Colostomy Closure Research Articles

Bowel preparation for colostomy reversal in children

PurposePediatric bowel preparation protocols used before colostomy reversal vary. The aim of this study is to determine institutional practices at our institution and evaluate the impact of bowel preparations on postoperative outcomes and hospital length of stay in children. MethodsThis was a retrospective review of children ≤18 years old undergoing colostomy reversal at Texas Children's Hospital (TCH) between 12/2013 and 8/2017. Preoperative bowel regimens and outcomes were collected and analyzed using descriptive statistics, Wilcoxon Rank-Sum and Fishers Exact tests. Continuous variables are presented as median [IQR]. ResultsSixty-one children underwent colostomy reversal. Thirty-eight (62%) did not receive a preoperative bowel preparation. The two cohorts were similar in age, gender, and race. The most common indication for colostomy was anorectal malformation for thirty-seven (61%). Time from admission to surgery (19 h [17, 23] vs 3 [2, 3]; p < 0.01) and HLOS (6 days [5, 8] vs 5 [4, 6]; p = 0.02) were both longer in the bowel preparation cohort. Complications (3 [13%] vs 5 [22%]; p = 0.12) and 90-day readmissions (3 [13%] vs 6 [16%]; p = 0.64) were similar in both cohorts. ConclusionForegoing bowel preparation may have the potential to improve cost and reduce morbidity in children undergoing colostomy closure. Level of evidenceIII. Study typeTreatment study.

Colostomy closure in post Conflict Iraq

Background: Colostomy minimizes the risk of leakage at expense of requiring a second operation. In Iraq, published on colostomy closure in penetrating abdominal wall injuries is scarce.&#x0D; Objective: to Study the prognosis of colostomy closure in post-conflict patients in Iraq.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; J Fac Med Baghdad 2018; Vol.60, No.3 Received: June, 2018 Accepted: Oct., 2018&#x0D; Published: Dec.2018&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Method: This is a retrospective study of 52 patients subjected to colostomy closure, recruited for the period 2008 to 2009 from Al-Yarmouk Teaching Hospital and Children Central Teaching Hospital. Demographic data and information about colostomy (type, methods of preparation … etc.) were studied.&#x0D; Results: Trauma was noticed in 57.7% patients. Transverse colon was the commonest site of injuries. The complications were wound infection (19.2%), fecal fistula (3.8%), anastomotic leak (1.9%) and abdominal abscess (1.9%). A significant high complication rate was associated with conventional method of preparation, and double layer anastomosis (p = 0.004 rand 0.003, respectively).&#x0D; Conclusion: the finding were comparable with other centers in the world.

غلق فغر القولون في عراق ما بعد الازمة

Background: Colostomy minimizes the risk of leakage at expense of requiring a second operation. In Iraq, published on colostomy closure in penetrating abdominal wall injuries is scarce. Objective: to Study the prognosis of colostomy closure in post-conflict patients in Iraq. J Fac Med Baghdad 2018; Vol.60, No.3 Received: June, 2018 Accepted: Oct., 2018 Published: Dec.2018 Method: This is a retrospective study of 52 patients subjected to colostomy closure, recruited for the period 2008 to 2009 from Al-Yarmouk Teaching Hospital and Children Central Teaching Hospital. Demographic data and information about colostomy (type, methods of preparation … etc.) were studied. Results: Trauma was noticed in 57.7% patients. Transverse colon was the commonest site of injuries. The complications were wound infection (19.2%), fecal fistula (3.8%), anastomotic leak (1.9%) and abdominal abscess (1.9%). A significant high complication rate was associated with conventional method of preparation, and double layer anastomosis (p = 0.004 rand 0.003, respectively). Conclusion: the finding were comparable with other centers in the world.

Application of modified purse-string closure in the wound following loop stoma reversal

To compare the safety and feasibility between modified circumferential purse-string closure and conventional primary linear closure of the wound following loop stoma reversal. Clinical data of 88 consecutive patients who underwent loop colostomy or loop ileostomy closures at our hospital from July 2011 to June 2013 were retrospectively analyzed. Among them, 43 cases underwent modified purse-string technique (modified purse-string group), 45 cases underwent direct suture (direct suture group). The operation method of modified purse-string suture was as follows: (1) the circumferential subcutaneous adipose tissue was sutured with the absorbable suture, avoiding tightening at knotting and retaining a 1 cm pore;(2)absorbable suture was used to perform purse-string suture of the dermis, retaining a 0.5 cm central pore when knotting; (3) a rubber drain was placed through the pore. The clinical parameters, surgical results and postoperative complication of two groups were recorded and compared. There were 56 males and 32 females with age of (65.0±11.5) years old. Seventy-nine cases were malignant tumors, 6 were benign tumors and 3 were traumatic. There was no significant difference in the baseline data between two groups (all P>0.05). Compared with the direct suture group, the modified purse-string group had significantly lower wound infection rate [7.0%(3/43) vs. 24.4%(11/45), χ²=5.015, P=0.025]; significantly shorter postoperative hospital stay (mean 7.1 days vs. 8.6 days, t=-2.656, P=0.010); significantly lower total hospitalization costs (mean 25 668.4 yuan vs. 27 718.1 yuan, t=-2.488, P=0.015); however, the wound healing time of the modified purse-string group was significantly longer (mean 22.0 days vs. 13.0 days, t=5.701, P<0.001). The average healing time of the wounds in the direct suture group was 29.8 days, which was significantly longer than that of the first-stage healing cases (7.5 days, t=-15.446,P<0.001). The average wound healing time of the infected cases in the modified purse-string suture group was 22.0 days, compared with 22.1 days in the first-stage healing cases, the difference was not statistically significant(t=0.077,P=0.943). Modified purse-string closure after loop stoma reversal is an appropriate technique with lower stoma site infection rate, shorter postoperative hospital stay and lower hospitalization cost than conventional primary closure, although wounds may take longer to heal in this approach.

غلق فغر القولون في عراق ما بعد الازمة

غلق فغر القولون في عراق ما بعد الازمة

Decision Making in Colostomy Closure

Decision Making in Colostomy Closure

Altered expression of KCNG3 and KCNG4 in Hirschsprung's disease.

Voltage-gated potassium ion channels have long been implicated in gastrointestinal motility. Recent studies have highlighted the role of voltage-gated channel subfamily G member 3 (KCNG3) and 4 (KCNG4) genes in the electrical functioning of interstitial cells of Cajal and PDGFRα+ cells of the mouse colon. We designed this study to investigate KCNG3 and KCNG4 expression in the normal human colon and in Hirschsprung's disease (HSCR). HSCR tissue specimens (n = 6) were collected at the time of pull-through surgery, while control samples were obtained at the time of colostomy closure in patients with imperforate anus (n = 6). qRT-PCR analysis was undertaken to quantify KCNG3 and KCNG4 gene expression, and immunolabelling of KCNG3 and KCNG4 proteins was visualized using confocal microscopy. qRT-PCR analysis revealed significant downregulation of the KCNG3 and KCNG4 genes in both aganglionic and ganglionic HSCR specimens compared to controls (p < 0.05). Confocal microscopy revealed KCNG3 and KCNG4 expression within neurons, ICC and PDGFRα+ cells of the myenteric plexus and smooth muscle layers, with a reduction in both proteins in aganglionic and ganglionic HSCR colon compared to controls. KCNG3 and KCNG4 gene expression is significantly downregulated in HSCR colon, suggesting a role for these genes in colonic motility. KCNG3 and KCNG4 downregulation within ganglionic specimens highlights the physiologically abnormal nature of this segment in HSCR patients.

Abnormal Scn1b and Fxyd1 gene expression in the pulled-through ganglionic colon may influence functional outcome in patients with Hirschsprung's disease.

Smooth muscle cells are electrically coupled to ICC and PDGFRα+ cells, to regulate smooth muscle contraction. Recent studies have reported that the voltage-gated sodium channel type 1β (Scn1b), and the chloride channel subunit, Fxyd1, are highly expressed by both ICC and PDGFRα+ cells in the mouse colon. We designed this study to investigate the expression of the Scn1b and Fxyd1 genes in the normal human colon and in HSCR. HSCR tissue specimens (n = 6) were collected at the time of pull-through surgery, while control samples were obtained at the time of colostomy closure in patients with imperforate anus (n = 6). qRT-PCR analysis was undertaken to quantify Scn1b and Fxyd1 gene expression, and immunolabelling of Scn1b and Fxyd1 proteins were visualized using confocal microscopy. qRT-PCR analysis revealed significant downregulation of Scn1b and Fxyd1 genes in both aganglionic and ganglionic HSCR specimens compared to controls (p < 0.05). Confocal microscopy revealed a reduction in Scn1b and Fxyd1 protein expression in both aganglionic and ganglionic HSCR colon compared to controls. Scn1b and Fxyd1 expression was significantly downregulated in HSCR colon. These results add to mounting evidence suggesting that the pulled-through ganglionic segment of bowel in these patients is abnormal, despite the presence of ganglion cells.

The midterm outcomes of 1-stage versus 3-stage laparoscopic-assisted anorectoplasty in anorectal malformations with rectoprostatic fistula and rectobulbar fistula: A retrospective cohort study.

The aim of this study was to compare the midterm outcomes of 1-stage and 3-stage surgical procedures to treat anorectal malformations (ARMs) with rectoprostatic and rectobulbar fistula using laparoscopic-assisted anorectoplasty (LAARP).A total of 56 patients with ARMs and rectoprostatic and rectobulbar fistula who underwent LAARP from January 2011 to May 2014 in our institution were included in the study. They were divided into 2 groups according to the stage of procedure. The patients’ data and postoperative complications were compared between the 2 groups. The Krickenbeck classification was used for assessing the bowel functions.About 20 ARM newborns (rectoprostatic fistula [12], rectobulbar fistula [8]) successfully underwent a 1-stage LAARP, and about 36 ARM children (rectoprostatic fistula [20], rectobulbar fistula [16]) underwent a 3-stage LAARP (colostomy, LAARP, and closure of colostomy). The average age at the LAARP procedure in 1-stage group was significantly lower than that in 3-stage group (39.8 ± 8.1 hours vs 4.9 ± 1.2 months; P = .00). The average operative time during the definitive procedure was 132.2 ± 15.9 minutes in the 1-stage group and 120.5 ± 12.7 minutes in the 3-stage group (P = .13). There was only 5 to 10 mL of blood loss during the LAARP procedure both the groups (P = .75). There were no significant differences between the 2 groups in postoperative hospital stay during the definitive procedure (10.2 ± 2.3 days vs 8.5 ± 2.2 days; P = .22). The rate of surgical site infection and dehiscence was 5% (1/20) in the 1-stage group and 5.6% (2/36) in 3-stage group (P = 1.00). During the period of follow-up, the rate of voluntary bowel movement was 90% (18/20) in 1-stage group and 94.4% (34/36) in 3-stage group (P = .94). Free from soiling or grade I soiling was 80% (16/20) in 1-stage group and 83.3% (30/36) in 3-stage group (P = 1.00); grade II soiling was found in 3 (10%) patients in 1-stage group and 85.7% in 3-stage group (P = .75); grade III soiling was found in 3 (10%) patients in 1-stage group and 85.7% in 3-stage group (P = 1.00). Three patients (15%) in 1-stage group and 5 patients (13.9%) in 3-stage group suffered from grade I constipation (P = 1.00); while 3 (15%) patients in 1-stage group and 4 patients (11.1%) in 3-stage group had grade II constipation (P = 1.00); no patients in the 2 groups suffered from grade III constipation.The 1-stage LAARP procedure for neonate with rectoprostatic and rectobulbar fistula can achieve comparable midterm outcomes as the conventional 3-stage LAARP procedure. It provides an alternative method to rectify the ARMs with rectoprostatic fistula and rectobulbar fistula without colostomy.

Abstract 673: Preoperative radiation therapy in advanced carcinoma colon with post-colostomy intestinal obstruction: The first report

Abstract Introduction We report the use of preoperative radiotherapy in a moribund patient with advanced carcinoma colon with complete intestinal obstruction who had undergone colostomy for a previous episode of intestinal obstruction. Methods Fifty-five-year-old man presented in Dec 2016 with acute intestinal obstruction with pain in abdomen and vomiting for 3 months. On exploratory laparotomy, a 12x15 cm hard mass in splenic flexure of colon was found involving root of mesentery, superior mesenteric vein and third part of duodenum and abutting tail of pancreas. Finding it unresectable, loop transverse colostomy was performed. He was started on Capecitabine. In Mar 2017, he presented to us in emaciated condition weighing 28 kilograms with acute intestinal obstruction with a large abdominal mass. He was started on nasogastric aspiration with total parenteral nutrition. Imaging revealed a 14x19 cm large abdominal mass involving pancreas, duodenum, spleen and transverse colon with dilated stomach. In view of poor general condition and advanced disease, the prognosis was discussed with the family and the idea of radiotherapy to relieve intestinal obstruction was discussed with family. After taking the consent, he was started on radiation therapy with 1.8 Gy per fraction after three-dimensional conformal radiation planning to spare maximum bowel. After 11 fractions, the patient started passing stools through the stoma. He was gradually started on enteral nutrition and was discharged to continue radiation therapy on outpatient basis. After 15 fractions, planning PET-CT scan was taken for adaptive therapy to make changes as per the reducing tumor size. He was also started on capecitabine as he was taking orally well. He completed 45 Gy in 25 fractions over 5 weeks. One month after completion of radiation therapy, he was found to be doing well and was planned for definitive surgery. Six weeks after the radiation therapy completion, extended left hemicolectomy with distal pancreatico-splenectomy and colostomy closure was performed. Histopathology showed residual viable poorly differentiated adenocarcinoma invading full thickness of colonic wall into pericolic soft tissues with a discontinuous microscopic nodular tumor deposit in pericolic soft tissue with all margins and nodes negative. Postoperatively, he developed biliary leak which healed with conservative management. Six weeks after the surgery, he recovered completely and was started on adjuvant Capecitabine. Five months after the surgery, he is doing well and is on oral Capecitabine. Conclusion To our knowledge, this is the first reported case of preoperative radiation therapy in advanced carcinoma colon and also in the setting of intestinal obstruction. Radiotherapy should be further tested in setting of malignant intestinal obstruction due to unresectable carcinoma colon and may spare patients with ileo/colostomy. Citation Format: Amit Jain, Elumalai L, Punam Goswami. Preoperative radiation therapy in advanced carcinoma colon with post-colostomy intestinal obstruction: The first report [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 673.

Colonic atresia associated with imperforate anus in a patient with down syndrome, expect the unexpected

Abstract We are describing an extremely rare clinical case of two congenital anomalies coexist simultaneously in a full term 18 months-old girl, known down syndrome with imperforate anus. She underwent PDA closure and divided diverting colostomy at the neonatal period. She had multiple history of pediatric intensive care unit (PICU) admissions due to recurrent bronchial asthma exacerbation and aspiration pneumonia. She presented to the Emergency Department at the age of 14 months with 4 days history of abdominal pain, biliouse emesis, urine retention and scant stoma out-put. On Physical examination, the proximal stoma was patent and functioning well after saline irrigation. Palpable non tender central abdominal mass was found. Radiological investigations revealed a markedly distended rectal pouch extending up to mid abdomen, hydrocolpus was excluded. Exploratory midline laparotomy showed colonic atresia at sigmoid distal to the mucus fistula which was not noticed before. Patient is still awaiting PSARP and closure of colostomy once her general condition improves. Imperforate anus associated with colonic atresia is an extremely rare anomaly with a very few number of cases had been reported in the literature. Being aware of such coexistence might minimize the need for a second laparotomy.

Psychometric validation of the Stoma-QOL questionnaire in a Canadian cross-sectional sample of colostomy and ileostomy patients

Objectives: The Stoma-QOL questionnaire is a patient-reported outcome (PRO) used to measure quality of life in patients with ileostomy or colostomy. This study assesses the Stoma-QOL’s overall and item-level psychometric characteristics in patients with temporary stomas, and whether stoma-related quality of life differs by demographic characteristics.Materials and methods: Analysis of cross-sectional observational PRO data from hospitals in Vancouver, Canada. Patients registered for elective ileostomy or colostomy closure, over the age of 18, and able to read English were eligible for participation. Emergent and cancer-related cases were excluded. One-way analysis of variance was used to test for demographic differences in Stoma-QOL scores. Cronbach’s alpha was used for reliability, and Rasch item-response theory was used to assess overall and item characteristics.Results: 120 patients were included. No statistically significant difference in Stoma-QOL scores was found by age, sex, or socioeconomic status. Reliability was 0.93. Mean item responses ranged from 1.77 to 3.55 and item-total correlation ranged from 0.51 to 0.77. The Rasch item-response theory model demonstrated significant misfit, likely due to the misfit of item 9, which asks about sexuality, and high residual correlations between item pairs 6 and 8 about fatigue, and items 16 and 17 about social relationships.Conclusions: The Stoma-QOL questionnaire is a well-designed PRO for measuring stoma-related quality of life. Demographic variables do not appear to have a strong influence on Stoma-QOL scores. Item 9 demonstrated misfit but removal likely does not improve the instrument. Future research should focus on revising items 6, 8, 16, and 17.

Colostomy Closure in Pediatric Age Group: Analysis Of Out Come in Single Center Experience

Background: Closure colostomy is a common procedure in the pediatric surgical practice, considered a major one because it involves anastomosis of the large bowel, and requires strict bowel preparation and prophylactic antibiotics. It’s the last event in the management of some pediatric surgical conditions, as Hirschsprung’s disease and anorectal malformations.Objectives: To evaluate the complications of colostomy closure in pediatric patients.Patients and methods: A total of 106 patients underwent colostomy closure were enrolled in this prospective study conducted in Welfare Teaching Hospital in Medical City Complex, from October 2015 to January 2017, were reviewed looking for complications following closure colostomy. Data were collected including age, gender, indication of colostomy, type and location of colostomy, presence of stoma complication, and presence of associated anomalies. Details of colostomy closure, including pre-operative, intra-operative and post-operative variables were recorded.Results: Of 106 patients included, there were 38(35.8%) females and 68(64.2%) males, with an average age of 2.4 years. Indications for colostomy were Hirschsprung’s disease 58(54.7%) and anorectal malformations 48(45.3%). The site of colostomy was transverse colon 54(50.9%), and sigmoid colon 52(49.1%). The type of colostomy was divided 8(7.5%) and loop 98(92.5%). Forty-eight patients (45.3%) developed complications; the most common being wound infection 30 (28.3%), followed by fecal fistula 6 (5.7%), wound dehiscence 4 (3.8%), adhesive intestinal obstrution 4 (3.8%) and incisional hernia 4 (3.8%).Conclusion: Closure colostomy is a high morbidity procedure. With morbidity rate of 45.3%, the highest complications were wound infection.Keywords: Hirschsprung’s disease (HD), Anorectal malformation (AM)&#x0D; غلق كولوستومي : تحليل النتائج في مركز منفرد&#x0D; الاستاذ المساعد الدكتور حسن كريم كاطع &#x0D; خلفية: عملية غلق فغر القولون هي عملية شائعة في مجال عمل جراحة الاطفال، وتعتير عملية كبرى لانها تتضمن ربط الامعاء الغليضة ببعضها, وتحتاج قبلها الى تحضير للامعاء مع مضادات حيوية وقائية. وهي الحدث الاخير في علاج بعض حالات جراحة الاطفال، والتي تتطلب اجراء عملية فغر القولون كخطوة اولى في علاجها, مثل شلل القولون الولادي والتشوهات الشرجية الولادية &#x0D; هدف الدراسة: لتحديد مضاعفات عملية غلق فغر القولون.&#x0D; المرضى وطريقة العمل: في دراسة مستقبلية اقيمت في مستشفى حماية الاطفال/مدينة الطب ، والتي شملت 106 مريض خضعوا لعملية غلق فغر القولون للفترة من تشرين الاول 2015 الى كانون الثاني 2017، لغرض البحث عن حدوث مضاعفات بعد هذه العملية. البيانات المدروسة جمعت من ملفات دخول المرضى فيما يخص العمر، الجنس،الحالة الموجبة لعملية فغر القولون، نوع وموقع فغر القولون، وجود مضاعفات لفغر القولون، وجود تشوهات وامراض مصاحبة للتشخيص الاولي للمريض، بالاضافة الى تفاصيل عملية غلق فغر القولون فيما يخصمتغيرات قبل ، اثناء و بعد العملية. &#x0D; النتائج: من بين 106 مريض تمت دراسة 38 انثى و 68 ذكر، مع معدل عمر 2،4 سنة، موجبات عملية فغر القولون كانت 58 حالة شلل القولون الولادي، 48 حالة تشوهات الشرج الولادية، موقع فغر القولون كان القولون المستعرض في 54 حالة، و القولون السيني في 52 حالة، نوع فغر القولون كان فغر قولون منفصل في 8 حالات و فغر قولون عقدي في 98 حالة. ثمانية واربعون مريضا عانوا من مضاعفات، اكثرها شيوعا كان التهاب الجرح في 30 حالة بنسة 28،3%، تبعها ناسور الامعاء في 6 حالات بنسة 5،7%، تفزر الجرح في 4 حالات بنسبة 3،8%، انسداد الامعاء التلاصقي في 4 حالات بنسبة 3،8% و الفتق الجراحي في 4 حالات بنسبة 3،8% &#x0D; الاستنتاج: عملية غلق فغر القولون هي عملية ذات نسبة مضاعفات عالية، اكثرها كان التهاب الجرح. لم تسجل وفيات خلال الدراسة. وجد ان نسبة المضاعفات مع مرض شلل القولون الولادي كانت اكثر من حالات تشوهات الشرج الولادية. فغر القولون العقدي للقولون المستعرض سجل خطورة عالية. كما وجد ان تحضير الامعاء(غسل الامعاء) قبل عملية غلق فغر القولون مع اعطاء المضادات الحيوية الوقائية تقلل المضاعفات بعد العملية. من العوامل المسجلة والمأثرة على تكوين المخاطر هو عدم توافق حجم الامعاء اثناء غلق القولون. كما وجد ان خياطة الامعاء بطبقة واحدة اثناء عملية الغلق تعطي نتائج افضل. &#x0D; مفتاح الكلمات: HD- شلل القولون, AR M, تشوة المقعد والمستقيم

Colostomy Closure in Pediatric Age Group: Analysis Of Out Come in Single Center Exp erience

Background: Closure colostomy is a common procedure in the pediatric surgical practice, considered a major one because it involves anastomosis of the large bowel, and requires strict bowel preparation and prophylactic antibiotics. It’s the last event in the management of some pediatric surgical conditions, as Hirschsprung’s disease and anorectal malformations.Objectives: To evaluate the complications of colostomy closure in pediatric patients.Patients and methods: A total of 106 patients underwent colostomy closure were enrolled in this prospective study conducted in Welfare Teaching Hospital in Medical City Complex, from October 2015 to January 2017, were reviewed looking for complications following closure colostomy. Data were collected including age, gender, indication of colostomy, type and location of colostomy, presence of stoma complication, and presence of associated anomalies. Details of colostomy closure, including pre-operative, intra-operative and post-operative variables were recorded.Results: Of 106 patients included, there were 38(35.8%) females and 68(64.2%) males, with an average age of 2.4 years. Indications for colostomy were Hirschsprung’s disease 58(54.7%) and anorectal malformations 48(45.3%). The site of colostomy was transverse colon 54(50.9%), and sigmoid colon 52(49.1%). The type of colostomy was divided 8(7.5%) and loop 98(92.5%). Forty-eight patients (45.3%) developed complications; the most common being wound infection 30 (28.3%), followed by fecal fistula 6 (5.7%), wound dehiscence 4 (3.8%), adhesive intestinal obstrution 4 (3.8%) and incisional hernia 4 (3.8%).Conclusion: Closure colostomy is a high morbidity procedure. With morbidity rate of 45.3%, the highest complications were wound infection.Keywords: Hirschsprung’s disease (HD), Anorectal malformation (AM)&#x0D; غ

Can mechanical bowel preparation with oral antibiotics reduce surgical site infection and anastomotic leakage rates following elective colorectal resections?

Background: Surgical site infection(SSI) and anastomotic leakage are major causes of morbidity after colorectal resections. Mechanical bowel preparation (MBP) combined with oral antibiotics (OAs) was considered to reduce SSI and anastomotic leakage. Purpose: This study analyzed the influence of oral antibiotic use together with MBP on SSI, anastomotic leakage rate and length of hospital stays in patients with elective colorectal surgery. Materials and Methods: From January 2013 to December 2015, 321 patients who underwent elective colorectal resections with complete bowel preparation were included in the study. All patients received MBP. Patients in group A did not receive OAs, whereas patients in group B received OAs. Exclusion criteria were emergent operation, colonoscopy, colostomy or closure of colostomy and received preoperative chemoradiotherapy. The outcome measured was SSI, anastomotic leakage and prophylactic colostomy. Results: Of 321 patients, group A (n =122) and group B (n =199), both groups had similar age, gender, localization and stage of the disease, underlying disease, prophylactic stomy and operation time. Patients receiving OAs with MBP didn't demonstrated a lower rate of SSI and lower leakage rate after multivariate logistic analysis. Conclusions: OAs with MBP prior to elective colorectal resection was no better than MBP only on reducing SSI and anastomotic leakage rates. And OAs will increase patients uncomfortable and GI function side effect. Therefore, MBP alone might be enough colon prepare and higher compliance for the patients.

Child with dilated cardiomyopathy for colostomy closure: Anesthesia considerations

Perioperative management of a patient with dilated cardiomyopathy (DCM) is challenging for an anesthetist in view of depressed function of myocardium, ventricular enlargement, risk of perioperative arrhythmia, and sudden cardiac death. Preoperative assessment, optimization of medical condition with drug therapy, and appropriate anesthesia management help in better perioperative outcome. Here, we discuss successful perioperative management of DCM in a child scheduled for colostomy closure under general and epidural anesthesia.

Reversal of Hartmann's procedure: still a complicated operation.

Hartmann's procedure, colonic resection with an end colostomy and rectal closure, is used in a variety of surgical emergencies. It is a common surgical procedure that is often practiced in patients with colonic obstruction and colonic perforation, resolving the acute clinical situation in the majority of cases. Reversal of Hartmann's procedure with restoration of bowel continuity occurs in a significantly low percentage of patients. There are several reasons contributing to the fact that many patients remain with a permanent colostomy following Hartmann's procedure. These include factors related to the patients' clinical status but also to the significant difficulty and morbidity related to the surgical reversal of Hartmann's procedure. The aim of this study was to review the factors related to the fairly low percentage of patients undergoing Hartmann's reversal as well as surgical techniques that could help surgeons restore intestinal continuity following Hartmann's procedure and deal with the postoperative outcomes.

Retained Intra-Abdominal Hemostatic Materials: A Rare Cause of Abscess, Intestinal Obstruction, and Intestinal Fistula

Background: A retained intra-abdominal surgical sponge is always followed by foreign body granuloma and serious complications such as perforation, intra-abdominal abscess, intestinal obstruction, and intestinal fistula. Hemostatic materials have become increasingly popular and are used to control intra-abdominal hemorrhage, remaining in the abdominal cavity after surgery. Usually there are no symptoms in patients who have retained hemostatic materials because these materials are bioabsorbable and cause no harm. However, if the body fails to absorb the hemostatic materials completely, the retained materials will cause the same problems as the gossypiboma does. Case Presentation: We report a 37-year-old male who underwent emergency surgery because of closed abdominal trauma, rectum rupture, and intra-abdominal hemorrhage after an automobile accident. Partial rectectomy with sigmoid stoma was performed, however, the hemostatic materials used during the emergency surgery became calcified and caused damage to the intestine, leading to severe post-operative complications including intra-abdominal abscess, intestinal obstruction, and intestinal fistula. The patient was then transferred to our hospital and cured after the removal of the foreign bodies, resection of the terminal ileum fistula with anastomosis, and colostomy closure. Conclusions: Surgeons need to be cautious when leaving hemostatic materials in the abdominal cavity even if they are bioabsorbable.

Temporary closure of colostomy with suture before colostomy takedown improves the postoperative outcomes

PurposeTemporary loop colostomy is a common surgical procedure used to avoid complications in high-risk distal anastomosis as well as pelvic inflammation. Issues regarding postoperative outcomes of colostomy takedown have been widely discussed in the literature, wound infection especially. Temporary closure of colostomy with suture before takedown was adopted in our study, which provided excellent traction to aid mobilization of stomy and avoided stool spillage to downgrade the wound classification to “clean contamination.” We aimed to determine the effects of the procedure on postoperative outcomes.MethodsThis was a prospective case-control study at a single tertiary medical center. Patients presenting for elective colostomy takedown were included. Allis clamp (n = 50) or silk suture (n = 60) was applied to mobilize the colostomy, and results were compared. Operative time and wound infection rate were measured as primary postoperative outcomes. Univariate and multivariate analyses were used to demonstrate the association between the two groups and outcomes.ResultsIn univariate analyses, significantly shorter operative time (median = 57 min, p = 0.003) and lower postoperative wound infection rate (3%, p = 0.03) were noted in the group receiving silk suture. Multivariate analyses results showed that silk suture was significantly associated with both operative time (B = − 8.5, p = 0.01) and wound infection (odds ratio = 0.18, p = 0.04).ConclusionWith the advantage of enhancing traction and decreasing contamination, the temporary closure of colostomy with suture improved takedown outcomes, including a shorter operative time and lower wound infection rate.

A Case of Proximal Colon Bowel Volvulus after Low Anterior Resection for Rectal Cancer

Colonic volvulus is responsible for 4–5% of all cases of intestinal obstruction and most often found in the sigmoid colon, in elderly patients with chronic constipation, where patients develop a large redundant sigmoid colon and with a violation of diet. Twisting and compression of mesenteric blood vessels leads to disruption of intestinal wall nutrition followed by necrosis. Most cases of volvulus require the surgical treatment. Abdominal radiography (barium enema, MSCT) is frequently obtained as the initial diagnostic imaging and has characteristic appearances. We present a case of MRI diagnosis of the colon volvulus after the closure of the transverse loop colostomy after low anterior resection for rectal cancer. The cause of the volvulus was the twisting of the mobilized part of colon with the mesentery when it was lowered into the pelvis. The protective transverse loop colostomy caused the absence of clinical manifestations. After its closure patient was present the clinical features of bowel obstruction and the appearance of MR symptoms typical for this pathology. A retrospective analysis of MR tomograms obtained before the closure of the transverse loop colostomy, allowed revealing of signs of its subclinical ischemia. This case demonstrates the possibilities of MRI in identifying both the typical symptoms of colon volvulus and the signs indicating the possibility of colon twisting in patients after low anterior rectal resection, examined before closing the transverse loop colostomy.