Abstract
To verify prospectively the practicability of performing loop colostomy closure under local anesthesia and sedation. 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. 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. Loop colostomy closure under local anesthesia and sedation is feasible, safe and acceptable to patients.
Highlights
Despite the apparently low risk involved in loop colostomy closure, there are reports of significant morbidity rates: 10-50%1 and 22-30%2; with occasional mortality: 0.51%1
Pain was evaluated during the operation, on the first postoperative day and at hospital discharge
95.2% of the patients (20/21) said they were in favor of the local anesthesia technique
Summary
Despite the apparently low risk involved in loop colostomy closure, there are reports of significant morbidity rates: 10-50%1 and 22-30%2; with occasional mortality: 0.51%1. A review of the literature demonstrated the existence of only two reports on loop stomata closure using local anesthesia: one for colostomy and the other for ileostomy.[3, 4] Both of these authors reported that local anesthesia has advantages over general anesthesia and locoregional blockade: it involves a limited area of the body; there is little interference with the functioning of other organs; there are no alterations to the patient’s respiratory function; there is minimal incidence of nausea and vomiting during the postoperative period; intraoperative hydration is simpler to perform; the immediate postoperative period is pain-free; and local anesthesia is well tolerated by high-risk patients These authors concluded that this type of anesthesia was effective and safe for surgery to close stomata. It was proposed to make a prospective study with the aim of better analyzing the immediate results and the practicability of loop colostomy closure under local anesthesia and sedation
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