Colostomy Group Research Articles

The effect of diverting colostomy on anastomotic healing after resection of left colon obstruction

A standardized stenosis of the left colon was created in the rat model. After four days the stenosis was resected and a primary anastomosis made. Half of the animals (n = 21) were randomized to a proximal diverting colostomy and the other half to a non-colostomy control group. On postoperative days two and seven anastomotic complications were recorded and anastomotic strength was determined. Collagen content in the anastomotic area was measured. In the colostomy group no anastomotic complications occurred, while 6/21 (29%) animals in the non-colostomy group had complications. On day two there was no difference between the groups as regards anastomotic strength and collagen content. After a week, however, the control group showed a significant increase in both anastomotic strength and collagen content which was not observed in the colostomy group. The absence of increase in anastomotic strength in the colostomy group had no adverse effect on anastomotic healing, as judged by complications. Thus, a diverting colostomy may be of value in reducing anastomotic complications after resection of a left colon obstruction.

Penetrating Colon Injuries

Eighty-five patients with penetrating colon injuries, treated either by exteriorized repair (39) or loop colostomy (46), were analyzed. Missile wounds accounted for 75.3% of the injuries. The Penetrating Abdominal Trauma Index (PATI) was the scoring method employed to assess quantitatively the severity of injuries in each patient. Of 21 patients with right colon injuries, eight were treated by exteriorized repair and the remainder by loop colostomy. PATI and other variables were comparable in both groups. Suture line leaks occurred in two patients (25%) with exteriorized repair. The morbidity was similar in both groups. In left colon trauma, exteriorized repair was employed in 31 patients and 33 underwent loop colostomy. The injury severity indices, clinical status, and time lapse to laparotomy were similar in both groups. Colostomy was avoided in 67.7% (21 of 31) patients with exteriorized repair. The incidence of abscesses was significantly higher in the colostomy group compared to the group treated by exteriorized repair (24.2% and 6.4%, respectively; p less than 0.05). The length of hospital stay was shorter after exteriorized repair (17.2 days vs. 23.2 days; p less than 0.05). All three mortalities (3.5%) were related to associated injuries. We conclude that exteriorized repair is a safe and superior alternative to loop colostomy in penetrating colon trauma.

An ideal operation for diverticulitis of the colon

A review has been made of the records of 208 patients operated on for complications of diverticulitis of the colon. One hundred forty patients had emergency operations and 68, elective operations. Resection and anastomosis, with or without temporary diverting colostomy, practiced in the majority of emergency cases in the earlier years covered in this review, has been replaced in the past 10 years by resection without anastomosis. Transverse colostomy, first carried out as part of a three-stage procedure, has been partially replaced by descending colostomy in the past few years. A comparison of the findings at exploration in patient who underwent resection, anastomosis, and temporary transverse colostomy with the findings in those who had the Hartmann procedure showed a slightly higher incidence of free perforation or abscess in those who had the former procedure. The hospital stay was similar in the two groups, but time in the operating room and days of disability were much less in the resection group. Only 14 of the 23 patients who survived the Hartmann procedure underwent restoration of continuity, whereas all of those in the resection group did. Follow-up of the patients who had descending colostomy showed that only 6 of 11 surviving patients underwent resection and anastomosis, but that inflammation regularly subsided, and all those with continent sphincters under age 80 eventually had restoration of continuity. This is in contrast to a more than 20 percent incidence of permanent stomas in the transverse colostomy group, all of which were in patients under age 70.

Results of psychosocial adjustment to long-term colostomy.

114 patients with permanent colostomy for carcinoma of the rectum were compared by questionnaire and interview with 110 cancer patients, having undergone colonic resection but not bearing a colostomy. The patients' own assessment of their health was for the colostomy group even better than for the controls. The emotional state before and after surgery showed significant degrees of hopelessness, depressions and fear especially for young women awaiting colostomy. Social contacts were considered as far as visits of friends or cinema, theatre are concerned. Sexual activity decreased significantly for 75% of colostomized men. In 40% organic lesions led to impotence. The Giessen test revealed significant rates of social impotence, negative social resonance and depression for men with colostoma.