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PubMed1981

Colonic mucosal-submucosal blood flow and the incidence of faecal fistula formation following colostomy closure.

Fistula formation following closure of a colostomy occurs most frequently when closure is carried out within the first few weeks of construction and may be related to an impaired local microcirculation. Using a recently described method for measuring colonic mucosal-submucosal blood flow, the variations in local flow which occur during the first month after colostomy construction were determined in 8 patients. Mean blood flow increased from 6.9 +/- 1.8 ml min-1 100 g-1 (s.d.) at 7 days to 31.1 +/- 12.5 ml min-1 100 g-1 (s.d.) at 28 days. In a further 40 consecutive patients undergoing colostomy closure, blood flow measurements were made before operation. Eight patients developed a faecal fistula, and in 5 of these patients mucosal-submucosal blood flow was found to be less than 15 ml min-1 100 g-1. In every successful colostomy closure blood flow was greater than 15 ml min-1 100 g-1. This study provides evidence that a subnormal blood flow is one of the factors associated with fistula formation following the operation of colostomy closure.

Colon↗

PubMed1981

A controlled trial of colostomy management by natural evacuation, irrigation and foam enema.

Twenty patients entered a prospective controlled trial of colostomy management by three techniques--natural evacuation, colostomy irrigation and foam enema. Every patient spent 2 months using each technique. The mean number of colostomy actions weekly was 17 during natural evacuation, 6 during irrigation and 10 with the enema. There was no significant difference in the time taken to manage the colostomy by each technique. Eighteen patients considered that both irrigation and the foam enema improved the quality of their life, and opted to continue with irrigation on completion of the study. There were no major complications during the trial but leakage of foam and an increase in flatus were problems with the foam enema. It is concluded that patients should be made aware of the alternative methods available for colostomy management and be encouraged to use the method of their choice.

Aged↗

PubMed1992

Anterior resection without a defunctioning colostomy: questions of safety.

The need to defunction the anastomosis at anterior resection remains controversial. As the policy in this unit has been not to perform a defunctioning colostomy during anterior resection, the outcome of a consecutive series of 114 anterior resections, all carried out without a covering colostomy, was studied. During the period February 1985 to September 1991, 21 abdominoperineal resections, six Hartmann's procedures and two resections with coloanal anastomosis were also performed. Within the anterior resection group six clinical leaks (5.3 per cent) occurred, all in the low anastomosis group (8 per cent leak rate) and all of which required an end colostomy. The perioperative mortality rate within the anterior resection group was 3.5 per cent; of the four deaths one was attributable to anastomotic dehiscence and sepsis and the others were due to unassociated medical conditions. The results demonstrate similar leakage and mortality rates to published studies where anterior resection is frequently performed with a defunctioning colostomy. These results indicate that the routine use of a defunctioning colostomy at anterior resection should now be questioned.

Adult↗

PubMed2000

Laparoscopic loop colostomy for advanced ovarian cancer, rectal cancer, and rectovaginal fistulas.

OBJECTIVES: The objectives of this study were to present a minimal invasive technique of intestinal diversion for selected cases of advanced inoperable ovarian cancer, rectal cancer, and rectovaginal fistulas, and to discuss indications, pitfalls, and potential complications. METHODS: The technical features of laparoscopic colostomy are described. RESULTS: Between August 1995 and July 1997 laparoscopic colostomy was successfully carried out in 12 patients with advanced ovarian cancer, inoperable carcinoma of the rectum, or rectovaginal fistulas. There were no intraoperative or postoperative complications and postoperative recovery was rapid, with all patients having function of the colostomy within 24 h and regaining their preoperative state of mobility on the second postoperative day. CONCLUSION: The laparoscopic approach allows careful selection of the colostomy site and easy mobilization of the colon, causing only little disruption to intestinal function and, hence, improving postoperative recovery. From our experience, laparoscopic colostomy is in most cases a simple and safe operation and can be used as the preferred technique of intestinal diversion.

Colostomy↗

PubMed1993

The unopened colostomy: a procedure to protect colonic anastomosis.

The results of an alternative to the classic diverting lateral colostomy when used to protect a high risk anastomosis are reported. Fourteen out of 122 patients undergoing colonic or colorectal resection had a restoration of intestinal continuity with a proximal closed loop colostomy--of these 11 did not require opening in the immediate post-operative period. These had an uneventful early post-operative course, and the return of the colostomy to the abdominal cavity was performed within 10 days post-operatively, without having been opened. In three cases where local or general complications occurred, the opening of the colonic loop led to the creation of a conventional temporary protective colostomy. This procedure allowed a reduction of the originally planned number of colostomies by 50%.

Adult↗

PubMed1994

Does the frequency of paracolostomy hernias depend on the position of the colostomy in the abdominal wall?

The aim of this study was to determine the rate of paracolostomy hernia in relation to transrectal or pararectal position of a colostomy. Fifty-four consecutive patients who had undergone an abdomino-perineal excision for rectal neoplasia were studied. The location of the colostomy was assessed by physical examination. Computerised Tomography (CT) scanning was used in the cases where its anatomical position remained in doubt. The colostomy was in a pararectal position in 29 (54%), while in 25 (46%) it was transrectal. CT was necessary to determine the location of the colostomies in 9 cases (16%), eight of which had a parastomal hernia. The colostomy was pararectal in 15 (52%) of the 26 patients who had a paracolostomy hernia, and in 14 (48%) of the 28 patients without a paracolostomy hernia. No statistically significant correlation was found between the presence of a parastomal hernia and the position of the stoma in the abdominal wall.

Abdominal Muscles↗

PubMed1986

A clinical and experimental study of colostomy blood flow and healing after closure.

Colostomy blood flow and healing have been studied in both man and rat. Laser Doppler velocimetry (LDV) was used to measure flow and showed a significant difference between colostomy blood flow measured at 1 week and at more than 8 weeks after fashioning (p less than 0.002). Hartmann colostomies were constructed in rats and closed at 3 or 6 weeks later. There was a correlation between distal colonic (stump) blood flow and anastomotic bursting pressures 3 days after closure in the 3-week group (r = 0.080; p less than 0.01). Colostomies closed at 6 weeks were significantly stronger than those closed at 3 weeks (p less than 0.02). Collagen concentration in proximal (stoma) colon was higher in the 6-week group compared with the 3-week group prior to anastomosis. There was also a fall in the proximal collagen after anastomosis in both 3- (p less than 0.01) and 6-week groups (p less than 0.01). Poor blood flow measured by LDV and colonic collagen concentration may predict poor healing after colostomy closure. LDV is a non-invasive technique with clinical application in this field.

Aged↗

PubMed1983

A method and the results of loop colostomy.

A technique of loop colostomy which avoids a sutured skin wound, employs a deep tension suture with retained polythene sleeve as a bridge, and permits routine use of standard terminal colostomy appliances is described. The clinical results in 51 patients are reported and the advantages of this method of construction discussed. All patients were able to use standard, terminal colostomy appliances routinely from the time of construction. There were no immediate postoperative complications. Delayed complications occurred in 5 (10 per cent) patients. Intraperitoneal closure was performed in 43 patients and was complicated by 1 (2.3 per cent) transient fecal leak and 4 (9.3 per cent) would infections. The absence of a sutured skin wound, the small bridge size, and the circular shape of the stoma facilitate use of accurately fitting, standard terminal colostomy appliances rather than the usual loop colostomy apparatus. This results in an improved skin seal, reduced fecal leakage, easier nursing and stoma care, and better patient morale.

Adolescent↗

PubMedDate not supplied

Irrigation vs. natural evacuation of left colostomy: a comparative study of 340 patients.

A comparative study of two methods of managing left colostomy (irrigation and natural evacuation) was carried out on 340 patients who were examined and interviewed at the Stoma Rehabilitation Clinic of the Institute of Surgical Pathology of the University of Padua. Ninety-two per cent of patients who irrigated their colostomies gained fecal continence. No patient who irrigated his colostomy had any cutaneous problem, and this group had significantly better results in preventing leakage of gas and odors compared with those patients using natural evacuation. For most patients who irrigated, the ability to predict or control bowel movements overcame fears of "being dirty" and related psychological problems. These patients also had more normal social and working lives than did those patients not irrigating their colostomies. Only one patient in our series had a colonic perforation, and any chance of a repeat incident will probably disappear with the cone-shaped catheters now available. The authors conclude that in properly selected patients, irrigation is the method of choice for management of left colostomy.

Aged↗

PubMed1982

Factors affecting the morbidity of colostomy closure: a retrospective study.

The use of a temporary colostomy is essential in the management of trauma, carcinoma, iatrogenic perforations, diverticulitis, and a number of congenital anomalies of the colon. Closure of a colostomy can be associated with a significant complication rate and even mortality and should not be considered a minor procedure. This is a retrospective study of 114 patients undergoing closure of colostomy, in which an attempt was made to investigate and single out the factors determining complications of colostomy closure. The results point toward timing and technique of closure as the two main factors determining complications associated with colostomy closure.

Adolescent↗

PubMed2004

Smooth muscle sphincteroplasty in colostomy.

PURPOSE: The present work elaborated on Schmidt's idea of an effective smooth muscle sphincteroplasty. The aim of the study was to analyze the effects on the patients with a lower quadrant colostomy constructed after abdominoperineal extirpation of a modified smooth muscle sphincteroplasty combined with colon irrigations. METHODS: Seventy-two rectal cancer patients (39 men and 33 women, median age, 54.5 years) with smooth muscle sphincteroplasty and 20 controls with conventional colostomy using colon irrigations (11 men and 9 women, median age, 63.2 years) were examined. A modified smooth muscle wrap of the colostomy with a free graft of a 4-cm-long colon segment without mucosa was applied. In this precolostomy segment a high intraluminal pressure was achieved. The functional capacity and anatomic integrity of the transplanted smooth muscle graft were examined manometrically, electromyographically, and histomorphologically. The functional activity of the colostomy was assessed by periodic recording of the number of "spontaneous" and "directed" defecations.RESULTS. In the patients with smooth muscle sphincteroplasty, the basal intraluminal pressure of the precolostomy segment two years after operation measured 29.7 mmHg. After dilatation of the transplant, these pressures reached up to 43 mmHg ( P < 0.001). The weekly "spontaneous" stools were 3 to 5 times less frequent than in the controls ( P < 0.001). CONCLUSIONS: The modified smooth muscle sphincteroplasty offers operative-technical opportunities for increasing intraluminal pressure in the precolostomy colon segment. Its combination with colonic irrigations facilitates control of the evacuatory rhythm and "spontaneous" stools in colostomy patients, thus improving their quality of life.

Adult↗

PubMed2003

Minimally invasive, endoscopically assisted colostomy can be performed without general anesthesia or laparotomy.

PURPOSE: Fecal diversion is frequently required in critically ill patients who may not be able to tolerate a laparotomy. Laparoscopic-assisted and trephine colostomies are alternative methods for colostomy without laparotomy, but require general anesthetic. The objective of this study was to evaluate the possibility of performing fecal diversion with the assistance of a colonoscope and without the additional morbidity of abdominal exploration or general anesthesia. METHODS: Patients were diverted using a colonoscope to identify a site of the sigmoid colon that could easily be approximated to the anterior abdominal wall as confirmed by transillumination of the abdominal wall. A small skin disc was then removed at this location and a loop colostomy was made. The colonoscope was also used as a guide to identify the proximal and distal limbs of the loop colostomy. Four patients were considered to be critically ill and local or regional anesthetic with sedation was used in these patients. RESULTS: A total of 15 patients were reviewed during the past five years. All 15 patients were successfully diverted using minimally invasive techniques with the aid of the colonoscope. Four of these patients were diverted using local or regional anesthetic without complication, thus avoiding the morbidity associated with a general anesthetic in critically ill patients. CONCLUSION: No complications related to this technique were noted in this five-year review. Endoscopically assisted colostomy is an acceptable method for fecal diversion without the need for laparotomy and can be accomplished using a local or regional anesthetic with sedation.

Adult↗

PubMed1976

Morbidity of colostomy closure.

An unexpectedly high morbidity (28 per cent) followed colostomy closure in 100 patients. One patient died postoperatively because of sepsis resulting from disruption of the colon anastomosis. Wound infection (10 per cent), intraperitoneal abscess (1 per cent), bowel obstruction (7 per cent), and fecal fistula (4 per cent) were other significant complications. Wound sepsis was greater after primary than after delayed wound closure. Obstruction did not correlate with the use of either an open or closed technic of anastomosis. Three patients required reoperation for complications. Temporary colostomy was constructed for colon injury in 85 per cent of patients. In view of the considerable morbidity of colostomy closure, alternate technics of managing colon trauma should be considered. Such technics include primary closure and exteriorization of repaired colon. When temporary colostomy is unavoidable, closure is best done by open, two layer anastomosis with delayed wound closure. Colostomy should be recognized as an important procedure associated with significant morbidity.

Abdominal Injuries↗

PubMed1979

Improving transverse colostomy function.

Loop transverse colostomies as usually constructed without immediate mucocutaneous anastomosis function poorly even a year later, with diarrheal fluid output approaching 1 liter/day on a regular diet. In contrast, primarily matured end transverse colostomies produce an average of 750 cc/day at one month and 560 cc/day at nine to twelve months on a similar diet. A further reduction to 360 cc/day was achieved on an experimental 70 mEq sodium diet. It is suggested that end transverse colostomies with immediate maturation should be performed in all patients requiring a transverse colostomy for more than a very short time to markedly improve colostomy function.

Colon↗

PubMed1992

Complications of colostomy performed on gynecologic cancer patients.

From 1/1/80 to 5/31/90 111 patients underwent a colostomy on a gynecologic oncology service. Six patients developed 7 (6.3%) early colostomy-related complications, including sepsis (1), stomal retraction (1), ostomy wound infection (3), and partial stomal obstruction (2). The sepsis was felt to be related to spillage of stool upon maturing the colostomy, and this patient expired on Postoperative Day 63. There were no other mortalities attributed to the colostomies. Fourteen patients developed 17 (15.3%) delayed colostomy-related complications, including parastomal hernia (5), stomal retraction (1), stomal prolapse (3), tumor replacement (2), and site-choice problems (6). These results compare favorably with those in the literature and support the continued role of the gynecologic oncologist in gynecologic cancer-related gastrointestinal surgery.

Adult↗

PubMed2005

[Perineal colostomy with antegrade continence enemas as an alternative after abdominoperineal resection for low rectal cancer].

Some young and active patients requiring abdominoperineal resection for rectum cancer ask for an alternative of an abdominal colostomy. We analysed the results after a combination of a perineal colostomy and antegrade continence enemas (ACE). Fifteen patients have been operated between 1999 and 2004. Follow-up was >six months in 12 patients with a mean of two years and with a maximum of 55 months. The QLQ-C30 (version 3) and CR 38 questionnaires of the EORTC have been used to evaluate quality of life aspects. Five out of 15 patients presented complications: infection of the caecal conduit (2), small bowel obstruction (1), prolapse of the perineal colostomy (1), eventration (1), urologic complications (2). ACE are still used by all patients. The volume needed was 400 ml and duration of irrigation was 30 minutes (15-45 minutes). The median score for faecal incontinence was 0 ; faecal pseudocontinence was obtained by 7/12 patients. The scores for all aspects of functioning were excellent, as well as the score for body image. The general health status and quality of life were estimated at 75% from normal value. The procedure is simple and can be performed in one operative session. A perineal colostomy with ACE seems to be a valuable and less expensive alternative for an abdominal colostomy, and certainly for total anorectal reconstruction.

Adult↗

PubMed2004

Percutaneous endoscopic colostomy of the left colon: a new technique for management of intractable constipation in children.

BACKGROUND: The antegrade colonic enema is accepted as effective for management of intractable constipation in children when conventional bowel management has failed. This study describes experience with a new, minimally invasive technique, the distal antegrade colonic enema, which involves percutaneous endoscopic colostomy of the left colon. METHODS: Fifteen children with refractory constipation and soiling who had radiographic evidence of megarectum and/or distal colonic delay were selected for the procedure. The junction of the descending and the sigmoid colon was identified colonoscopically, and the percutaneous endoscopic colostomy tube, through which antegrade distal colonic enema are administered, was inserted. RESULTS: Fourteen children underwent distal percutaneous endoscopic colostomy insertion. The median time required for the procedure was 30 minutes (20-50 minutes). Excluding one child (technical difficulties with percutaneous endoscopic colostomy placement), median post-procedural hospital stay was 4 days (2-27 days). Thirteen children were no longer soiling, and improvement in quality of life was reported at 2 months' follow-up. At 6 months' follow-up, 90% of children were clean during intervals between enemas. All children evaluated at 12 months' follow-up remained clean. Median duration of follow-up was 12.5 months (2-51 months). CONCLUSIONS: The distal percutaneous endoscopic colostomy is a simple alternative to established methods for delivery of antegrade enemas. It is less invasive and on reversal leaves only minor scarring.

Child↗

PubMed2001

Does a colostomy alter quality of life in patients with spinal cord injury? A controlled study.

STUDY DESIGN: Prospective controlled comparative analysis. OBJECTIVE: To determine whether a colostomy changes quality of life in patients with a spinal cord injury. METHOD: A previously validated questionnaire designed to assess quality of life in spinal injured patients (Burwood Questionnaire) was sent to 26 spinal cord injured patients with colostomies and 26 spinal cord injured patients without colostomy. The two groups were matched for level of injury, completeness of injury, length of time since injury, age (+/- 5 years) and gender. RESULTS: There was 100% completion of the questionnaire. There was no significant difference (P > 0.05) in the two groups of patients in regard to their general well being, emotional, social, or work functioning. CONCLUSIONS: Patients with colostomy following spinal injury are no worse off in regard to quality of life, than those without. The inference is that perhaps a colostomy should be considered earlier in patients with major bowel dysfunction following spinal cord injury. SPONSORSHIP: Financial support for Dr AC Lynch was provided by Royal Australian College of Surgeons with a Foundation Scholarship and Grant in aid by the Burwood International Spinal Trust. Mr N Randell was supported by the Canterbury Medical Research Foundation with a summer studentship.

Adult↗