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At least 127 records · Page 7Linked to original sources
PubMed1996

Use or misuse of colostomy to heal pressure ulcers.

PURPOSE: The purpose of this study is to evaluate the effectiveness of colostomy performed as an adjunct measure in the attempt to heal pressure ulcers by flap closure. METHODS: Twenty-seven consecutive patients who underwent colostomy for healing of pressure ulcers were studied by chart review and patient questionnaire. Fecal diversion was accomplished by colostomy in each case. RESULTS: There were four (15 percent) deaths. Twenty-three patients subsequently underwent flap closure of their ulcer. Of 19 patients available for follow-up, only 6 (32 percent) patients had completely healed, although most patients thought their quality of life improved because of the colostomy. None of the patients underwent colostomy closure. CONCLUSION: Our conclusions are that, although most patients will have an improved quality of life subsequent to diversion, the high mortality and low rate of pressure ulcer healing should temper enthusiasm for performing colostomy in this setting.

Adult↗
PubMed1996

Colostomy closure. Ochsner Clinic experience.

PURPOSE: We retrospectively reviewed the records from our past five years of experience with colostomy closure at a large multispecialty hospital to determine postoperative morbidity. RESULTS: From March 1988 to April 1993, 46 patients underwent colostomy closure. Patients ranged in age from 24 to 87 (mean, 41.8) years, and 25 (54 percent) were women. Stomas had been created during emergency operations in 40 patients (87 percent); most operations (54 percent) were for complications of acute diverticulitis. Of the 46 procedures, 40 (87 percent) were end colostomies, and 6 were loop colostomies. Stomas were closed at a range of 11 to 1,357 days after creation (mean, 207 days; median, 116 days). Twenty-six patients (57 percent) underwent colostomy closure alone, and the remainder underwent additional procedures ranging from appendectomy to hepatic lobectomy. Duration of operations ranged from 1 to 9.5 (mean, 4.2) hours, and estimated blood loss averaged 400 ml. Overall hospital stay for closure was 6 to 62 (mean, 11.5) days. Inpatient complications occurred in 15 percent of patients, including congestive heart failure (2 percent), cerebrovascular accident (4 percent), pneumonia (2 percent), enterocutaneous fistula (2 percent), and pulmonary embolus with death (2 percent). The most common long-term complication was midline wound hernia, which occurred in 10 percent of surviving patients. Overall, complications occurred in 24 percent. CONCLUSIONS: Colostomy closure is a major operation; however, with good surgical judgement and technique, associated morbidity and mortality can be minimized.

Acute Disease↗
PubMed1978

Colostomies--indications and contraindications: Lahey Clinic experience, 1963--1974.

Over a 12-year period, 276 temporary colostomies were performed on 271 patients. During this interval 118 colostomies were closed. The morbidity rate of colostomy construction was 21 per cent, and for closure it was 49.1 per cent. No definite factor could be indentified as contributing to this high rate of complications for colostomy construction. With respect to colostomy closure, predisposing factors that seemed to increase morbidity were shorter interval between creation and closure of the stoma and resection of colostomy (as opposed to closure without resection). Intra-abdominal drains were associated with a prohibitively high rate of wound infection, although subcutaneous drainage was not successful in reducing the incidence of infection significantly.

Adolescent↗
PubMed1977

Umbilical colostomy: a better intestinal stoma.

This study was undertaken to evaluate our experience with umbilical colostomy. There were 101 cases available for review. Four patients had major complications that necessitated reoperation, an incidence of 3.9%. One patient was operated on for necrosis of the stoma, one for retraction, and two for periostomal evisceration of omentum and small bowel. Three patients had minor strictures requiring digital dilatation, and one needed minor revision under local anesthesia. No patient had a peristomal hernia or prolapse, making this a distinctly better colostomy than the conventional left-lower-quadrant colostomy. The ease and comfort in the care of this colostomy were evident during follow-up visits. We feel that this procedure has all the advantages of a conventional matured colostomy and has extra advantages of easy accessibility and absence of peristomal hernias and prolapse. For any elderly patient who needs a permanent colostomy, umbilical location of the stoma offers distinct advantages.

Aged↗
PubMed1990

Comparative bioavailability of a morphine suppository given rectally and in a colostomy.

In eight patients with a colostomy, plasma morphine levels were followed for 8 h after administration of 20 mg morphine chloride as a suppository, first rectally and after at least 48 h via the colostomy. The bioavailability after administration in the colostomy showed very great variation; the mean value compared to rectal bioavailability was only 43% (range 0.1-127%). In four patients the plasma concentrations of morphine after colostomy administration were lower at all times than after rectal administration, and in three only small amounts of morphine were detectable. One patient showed higher plasma concentrations after colostomy application than after rectal administration. It is concluded that administration of morphine suppositories in a colostomy cannot be recommended.

Administration, Rectal↗
PubMed2001

Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery.

Several studies have compared loop ileostomy with loop colostomy to defunction colorectal anastomoses. The discordant results may be due to the heterogeneity of the indications. We therefore performed a retrospective study to compare the two procedures in a homogeneous group of patients operated on electively for rectal cancer. Among 462 consecutive patients undergoing rectal resection for cancer during 1986-1998, 60 had a loop colostomy and 107 a loop ileostomy to defunction a low anastomosis. The two groups were similar with respect to age, gender, obesity, tumor stage, and duration before closure (109 vs. 104 days; p = 0.28). All the stoma-related complications that occurred after construction and after closure of the stoma were recorded. There were no stoma-related deaths in the two groups. After stoma construction, the morbidity rate was significantly higher following loop colostomy than after loop ileostomy (35% vs. 19%; p = 0.02). After stoma closure the complication rate was significantly higher in the colostomy group than in the ileostomy group (34% vs. 12%; p = 0.004). The risk of surgical reintervention related to the morbidity of both construction and closure of the stoma was twice as high after loop colostomy than after loop ileostomy (22% vs. 9%; p = 0.03). The results of this study showed that, in our experience, the overall stoma-related morbidity and risk of reoperation were significantly lower after loop ileostomy than after loop colostomy. This suggests that loop ileostomy is the best procedure for defunctioning colorectal anastomoses electively. We therefore recommend using a loop ileostomy during rectal cancer surgery.

Adult↗
PubMed1998

Intraoperative bowel irrigation improves anastomotic collagen metabolism in the left-sided colonic obstruction but not covering colostomy.

This study investigated the effects of intraoperative colonic irrigation and proximal diverting end colostomy after segmental bowel resection in experimental left-colonic obstruction on anastomotic healing. Simple obstruction of descending colon was performed in male Sprague-Dawley rats. After 24 h we performed segmental colonic resection and anastomosis in the control group (n = 15); resection, anastomosis, and covering colostomy in the colostomy group (n = 14); resection and anastomosis after antegrade colonic lavage through cecum by using isotonic saline solution in the irrigation group (n = 13). In rats that were killed 7 days later anastomotic dehiscence and bursting pressure and tissue hydroxyproline concentration at the anastomosis were measured. No significant differences were observed between groups in terms of anastomotic dehiscence, bursting site, or pressure. The hydroxyproline concentration was significantly higher in the irrigation group than the control group (P = 0.025) and the colostomy group (P = 0.029), but no difference was noted between the control group and the colostomy group. These findings suggest that intraoperative antegrade colonic irrigation in the acute left-sided colonic obstruction positively affects collagen metabolism at the anastomotic site; if the anastomosis is performed without bowel cleansing, covering colostomy does not improve collagen metabolism.

Anastomosis, Surgical↗
PubMed2004

Comparison of stent placement and colostomy as palliative treatment for inoperable malignant colorectal obstruction.

BACKGROUND: Stent placement is a useful palliative treatment for inoperable acute malignant colorectal obstruction. However, data comparing stent placement with colostomy are scarce. METHODS: We compared the clinical outcome of 18 patients who had stent placement and 17 patients who underwent only colostomy. RESULTS: The postoperative hospital stay was 22.3 days for stent placement compared with 47.4 days for colostomy (p = 0.016). The duration to readmission was 129.2 days for stent placement and 188.4 days for colostomy. The estimated duration of primary stent patency was 106 days. Mean survival period was 134 days in patients with stent placement and 191 days in patients with colostomy. CONCLUSION: Postoperative hospital stay was shorter in patients with stent placement but duration to readmission and survival were longer in patients with colostomy. However, stent placement increases the option of palliative treatment and is an effective treatment contributing to improving quality of life.

Aged↗
PubMed2001

Colostomy closure using local anesthesia.

The feasibility of performing colostomy closures using local anesthesia was evaluated. The subjects comprised 14 patients: 2 with colostomies involving a mucous fistula and 12 with loop colostomies. Patients who had colostomies with mucous fistulas separated by 10cm or more were excluded from this study. All patients were graded as ASA 1 (according to the American Society of Anesthesiologists). The bowel was evaluated by colonoscopy in 6 patients and by barium enema in 8 patients. Bowel preparation was performed with Colayte and all patients were given prophylactic antibiotics. Closure of the colostomy was extraperitoneal and the time taken to perform the operation ranged from 40 to 120min. Tolerance was regarded as excellent in 9 patients, good in 3, and average in 2. There were 3 anastomotic leaks that resolved without further surgical treatment, 2 wound infections, and 1 bowel obstruction that was successfully treated with medication. Patients were discharged 2-22 days postoperatively, after a mean period of 9 days. Local anesthesia offers a safe and effective alternative to general or regional anesthesia for surgical closure of colostomies.

Adolescent↗
PubMed2005

Use of Malone antegrade continence enema in patients with perineal colostomy after rectal resection.

PURPOSE: Abdominoperineal resection, with iliac colostomy, remains the gold standard treatment for very low-lying rectal cancer, but it alters patients' quality of life. Alternatives to iliac colostomy need to be experimented. Antegrade enemas via a cecal access (Malone operation) obtains a colonic emptying and improves continence for incontinent patients. Continence and quality of life after abdominoperineal resection and perineal colostomy associated to a Malone antegrade continence enema were studied. METHODS: After abdominoperineal resection for cancer, 18 patients had a digestive reconstruction by perineal colostomy and Malone antegrade continence enema. Patients performed antegrade enemas every 24 to 48 hours with tap water. After six months, continence (Cleveland Clinic score) and quality of life (Fecal Incontinence Quality of Life scale) were recorded. RESULTS: Morbidity was 5 percent (1 appendix necrosis). All patients could perform antegrade enemas by themselves. Mean continence score was 6.41/20 (standard error, 2.31). Fecal Incontinence Quality of Life scores were: lifestyle 3.18/4 (standard error, 0.83); coping/ behavior 2.99/4 (standard error, 0.83); depression/self-perception 3.11/4 (standard error, 0.83); embarrassment 2.84/4 (standard error, 0.63). CONCLUSIONS: After abdominoperineal resection, Malone antegrade continence enema associated to perineal colostomy provided an acceptable continence. It preserved patients' body image and resulted in a satisfying quality of life. It could become an alternative to iliac colostomy in selected patients.

Adult↗
PubMed2002

The application of percutaneous endoscopic colostomy to the management of obstructed defecation.

PURPOSE: We describe the case of a 52-year woman with a 17-year history of obstructed defecation in whom all other standard treatments had failed and the patient had refused a colostomy. Her symptoms were controlled by percutaneous endoscopic colostomy with antegrade colonic irrigation. METHOD: A percutaneous endoscopic colostomy tube was placed in the sigmoid colon endoscopically using a colonoscope and the patient irrigated two liters of water through the percutaneous endoscopic colostomy twice each day and was able to successfully evacuate her rectum without excess straining or discomfort. CONCLUSION: Percutaneous endoscopic colostomy is an alternative option to colostomy in the management of obstructed defecation.

Colostomy↗
PubMed1989

Are the risks after colostomy closure exaggerated?

One hundred twenty-one patients underwent colostomy closure for trauma. There was no mortality and a 4.9 percent incidence of major morbidity. Although there was no apparent relationship between the interval between colostomy creation and closure, three of the six major complications occurred in patients whose colostomies were closed soon after complicated initial injuries. It is recommended that if the primary operation is complicated by intraabdominal sepsis or major wound problems, 6 months should ensue before attempting closure. Long term follow-up of these patients (mean 39 months) disclosed a low incidence of late complications secondary to colostomy closure. Although the trend toward the increased use of primary repair of colon injuries in selected patients is supported, our study indicates that the risk of colostomy closure has been exaggerated and should not be a factor in the decision to create a colostomy after colon trauma.

Adolescent↗
PubMed2006

Laparoscopic versus open colostomy reversal: a comparative analysis.

Open colostomy reversal carries significant rates of wound infection, anastomotic leak, and incisional hernia which often limit its acceptance. We hypothesized that the laparoscopic approach to the restoration of intestinal continuity may result in lower perioperative morbidity and faster postoperative recovery. Twenty-two cases of laparoscopic colostomy reversals performed at a single institution were identified and compared to 22 randomly selected open colostomy closures performed during the same time period. Patients were compared based on demographics, previous indications for colostomy procedures, and perioperative outcomes. A total of 152 patients underwent reversal of left-sided colostomies during the study period. The laparoscopic approach was successful in 20 of 22 cases; there were 2 conversions to open (9%) secondary to inability to adequately mobilize the rectal stump. The laparoscopic and open groups were comparable based on mean age (54 years versus 49 years; P = 0.23), BMI (26 kg/m(2) versus 27 kg/m(2); P = 0.66), gender (9% males versus 13% males; P = 0.23), ASA Class (2.6 versus 2.3; P = 0.07), and history of previous intra-abdominal sepsis (17 versus 16 cases). Operative times were similar (158 versus 189 minutes; P = 0.16), and estimated blood loss was significantly less in the laparoscopic group (113 versus 270 ml; P = 0.01). No intraoperative complications occurred in the laparoscopic group and two enterotomies occurred in the open group. The laparoscopic group had earlier passage of flatus (3.5 versus 5.0 days; P = 0.001) and shorter hospitalization (4.2 versus 7.3 days; P = 0.001). Perioperative complications occurred in 3 (14%) laparoscopic and 13 (59%) open cases (P = 0.01). There was no mortality in this series. The laparoscopic approach can be safely used in the restoration of intestinal continuity. It results in a decreased perioperative morbidity and faster recovery, and it offers distinct advantages over the open approach to colostomy reversal.

Adult↗
PubMed1978

Imperforate anus: avoiding a colostomy.

Early assessement of imperforate anus, combining clinical and radiographic data, determines the course of treatment. "High" lesions most often require combined abdominal and sacroperineal repair, usually preceded by a decompression colostomy. "Low" lesions are repaired through a perineal or sacroperineal approach not requiring a previous colostomy. Patients who do not have an apparent fistulous tract through which accurate radiographic assessment can be made frequently undergo preliminary colostomy to avoid colonic perforation. This occurs in patients who have "low" lesions and in whom colostomy may be avoided. Combining a new procedure and an old procedure may avoid unnecessary colostomy. A 14 Medicut intravenous cannula is inserted in the perineum and under fluoroscopic control is advanced into the radiolucent area identified in the pelvis as the probable lower rectal pouch. The position is confirmed by aspiration of gas or meconium and injection of contrast material. A limited contrast enema will clearly identify the level of the lesion and identify a fistula if one is present. If a low lesion is identified and no fistula is present to allow temporary colonic decompression, a fistulous tract may be created mechanically. A No. 4 Fogarty catheter is inserted through the previously placed cannula, the catheter balloon is inflated, and the entire apparatus is extracted under tension. This creates a small fistulous tract to the perineal surface. Subsequent dilation of this tract allows colonic decompression, and definitive operative repair may be planned at the most appropriate time. By employing this technique, we have avoided colostomy in 4 of 6 patients.

Anus, Imperforate↗
PubMed2006

Misremembering colostomies? Former patients give lower utility ratings than do current patients.

Community members often evaluate health conditions more negatively than do the patients who have them. The authors investigated whether experience with a health condition reduces this discrepancy by surveying colostomy patients by mail (n = 195), some of whom (n = 100) had their colostomies reversed and normal bowel function restored. The authors also surveyed a community sample recruited via the Internet (n = 567). They then compared all 3 groups' utility value for life with a colostomy by using the time trade-off utility measure and by examining ratings of current quality of life. Despite having direct experience with the health condition, former colostomy patients provided much lower utility valuations than did current patients. In fact, their valuations were similar to those given by a community sample. Rather than accurately remembering their actual experiences with colostomies, the former patients may have applied a theory of how colostomies had influenced their lives; this is consistent with other research on theory driven recall bias.

Adult↗
PubMed2002

Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision.

BACKGROUND: The aim of this study was to compare loop ileostomy and loop transverse colostomy as the preferred mode of faecal diversion following low anterior resection with total mesorectal excision for rectal cancer. METHODS: Patients who required proximal diversion after low anterior resection with total mesorectal excision were randomized to have either a loop ileostomy or a loop transverse colostomy. Postoperative morbidity, stoma-related problems and morbidity following closure were compared. RESULTS: From April 1999 to November 2000, 42 patients had a loop ileostomy and 38 had a loop transverse colostomy constructed following low anterior resection. Postoperative intestinal obstruction and prolonged ileus occurred more commonly in patients with an ileostomy (P = 0.037). There was no difference in time to resumption of diet, length of hospital stay following stoma closure and incidence of stoma-related complications after discharge from hospital. A total of seven patients had intestinal obstruction from the time of stoma creation to stoma closure (six following ileostomy and one following colostomy; P = 0.01). CONCLUSION: Intestinal obstruction and ileus are more common after loop ileostomy than loop colostomy. Loop transverse colostomy should be recommended as the preferred method of proximal faecal diversion.

Adult↗
PubMed2003

Relation of hospital volume to colostomy rates and survival for patients with rectal cancer.

BACKGROUND: Postoperative mortality after some types of cancer surgery is inversely related to the number of operations performed at a hospital (i.e., hospital volume). This study assessed the association of hospital volume with colostomy rates and survival for patients with rectal cancer in a large representative cohort identified from the California Cancer Registry. METHODS: We identified 7257 patients diagnosed from January 1, 1994, through December 31, 1997, with stage I-III rectal cancer who underwent surgical resection. Registry data were linked to hospital discharge abstracts and ZIP-code-level data from the 1990 U.S. Census. Associations of hospital volume with permanent colostomy and 30-day mortality were assessed with the Mantel-Haenszel trend test and logistic regression. Overall survival was examined with the Kaplan-Meier method and a multivariable Cox proportional hazards model. Multivariable analyses adjusted for demographic and clinical variables and patient clustering within hospitals. All tests of statistical significance were two-sided. RESULTS: In unadjusted analyses across decreasing quartiles of hospital volume, we observed statistically significant increases in colostomy rates (29.5%, 31.8%, 35.2%, and 36.6%; P<.001) and in 30-day postoperative mortality (1.6%, 1.6%, 2.9%, and 4.8%; P<.001) and a decrease in 2-year survival (83.7%, 83.2%, 80.9%, and 76.6%; P<.001). The adjusted risks of permanent colostomy (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.10 to 1.70), 30-day mortality (OR = 2.64, 95% CI = 1.41 to 4.93), and 2-year mortality (hazard ratio = 1.28, 95% CI = 1.15 to 1.44) were greater for patients at hospitals in the lowest volume quartile than for patients at hospitals in the highest volume quartile. Stratification by tumor stage and comorbidity index did not appreciably affect the results. Adjusted colostomy rates varied statistically significantly (P<.001) among individual hospitals independent of volume. CONCLUSIONS: Rectal cancer patients who underwent surgery at high-volume hospitals were less likely to have a permanent colostomy and had better survival rates than those treated in low-volume hospitals. Identifying processes of care that contribute to these differences may improve patients' outcomes in all hospitals.

Adult↗
PubMed1980

Morbidity of colostomy closure following colon trauma.

Recent reports have suggested alternative procedures to temporary colostomy because of the high morbidity associated with its closure. The charts of 137 patients, who had colostomy closure following colostomies for trauma, were reviewed. Barium enema was helpful in the preoperative evaluation in selected patients. Early closure in uncomplicated cases was not associated with greater problems. Fourteen patients had postoperative complications for an overall morbidity of 10.2%. There were no deaths in the series. Colostomy closure in the trauma patient appears to be safer than in patients whose colostomy is constructed for nontraumatic reasons. Meticulous technique, including leaving the skin and subcutaneous tissue open, is essential. It is concluded that the principle of diverting or exteriorized colostomy in the trauma patient should not be abandoned because of hazards of subsequent closure.

Anti-Bacterial Agents↗