Colostomy Procedures Research Articles

Long-term assessment of functional outcome in operated cases of Hirschsprung disease

Background: Hirschsprung disease (HD) is a rare congenital anomaly (1 in 5000 live births) characterized by varying levels of aganglionosis. The evolution of surgical options and outcomes for the successful management of HD has been driven by the aspiration of pediatric surgeons. Hirschsprung's disease postoperative results of pull-through procedure could be influenced by surgical and pathological proficiency and the quality of perioperative care. Controversies persist as to which technique offers the best outcome. The absence of incontinence and constipation remains the most important marker of a good outcome. Methods: Medical records of HD children who underwent temporary colostomy procedures were analyzed retrospectively from July 2017 to June 2021. Risk factors were evaluated to determine the outcome of HD procedures. Results: Ninety-two HD patients were included. Based on the univariate analysis, most patients in the study (58.7%) were between the ages of 2 and 12 months. The study population predominantly consisted of males (68.5%) who had low vegetable intake (65.2%) and occasionally exhibited stool stains (66.3%), but their stool consistency was mainly normal (47.8%). Further examination through bivariate analysis revealed a significant negative correlation between stool stains and SOAVE (name of the condition). Similar findings were observed for stool consistency, indicating a significant correlation. Consequently, both variables were subjected to multivariate analysis. The multivariate analysis demonstrated a significant association between stool consistency and SOAVE among patients aged 2-12 months (p=0.000, OR =2.044E-7) and those aged 1-5 years (p=0.000, OR =2.044E-7). An odds ratio (OR) value of less than 1 implies that individuals with normal stool consistency have a lower likelihood of experiencing SOAVE at a young age. Conclusions: This study showed that children with HD correlated with low daily vegetable intake. Normal feces were associated with higher SOAVE ages and a lower possibility of experiencing SOAVE at a young age.

Standardized one-day evaluation before urinary reconstructive surgery for neurogenic lower urinary tract dysfunction: Feasibility and impact on surgical strategy and care pathway.

To describe a concept of standardized preoperative one-day evaluation before urinary reconstructive or diversion surgery for the treatment of neurogenic lower urinary tract (LUT) dysfunction, and to evaluate its feasibility and its impact on the care pathway. All patients who underwent a one-day standardized evaluation before a urinary reconstructive or derivation surgery for the treatment of neurogenic LUT dysfunction between January 2017 and December 2021 in our institution were included. Data were collected retrospectively from standardized reports. The main outcome was the rate of completion of the tests and consultations planned during this evaluation. Secondary outcomes included the findings from the one-day evaluation and changes in the urological surgical strategy at different time points within one year. One hundred and thirty-one patients benefited from this one-day standardized evaluation. The overall completeness rate of the data collected was 77.5%, increasing from 62.3% in 2017 to 89.3% in 2021. The urological surgical plan was modified for 19.1% of patients following this preoperative evaluation. The indication was then confirmed for 114 patients (87.0%) by the multidisciplinary meeting and was carried out unchanged during the following year for 89 patients (67.9%). An associated colostomy procedure was proposed for 18.3% of patients and was finally performed in 11.5%. A standardized multidisciplinary preoperative one-day evaluation before performing reconstructive or diversion surgery for the treatment of neurogenic LUT dysfunction seems feasible and makes it possible to optimize the surgical plan and adapt the course of care.

Quality of life in ostomy patient.

Background: The patient undergoing ostomy surgery experiences changes in multiple areas of their life related to their altered self-perception. In addition to potential postoperative complications, they face significant physical, physiological, psychological, and social changes that directly affect their physical and mental health. An ostomy is a process that saves thousands of lives every day and offers a second chance to patients suffering from diseases such as colorectal cancer, visceral perforation, diverticula, Crohn's disease, ulcerative colitis, and others. It involves redirecting a hollow viscus to the surface of the body in a location different from its natural opening, creating an opening on the surface of the body called a stoma, which diverts the intestinal transit. The patient will require a collecting bag for bodily waste. Currently, there are multiple investigations aimed at assessing the quality of life related to the health of patients who have undergone this surgical intervention, and the concerns they experience in their day-to-day lives. Therefore, this systematic review analyzed the literature in order to determine the perceived impact on quality of life related to health in ostomized patients. Material and methods: A systematic retrospective search was conducted in the following databases: PubMed (MEDLINE), TripDatabase, CINAHL, Cochrane Library, Google Scholar and PsycINFO. The MESH search terms used in this study were: Colostomy; Stoma; Ostomy; Ileostomy; Quality of life; Complications; Adaptations; Problems. Using the Boolean operators OR and AND. A total of 527 articles were obtained as a result, of which 17 articles met the inclusion criteria of this study. Results: A total of 9308 patients were studied, 55.65% of whom were men and 44.34% were women. 73.53% underwent colostomy procedures, while 24.15% underwent ileostomy, 76.28% maintained a permanent ostomy, and 20.93% had a temporary ostomy. Of the total number of studies evaluated, it was observed that ostomized patients had a clear alteration in quality of life in one or more of the analyzed variables. Conclusion: The quality of life of ostomy patients is severely impacted. Among the analyzed variables, the causes of this finding were: changes in body image, lack of control over bowel evacuation, unpleasant odors, unpleasant sounds, constipation, and leaks. The consequences of these findings were: disruptions in physical self-perception, psychological, social, and emotional alterations, low self-esteem, depressive feelings, changing clothing, difficulties traveling, social isolation, deterioration of the family role, and insecurity in managing their ostomy.

Endoscopic management of acute sigmoid volvulus in high risk surgical elderly patients: a randomized controlled trial

BackgroundMost patients with sigmoid volvulus are of old age with multiple comorbidities. So, the risk of surgery for those elderly patients is usually associated with increased rates of morbidity and mortality. Early intervention is required for managing sigmoid volvulus to avoid its serious complications; therefore, early endoscopic untwist of sigmoid colon can be performed followed by endoscopic fixation of sigmoid colon under sedation in this category of the patients to avoid development of high risk surgical complications following surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy procedure to relieve obstruction.MethodsThis prospective randomized controlled clinical trial included all patients who developed acute sigmoid volvulus and were referred to the Zagazig University Hospital Emergency Department between December 2020 and August 2022. The study was prospectively approved by Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 9989/23-10-2022) and was retrospectively submitted in http://clinicaltrials.gov in November 2022 (http://clinicaltrials.gov ID: NCT05620446). Included eligible patients were simply randomized at a 1:1 ratio to “Endoscopic Group (EG)” or “Surgical Group (SG)” via drawing of sealed envelopes containing computer-generated random numbers prepared by a third party before start of intervention.ResultsSample size included 18 patients divided into 2 equal groups. (1) Endoscopic group included 9 patients who were subjected to endoscopic untwist of sigmoid colon followed by endoscopic fixation of sigmoid colon under sedation; (2) Surgical group included 9 patients who were subjected to surgical fixation of sigmoid colon or sigmoidectomy after initial simple loop colostomy under general anesthesia. In comparison between both groups, there were statistically significant differences regarding length of hospital stay and procedure time. Unfortunately, there were no statistically significant differences regarding postoperative complications and co-morbidities. Eight patients in the endoscopy group demonstrated excellent quality of life, and one demonstrated good quality of life; unlike the surgical group, there were 3 patients with excellent quality of life, 5 patients with good quality of life, and 1 patient with poor quality of life. So there was statistically significant difference regarding quality of life between both groups. During the 9-month follow-up period, both groups demonstrated no cases of recurrence post-fixation.ConclusionEndoscopic management of acute sigmoid volvulus is effective and safe in elderly high risk surgical patients (either in managing the intestinal obstruction caused by volvulus or in definitive treatment of volvulus).

Characteristics, Hospital Length of Stay, and Readmissions Among Individuals Undergoing Abdominal Ostomy Surgery: Review of a Large US Healthcare Database.

The purpose of this study was to examine patient characteristics, length of stay (LOS), hospital revisits, and complications of patients undergoing abdominal ostomy surgery. Retrospective cohort study. Data were extracted from the PINC AI Healthcare Database (PHD), a large archive that stores data from 25% of all US inpatient hospital discharges. Patients were admitted to 658 hospitals in the United States between December 1, 2017, and November 30, 2018. The sample comprised 27,658 adult patients; 15,512 underwent creation of a colostomy, 10,207 underwent ileostomy construction, and 1930 had a urostomy procedure. Their median age was 64 years (interquartile range [IQR] = 19 years). Emergent admission type was 71.2% for patients who underwent a colostomy procedure, 49.4% for ileostomy, and 9.9% for urostomy. The majority of patients underwent open surgery (77.7%); 22.3% of procedures used an endoscopic approach. Patients were identified as having undergone abdominal ostomy surgery via ICD-10-PCS (International Classification of Diseases, Tenth Revision, Procedure Coding System) procedure codes. Demographic, visit, hospital and clinical characteristics, LOS, and hospital revisits (ie, readmissions and emergency department [ED]) were captured for qualifying patients. Data were evaluated using unadjusted descriptive analyses. The median LOS of 9 days (IQR = 9 days) varied by ostomy surgery; the cumulative postsurgical LOS was 7 days (IQR = 5 days). The most frequent underlying diagnoses resulting in ostomy surgery were diverticulitis of the large bowel (19.6%) managed by colostomy, colorectal cancer managed by ileostomy (22.5%), or urothelial cancer managed by urostomy (78.1%). Slightly less than a quarter (23.7%) of patients were discharged home without home care, 43.0% went home with home healthcare, and 29.6% were discharged to a non-acute care facility. Hospital readmission within 120 days of discharge was 36.3% for patients with a colostomy, 52.3% for those with an ileostomy, and 34.6% for patients with a urostomy. Ostomy complications were identified as the reason for readmission in 62.4% of patients. Slightly more than 1 in 5 patients (20.7%) had a subsequent ED visit within 120 days, 39.7% of which involved ostomy complication. Characteristics of patients undergoing abdominal stoma surgery varied based on underlying diagnosis and ostomy type. The median hospital LOS was more than 1 week. Patients experienced high rates of healthcare utilization (hospital admission or ED visits) during the 120 days following surgery.

Comparison of blowhole colostomy and loop ostomy for palliation of acute malignant colonic obstruction.

PurposeSurgery to create a stoma for decompression might be required for unresectable stage IV cancer patients with complete colonic obstruction. The aim of this study was to compare the results of blowhole colostomy with those of loop ostomy.MethodsPalliative ileostomy or colostomy procedures performed at a single center between January 2011 and October 2020, were analyzed retrospectively. Fifty-nine patients were identified during this period. The demographic characteristics and outcomes between the blowhole colostomy group (n=24) and the loop ostomy group (n=35) were compared.ResultsThe median operative time tended to be shorter in the blowhole colostomy group (52.5 minutes; interquartile range [IQR], 43–65) than in the loop ostomy group (60 minutes; IQR, 40–107), but the difference did not reach statistical significance (P=0.162). The median length of hospital stay was significantly shorter with blowhole colostomy (blowhole, 13 days [IQR, 9–23]; loop, 21 days [IQR, 14–37]; P=0.013). Mean cecum diameter was significantly larger in the blowhole group than in the loop group (8.83±1.91 cm vs. 6.78±2.36 cm, P=0.001), and the emergency operation rate was higher in the blowhole group than in the loop group (22 of 24 [91.7%] vs. 23 of 35 [65.7%], P=0.021).ConclusionIn surgical emergencies, diverting a blowhole colostomy can be safe and effective for palliative management of colonic obstruction in patients with end-stage cancer and might reduce the operative time in emergent situations.

Retrospective analysis of factors associated with emergency colostomy: an institutional experience

<p class="abstract"><strong>Background:</strong> Colostomy is one of the commonest lifesaving procedures done worldwide with an intention of either decompression of an obstructed colon or diversion of stool. This study tries to assess the pattern of emergency colostomy and factors associated with its complication in adult patients at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.</p><p class="abstract"><strong>Methods:</strong> Retrospective reviews of charts were done of all adult patients who underwent colostomy procedure from December 1, 2016 to May 30, 2019. </p><p class="abstract"><strong>Results:</strong> There were 149 adult patients that underwent colostomy procedure in the study period and the majorities were male (83.2%). Majority of the procedures were done for indication of LBO secondary gangrenous sigmoid volvulus (49%). The most common comorbidity identified were renal disease (5%) and diabetes mellitus (3%). All patients who presented with gangrenous sigmoid volvulus underwent end colostomy procedure and 16.8% of them died. Generally, 69 patients among 149 (46.3%) developed certain type of complication. Presence of complication was significantly associated with increased chance of death by eight times than those who had no complication after the procedure. End colostomy was significantly associated with development of complication when compared to loop colostomy. Among the study participants 87.9% of them were discharged improved. The main cause of death was multi organ failure secondary to septic shock, which accounted to 52.9% of all deaths.</p><p class="abstract"><strong>Conclusions:</strong> Gangrenous sigmoid volvulus, colorectal cancer and trauma were leading indications for colostomy. Presence of complication and type of colostomy were factors significantly associated with outcome.</p>

Loop colostomy to relieve debilitating chronic constipation in spina bifida patients: a case report

Introduction and importance: Spina bifida often results in neurogenic bowel dysfunction due to the loss of sensory and motor control of the gastrointestinal tract. This dysfunction further leads to the difficulty of emptying the bowel, resulting in constipation. Therefore, a complication of spina bifida is chronic constipation. Long-standing constipation greatly affects the quality of life. Chronic constipation leads to loss of social and work opportunities, causes severe discomfort, and increases the potential for several secondary complications such as hemorrhoids, anal fissures, and urinary incontinence. Several treatment measures can be considered to relieve chronic constipation in order to improve the quality of life of patients with spina bifida. Case presentation: The purpose of this report is to present a rare case of an adult patient with spina bifida who underwent a loop colostomy procedure as a treatment option for her debilitating chronic constipation symptoms. The patient’s chronic constipation and associated symptoms led to an immense decrease in quality of life. After several failed attempts at relieving constipation, a loop colostomy procedure was conducted. Clinical discussion: A loop colostomy is a surgical procedure leading to exteriorization of the colon. As seen in this case, a loop colostomy can be considered as a curative option for chronic constipation specifically in patients with spina bifida. The surgical procedure alleviated chronic constipation and its associated symptoms. Conclusion: Chronic constipation and associated symptoms in adult patients with spina bifida can be treated with a loop colostomy procedure. This procedure is an innovative and helpful option for these specific patients. The possibility of increased quality of life in patients with impairing symptoms makes the loop colostomy procedure an optimistic treatment option.

Tratamiento quirúrgico de la gangrena de Fournier

OBJETIVO:Describir el manejo quirúrgico realizado para la reconstrucción génitoperineal (RGP) en pacientes con secuelas de Gangrena de Fournier (GF). MATERIAL Y MÉTODOS:Corresponde a una serie de casos retrospectiva de pacientes con secuelas de GF a los que se les realizó RGP entre el 2011 al 2019. Se realizó un análisis descriptivo con las variables de técnica quirúrgica, edad, sexo, comorbilidades, subunidades anatómicas afectadas, origen anatómico de la gangrena de fournier, número de procedimientos quirúrgicos, procedimiento de colostomía, terapia de presión negativa, Flexi-Seal®, bacterias aisladas, duración de estancia hospitalaria, tipo de procedimientos reconstructivos y complicaciones. RESULTADOS:Se realizó RGP a 43 pacientes (81,1% masculinos), con un promedio de edad de 59,1 (17–86 años). 72,7% eran diabéticos. El número de subunidades involucradas se asocia directamente y significativamente en relación al número de intervenciones quirúrgicas. Las técnicas utilizadas para la reconstrucción en orden de frecuencia fueron: colgajos (23%), cierre parcial más injerto dermoepidérmico de grosor parcial (IPP) (20%), cierre parcial (16%) e IPP (16%), cierre por segunda intención (10%), colgajo más IPP (7%) y cierre parcial para cierre por segunda intención de zona restante (5%).DISCUSIÓN:La elección de reconstrucción se basa en las características del defecto, es decir, el tamaño, la ubicación y profundidad, así como la disponibilidad de tejido local. De preferencia optar por cierres primarios sin tensión, seguido de colgajos y de IPP.CONCLUSIÓN: La RGP es un desafío para el cirujano plástico. Las técnicas descritas han demostrado ser seguras y reproducibles para el tratamiento quirúrgico de la Gangrena de Fournier.

Evaluation of Complications of Colostomy in Children

Background and Aims This study aimed to evaluate the complications of colostomy and its management in children at tertiary care centre.Methods This descriptive observational study was conducted over a period of four years from February 2017 to January 2021. All the children below five years of age who underwent colostomy were included in the study. The demographic and clinical data on age at colostomy procedure sex clinical details indication for colostomy site type of colostomy complications of colostomy procedure morbidity and mortality due to the colostomy procedure were collected and analyzed.Results During our study period 38 children underwent colostomy procedure who had fulfilled our inclusion criteria. Among 38 children 23 60.5 children were of High Anorectal Malformations and 15 39.5 children were of Hirschsprungrsquos disease. Children who had anorectal malformation were younger and underwent colostomy in neonatal period mean 3 days plusmn 2.41 compared to those who had Hirschsprungrsquos disease who underwent colostomy procedure between one month to five years mean 6.8 months plusmn 3.55. There were 26 60.4 male and 12 31.6 female children with male to female ratio of 2.21. Complications related to colostomy procedure were seen in 28 73.7 children. Early complications like wound infection superficial wound dehiscence stoma necrosis and bleeding stoma were seen in 13 34.2 children whereas late complications like Peristomal skin excoriation Colostomy retraction Colostomy stenosis Colostomy prolapse Para colostomy hernia were seen in 15 39.5 children. Majority of complications 17 44.7 were seen in end colostomy made in Hirschsprungrsquos disease children. Systemic complications like sepsis pneumonitis was seen in early post-operative period in 8 21.1 children among which two 5.3 children succumbed due to severe sepsis and respiratory failure.Conclusions Although colostomy complications are common in children majority of the colostomy complications are prevented or minimized by good surgical technique education of parents on colostomy care and hygiene.

Outcomes after enterostomies in children with and without motility disorders: A description and comparison of postoperative complications

PurposeTo provide an overview of complications after ileostomy or colostomy procedures in children, and to compare outcomes between patients with gastrointestinal motility disorders (i.e. functional constipation, Hirschsprung’s disease, pediatric intestinal pseudo-obstruction (PIPO)) and children without motility disorders (including necrotizing enterocolitis, anorectal malformation and inflammatory bowel disease). MethodsWe performed a retrospective study of children who underwent an enterostomy procedure at our institution. The number and type of complications and subsequent reoperations after ostomy formation were determined. Complications were scored using the Clavien–Dindo classification. A complication of ≥ grade III-b was considered a high-grade complication. Results129 children with an ileostomy and 61 children with a colostomy were included. Of these, 62 children (32.6%) had motility disorders; functional constipation (n=40), Hirschsprung’s disease (n=18) and PIPO (n=4). The total prevalence of complications was 73.2%. Comparing the perioperative data, children with motility disorders significantly more often underwent a laparoscopic procedure (59.7% vs. 10.9%, p=0.000) and had an end stoma-configuration (37.1% vs. 14.1%, p=0.000) as compared to children without motility disorders. Children with motility problems had a higher complication rate (88.7% vs. 65.5%, OR 4.1, 95% CI 1.7–9.8, p=0.001) compared to children without motility problems, and a larger proportion of complications was classified as high-grade complications (61.8% vs. 31.0% p =0.002). ConclusionA high complication rate after enterostomy formation was detected. Children with gastrointestinal motility disorders had more and more severe complications as compared to children without motility disorders. Level of evidenceLevel III Type of studyRetrospective comparative study

Nutritional supplementation for vitamin B12 and vitamin K2 deficiency following ileostomy or colostomy formation

Most dietary vitamins and minerals are absorbed from the duodenal and jejunal sections of the small bowel. The exceptions are vitamin B12 and vitamin K2, which are absorbed from the terminal ileum and colon respectively. Patients who have undergone ileostomy or colostomy procedures are at risk of deficiency of these vitamins, with associated risk of developing anaemia and nervous system dysfunction (vitamin B12), and bone weakening and cardiovascular disease (vitamin K2). Patients should therefore be monitored for deficiency of these vitamins, which may develop over a protracted period of time. Patients lacking the terminal ileum or colon can still absorb supplemental vitamins B12 or K2 given orally, provided a sufficient loading dose is given to facilitate absorption from the remaining gastrointestinal tract.

Anorectal Malformations at a University Teaching Hospital in Southern Nigeria

Ano-rectal malformations comprise a wide spectrum of diseases, which can affect males and females, and involve the distal anus and rectum as well as the urinary and genital tracts. The incidence, type or variety of malformations varies from one region or geographical location to another. Ano-rectal anomalies tend to be associated with other congenital anomalies. The aim of this study is to determine the incidence, presentation and types of ano-rectal malformations and their treatment outcome. It is a prospective observational study from March 2012 to February 2019. Information obtained from cases of ano-rectal anomalies who presented to our health institution during the study period was entered into a proforma. Relevant clinical information was obtained and documented in a structured proforma. A total of 60 patients were seen during the study period. Males were 35 (58.3%) while females were 25 (41.7%). Age at presentation ranged from 2 hours -15 years. High anomalies were seen in 34 (56.7%), low anomalies 18 (30%) and intermediate 8 (13.3%). Associated congenital anomalies were seen in 12 (20%) patients. 28 patients had the traditional three-stage procedure of initial colostomy, PSARP and colostomy closure while 13 patients had double staged procedure of initial colostomy and definitive surgery with colostomy closure at the same time. Fifteen (15) patients had single staged procedure (PSARP) without an initial colostomy. Three (3) patients are awaiting colostomy closure after definitive surgery. Post-Operative complications were seen in 16 patients. A mortality of 10 (16.7%) was observed.

Anorectal Malformations at a University Teaching Hospital in Southern Nigeria

Ano-rectal malformations comprise a wide spectrum of diseases, which can affect males and females, and involve the distal anus and rectum as well as the urinary and genital tracts. The incidence, type or variety of malformations varies from one region or geographical location to another. Ano-rectal anomalies tend to be associated with other congenital anomalies. The aim of this study is to determine the incidence, presentation and types of ano-rectal malformations and their treatment outcome. It is a prospective observational study from March 2012 to February 2019. Information obtained from cases of ano-rectal anomalies who presented to our health institution during the study period was entered into a proforma. Relevant clinical information was obtained and documented in a structured proforma. A total of 60 patients were seen during the study period. Males were 35 (58.3%) while females were 25 (41.7%). Age at presentation ranged from 2 hours -15 years. High anomalies were seen in 34 (56.7%), low anomalies 18 (30%) and intermediate 8 (13.3%). Associated congenital anomalies were seen in 12 (20%) patients. 28 patients had the traditional three-stage procedure of initial colostomy, PSARP and colostomy closure while 13 patients had double staged procedure of initial colostomy and definitive surgery with colostomy closure at the same time. Fifteen (15) patients had single staged procedure (PSARP) without an initial colostomy. Three (3) patients are awaiting colostomy closure after definitive surgery. Post-Operative complications were seen in 16 patients. A mortality of 10 (16.7%) was observed.

Anorectal Malformations at a University Teaching Hospital in Southern Nigeria

Ano-rectal malformations comprise a wide spectrum of diseases, which can affect males and females, and involve the distal anus and rectum as well as the urinary and genital tracts. The incidence, type or variety of malformations varies from one region or geographical location to another. Ano-rectal anomalies tend to be associated with other congenital anomalies. The aim of this study is to determine the incidence, presentation and types of ano-rectal malformations and their treatment outcome. It is a prospective observational study from March 2012 to February 2019. Information obtained from cases of ano-rectal anomalies who presented to our health institution during the study period was entered into a proforma. Relevant clinical information was obtained and documented in a structured proforma. A total of 60 patients were seen during the study period. Males were 35 (58.3%) while females were 25 (41.7%). Age at presentation ranged from 2 hours -15 years. High anomalies were seen in 34 (56.7%), low anomalies 18 (30%) and intermediate 8 (13.3%). Associated congenital anomalies were seen in 12 (20%) patients. 28 patients had the traditional three-stage procedure of initial colostomy, PSARP and colostomy closure while 13 patients had double staged procedure of initial colostomy and definitive surgery with colostomy closure at the same time. Fifteen (15) patients had single staged procedure (PSARP) without an initial colostomy. Three (3) patients are awaiting colostomy closure after definitive surgery. Post-Operative complications were seen in 16 patients. A mortality of 10 (16.7%) was observed.

Anorectal Malformations at a University Teaching Hospital in Southern Nigeria

Ano-rectal malformations comprise a wide spectrum of diseases, which can affect males and females, and involve the distal anus and rectum as well as the urinary and genital tracts. The incidence, type or variety of malformations varies from one region or geographical location to another. Ano-rectal anomalies tend to be associated with other congenital anomalies. The aim of this study is to determine the incidence, presentation and types of ano-rectal malformations and their treatment outcome. It is a prospective observational study from March 2012 to February 2019. Information obtained from cases of ano-rectal anomalies who presented to our health institution during the study period was entered into a proforma. Relevant clinical information was obtained and documented in a structured proforma. A total of 60 patients were seen during the study period. Males were 35 (58.3%) while females were 25 (41.7%). Age at presentation ranged from 2 hours -15 years. High anomalies were seen in 34 (56.7%), low anomalies 18 (30%) and intermediate 8 (13.3%). Associated congenital anomalies were seen in 12 (20%) patients. 28 patients had the traditional three-stage procedure of initial colostomy, PSARP and colostomy closure while 13 patients had double staged procedure of initial colostomy and definitive surgery with colostomy closure at the same time. Fifteen (15) patients had single staged procedure (PSARP) without an initial colostomy. Three (3) patients are awaiting colostomy closure after definitive surgery. Post-Operative complications were seen in 16 patients. A mortality of 10 (16.7%) was observed.

Anorectal Malformations at a University Teaching Hospital in Southern Nigeria

Ano-rectal malformations comprise a wide spectrum of diseases, which can affect males and females, and involve the distal anus and rectum as well as the urinary and genital tracts. The incidence, type or variety of malformations varies from one region or geographical location to another. Ano-rectal anomalies tend to be associated with other congenital anomalies. The aim of this study is to determine the incidence, presentation and types of ano-rectal malformations and their treatment outcome. It is a prospective observational study from March 2012 to February 2019. Information obtained from cases of ano-rectal anomalies who presented to our health institution during the study period was entered into a proforma. Relevant clinical information was obtained and documented in a structured proforma. A total of 60 patients were seen during the study period. Males were 35 (58.3%) while females were 25 (41.7%). Age at presentation ranged from 2 hours -15 years. High anomalies were seen in 34 (56.7%), low anomalies 18 (30%) and intermediate 8 (13.3%). Associated congenital anomalies were seen in 12 (20%) patients. 28 patients had the traditional three-stage procedure of initial colostomy, PSARP and colostomy closure while 13 patients had double staged procedure of initial colostomy and definitive surgery with colostomy closure at the same time. Fifteen (15) patients had single staged procedure (PSARP) without an initial colostomy. Three (3) patients are awaiting colostomy closure after definitive surgery. Post-Operative complications were seen in 16 patients. A mortality of 10 (16.7%) was observed.

Do North American colorectal surgeons use mesh to prevent parastomal hernia? A survey of current attitudes and practice

The use of prophylactic mesh in end colostomy procedures has been shown to reduce the rate of parastomal hernia. However, the degree to which the practice has been adopted clinically remains unknown. We conducted a study to evaluate the current opinions and practice patterns of Canadian and US colorectal surgeons with regard to the use of prophylactic mesh in end colostomy. Between May and July 2017, we conducted an internet-based survey of colorectal surgeons in Canada and the United States (selected at random). Using a questionnaire designed and tested for this study, we assessed the rate of mesh use, types of mesh and placement techniques, and perceived barriers and facilitators associated with the practice. Forty-eight (51.6%) of 93 invited Canadian surgeons and 253 (16.6%) of 1521 invited US surgeons responded (overall response rate 18.6%). Of the 301 respondents, 32 (10.6%) were currently using mesh, 32 (10.6%) had previously used mesh, and 237 (78.7%) had never used mesh. Of 29 respondents currently using mesh, 12 (41.4%) used it only in selected patients; the majority used a sublay technique (20 [69.0%]) and biologic mesh (17 [58.6%]). Most respondents agreed that parastomal hernias are common and negatively affect quality of life; however, there remained concerns about evidence quality and the perceived risk associated with mesh among those who had never or had previously used mesh. Prophylactic mesh placement remains relatively uncommon; when used, biologic mesh was the most common type. Many surgeons were not convinced of the safety or efficacy of prophylactic mesh placement.

EMOTIONAL IMPACTS OF THE PATIENT COLOSTOMY BAG

Introduction: The ostomy is a surgical procedure that creates an abdominal canal for the elimination of fecal or urinary remains in an external pouch. The clinical conditions that lead to an intestinal ostomy are related to the benign or malignant pathologies of the gastroenterological organ. Ostomy may be temporary or permanent, and its characteristics can not be voluntary, as is the case of the colostomy. This type of procedure may bring biopsychosocial impacts for the patient. Objective: Analyze the emotional effects on patients using a colostomy bag. Method: Integrative review and reporting of experience. Results: While providing psychological support for patients with colostomy, it is possible to see what are the different types of changes in their routine, which are not physiological, but also psychological, emotional and social. The adaptation is a long and continuous process, and it is related to the underlying disease, the degree of physical weakness, the individual values and the type of personality of the patient. The ostomy procedure implies not only the use of the colostomy bag, but also a new body image that needs to be reconstructed, which has direct connection with self-esteem, self-image, self concept, body concept and body scheme, important components of the patient’s identity. Having undergone the procedure, some patients may experience feelings of alienation of their own body for their body have changed after the surgery. Using a bag collector represents a mutilation on the patient’s body and leads to a lack of control over physiological excretion, the body, physical beauty and health, eventually causing self-rejection. This situation is experienced by patients with a feeling of incapacity and inutility, as a sensation of loss of productive capacity may arise, and it can still arouse feelings like hatred, disgust, repulsion and fear, making one move away from the social environment. In addition, it affects the sexual life of the patient, causing loss of libido and impotence. Conclusion: The patient undergoing a colostomy procedure is at an extremely fragile and delicate situation, and depending on the family’s approach to it, the process may become even more difficult. This is the first program of health and psychological support to address the pain and loss of health. Experience shows it is possible for the patient to develop their own concepts, according to their advantages and disadvantages, to accept and work their capabilities after a colostomy.

Trephine Transverse Colostomy Is Effective for Patients Who Have Previously Undergone Rectal Surgery.

PurposeColostomy creation is an essential procedure for colorectal surgeons, but the preferred method of colostomy varies by surgeon. We compared the outcomes of trephine colostomy creation with open those for the (laparotomy) and laparoscopic methods and evaluated appropriate indications for a trephine colostomy and the advantages of the technique.MethodsWe retrospectively evaluated 263 patients who had undergone colostomy creation by trephine, open and laparoscopic approaches between April 2006 and March 2016. We compared the clinical features and the operative and postoperative outcomes according to the approach used for stoma creation.ResultsOne hundred sixty-three patients (62%) underwent colostomy surgery for obstructive causes and 100 (38%) for fistulous problems. The mean operative time was significantly shorter with the trephine approach (trephine, 46.0 ± 1.9 minutes; open, 78.7 ± 3.9 minutes; laparoscopic, 63.5 ± 5.0 minutes; P < 0.001), as was the time to flatus (1.8 ± 0.1 days, 2.1 ± 0.1 days, 2.2 ± 0.3 days, P = 0.025). Postoperative complications (<30 days) were not different among the 3 approaches (trephine, 4.3%; open, 1.2%; laparoscopic, 0%; P = 0.828). In patients who underwent rectal surgery, a trephine colostomy was feasible for a diversion colostomy (P < 0.001).ConclusionThe trephine colostomy is safe and can be implemented quickly in various situations, and compared to other colostomy procedures, the patient’s recovery is faster. Previous laparotomy history was not a contraindication for a trephine colostomy, and a trephine transverse colostomy is feasible for patients who have undergone previous rectal surgery.