank Sum Test, p < 0.01). Similarly, the type of tape used to secure the pouching system significantly influenced the incidence of skin irritation. Analysis of the change in skin condition as it relates to all evaluated variables; i.e. pouching system, stoma shape, stoma size, stoma length and irrigation, showed that only the type of product used was significantly associated with a change in skin condition. This is the first report of a controlled clinical study to evaluate the effect of pouching systems and patient/stoma variables on skin integrity in colostomy patients. These findings confirm that skin irritation can be a considerable problem, even in patients who use irrigation techniques.(ABSTRACT TRUNCATED AT 250 WORDS)
A retrospective non-randomized study, comparing primary repair with colostomy, was made on a series of 102 patients with penetrating intraperitoneal colon injuries, in a war surgery programme in Cambodia. The overall case fatality rate (CFR) was 25.5%, whereas in the primary repair group CFR was 20%, compared to 30.8% in the colostomy group. The difference was not statistically significant (P = 0.30). Adjustment for possible confounding factors in the two groups did not alter the results. Considering the numerous advantages to the patient of a primary closure in the precarious situations where war surgery is often performed, this technique merits consideration.
Isolation of a colostomy during other abdominal operations could become burdensome or lead to contamination of operative site with feces. I present an effective, rapid, and safe technique that involves the placement of a purse string suture and colostomy packing in addition to external dressing.
A technique is described where the distal limb of a loop colostomy is tied with nylon or polydioxanone. This ensures total faecal diversion and dispenses with the supporting rod, enabling early application of stoma appliances. The technique does not interfere with the traditional transverse closure of a loop colostomy.
The Conseal plug was evaluated in a four week period among 30 consecutive colostomy patients. The clinical trial, a multicenter study covering 11 Danish Hospitals, was started five to 12 days postoperatively among motivated patients in good physical condition. Twenty patients (67%) completed the trial. Ten patients (33%) gave up because of wound infection, leakage, extrusion of the foam part or fault in the test procedure. At the end of the trial all 20 patients wanted to continue using the plug and 84% were still using the Conseal system six months later. We conclude that the plug is well tolerated among motivated patients less than a week postoperatively and that the Conseal plug is a good alternative to the colostomy bag early in the postoperative course.
Recently, the routine use of barium enema preceding colostomy closure in trauma patients has been challenged. It has been argued that the nature of the injury should be apparent from the initial laparotomy and that the likelihood of finding an unsuspected colonic lesion in the young, previously healthy patients who constitute the majority of trauma patients is very small. We retrospectively reviewed 124 consecutive cases of patients who received colostomy takedowns for trauma. One hundred six of the patients had preoperative barium enema evaluation. 87.1 per cent of the examinations were negative, with a subsequent stoma closure complication rate of 20.4 per cent. Of the 13 positive barium enemas, 9 were falsely positive. These patients had a higher stoma closure complication rate of 39 per cent, a fact that could not be explained on the basis of their abnormal studies. The 18 patients who did not have barium enema performed did not have an increase in complications (17.6%). Barium enema failed to uncover unsuspected pertinent diagnoses, often added unnecessary delays and expense, and in no case changed the operative management. Contrast studies were found to be useful in defining anatomy in cases of known fistulas and when the takedowns were performed without the benefit of operative reports from the previous surgery.
The aim of a defunctioning stoma is to protect patients from the consequences of faecal leakage and pelvic sepsis, should it occur. A retrospective audit of 77 patients who had undergone closure of a loop stoma between 1988 and 1996 was performed. Sixty patients had either transverse loop colostomy (52) or loop ileostomy (8) to defunction distal colorectal/anal anastomoses or pathology, and 17 patients had a loop ileostomy to defunction an ileoanal pouch. Those who had restorative proctocolectomy experienced a much higher (24%) complication rate than the loop colostomy group (5%), despite similar perioperative care and surgery performed by surgeons of equivalent seniority. The complication rate of ileostomy closure in pouch patients is similar to other published series. As a result of these findings, a selective approach to the use of loop ileostomy to protect pouches has been introduced. The absence of wound infections in our series would suggest that primary closure of the stomal wound without drainage can be achieved.
INTRODUCTION: Currently, the number of ostomates in Spain is approximately 30,000. The ostomate suffers a series of situations that influence his quality of life. Bearing this in mind, and with the objective of improving the well being and comfort of colostomates. Naturess and Naturess Mini, new one piece closed pouches with Stomahesive skin barrier, have been investigated and developed. OBJECTIVES: Evaluate the effectiveness in daily practice of the new closed pouches in colostomates. METHODS: Multicenter, open, non-comparative study of 412 (48.4% male and 51.6% female) patients with a mean age of 59.5 years. Wear time, skin adhesion, peristomal skin protection, filter effectiveness, ease of application, comfort and global performance were all studied. Descriptive statistics were used to analyse the data. RESULTS: 88.4% of the patients already used a colostomy pouch, 14.4 months being the average time since the colostomy was created. There was an improvement of the peristomal skin, with significant statistical difference between the first and final visit (p < 0.001). Wearing time of the pouch was 17.7 hours. The absence of leakages (80%), the adherence (84%), ease of application (89%), removal (84%), comfort (84%), filter (72%) and pouch change frequency (73%) were valued as excellent/very good by the investigator. The patient valued as excellent/very good the comfort (84%), ease of use (84%), security (74%) and discretion (86%). 77% of the patients stated that they would continue using these pouches. CONCLUSION: The use of these new one piece closed pouches could improve the quality of life of these patients as they contribute to optimum treatment in daily practice and are a therapeutic alternative for colostomates.
Over the 7 years period from January 1986 to December 1992, 36 colostomies were performed at the University of Port Harcourt Teaching Hospital (UPTH). The indications for the procedure were classified under congenital, traumatic, neoplastic and miscellaneous groups. Imperforate anus and Hirschsprungs disease, under the congenital group, formed the commonest indication (19 cases); traumatic conditions followed with 9 cases, carcinoma of the rectum comprised 5 cases while there were 3 cases in the miscellaneous group--made up of 2 sigmoid volvulus and one of stercoral perforation of the sigmoid colon. 27 of the colostomies were loop transverse, 6 absolute defunctioning transverse and 3 terminal Permanent). The peculiar problems encountered with this procedure are also highlighted.