Double-barreled Wet Colostomy Research Articles

Double-Barreled Wet Colostomy After Pelvic Exenteration.

Double-Barreled Wet Colostomy After Pelvic Exenteration.

Comparation between the Bricker ileal conduit vs double-barrelled wet colostomy after pelvic exenteration for gynaecological malignancies

BackgroundAfter exhausting other therapeutic options, pelvic exenteration is performed in patients who suffer from relapsed gynaecologic tumours, with most of them requiring some sort of urinary diversion. Material and methodsThe main objective of this study was to assess the short- and medium/long-term urinary complications associated with the Bricker ileal conduit versus double-barrelled wet colostomy after performing a pelvic exenteration for gynaecologic malignancies. ResultsA total of 61 pelvic exenterations were identified between November 2010 and April 2022; 29 Bricker ileal conduits and 20 double-barrelled wet colostomies were included in the urinary diversion analysis. Regarding the specific short-term urinary complications, no differences were found in the rate of urinary leakage (3 vs 0 %; p = 1), urostomy complications (7 vs 0 %; p = 0.51), acute renal failure (10 vs 20 %; p = 0.24) or urinary infection (0 vs 5 %; p = 0.41). Up to 69 % of patients with Bricker ileal conduits and 65 % of double-barrelled wet colostomies (p = 0.76) presented specific medium/long-term urinary complications. No differences in the rates of pyelonephritis (59 vs 53 %; p = 0.71), urinary fistula (0 vs 12 %; p = 0.13), ureteral stricture (10 vs 6 %; p = 1), conduit failure and reconstruction (7 vs 0 %; p = 0.53), renal failure (38 vs 29 %; p = 0.56) or electrolyte disorders (24 vs 18 %; p = 0.72) were found. ConclusionsThere are no significant differences in the rate of complications between double-barrelled wet colostomy and the Bricker ileal conduit. The long-term complications related to urinary diversion remained high regardless of the type of technique. In this context, the double-barrelled wet colostomy presents advantages such as the single stoma placement and the simplicity of the technique.

Een onbekende procedure: double-barreled wet colostomy

SamenvattingEen 62-jarige vrouw onderging een double barreled wet colostomy (DBWC) na een bekkenexenteratie. De DBWC is een relatief onbekende ingreep, waarbij een colostoma wordt aangelegd met twee openingen, waardoor urine en ontlasting via gescheiden compartimenten naar buiten worden geleid. Het doel van dit artikel is de DBWC te vergelijken met een gescheiden urostoma en colostoma aan de hand van een casus en een review van de beschikbare literatuur. Er werden drie retrospectieve studies gevonden die een DWBC vergeleken met een gescheiden uro- en colostoma, met in totaal 267 patiënten. Daaruit bleek geen verhoogde mortaliteit en morbiditeit bij een DBWC ten opzichte van een gescheiden urinestoma en colostoma. De conclusie luidt dat een DBWC kan worden overwogen na een bekkenexenteratie.

Urinary and Fecal Diversion Following Pelvic Exenteration: Comparison of Double-Barrelled and Plain Wet Colostomy.

To assess early and late-term outcomes of patients who had undergone pelvic exenteration and simultaneous fecal and urinary diversion with plain wet colostomy (PWC) or double-barrelled wet colostomy (DBWC). The medical records of all patients who had undergone pelvic exenteration and urinary diversion between 2006 and 2017 at our hospital were reviewed retrospectively. In total, 15 patients with a mean age of 56 ± 13 years were included in the study. Simultaneous urinary and fecal diversions were carried out as PWC (n = 8), or DBWC (n = 7). No significant differences were found between PWC and DBWC groups in terms of operation time (373.7 ± 66.5 versus 394.2 ± 133.2 min, P = .955), estimated blood loss (862.8 ± 462.4 versus 726.2 ± 489.4 mL, P = .613), length of hospital stay (13.2 ± 9.1 versus 14.1 ±6.9 days), early complications (25% versus 28.6%, P = 1.0) and late term complications (37.5% versus 42.9%, P = 1.0). The rate of recurrent pyelonephritis in PWC group was higher than DBWC group but not statistically significant (37.5% versus 14.3%, P = .569). Overall survival (OS) of the patients was 385 ± 91 days. There was no difference between OS of patients with PWC and DBWC (414 ± 165 versus 352 ± 70 days, P = .618). PWC and DBWC are valid options for creating simultaneous urinary and fecal diversion after extensive pelvic surgery in patients with short life expectancy. DBWC might be superior to PWC in terms of decreased risk of recurrent pyelonephritis.

Pelvic Exenteration With Rectal Resection for Different Types of Malignancies at Two Tertiary Referral Centers

IntroductionPelvic exenteration (PE) offers the best chance of cure for locally advanced primary or recurrent pelvic organ malignancies invading adjacent organs. The aims of this study were to analyze results for any pelvic exenteration that includes rectal resection and the analysis of results of fecal and urinary reconstruction. MethodFrom January 2000 to April 2014, 111 PE with rectal resection for any pelvic cancer were analyzed retrospectively at two national tertiary referral centers. ResultsThirty-six colorectal anastomosis were performed. Urologic reconstructions performed were 30 double barrelled wet colostomy (DBWC), 14 Bricker ileal conduit (BIC), and 2 ureterocutaneostomies. Postoperative complications occurred in 71 patients (64%). Six deaths (5.4%) occurred within 30 postoperative days. 5-Year overall survival following R0 resection was 62.6%; R1, 42.7%; R2: 24.2% (P=.018). The resection margin status was associated with overall survival, local recurrence and distant recurrence. ConclusionPelvic exenterations for any cause need to be performed in referral centers and by specialized surgeons. Anastomosis after modified supralevator pelvic exenteration for ovarian cancer, is safe. DBWC can be considered a valid option for urologic reconstruction. The most important prognostic factor after pelvic exenteration for malignant pelvic tumors is the status of surgical margins.

Comparison of outcomes of double-barrelled wet colostomy vs ileal conduit and end colostomy for urinary and faecal diversion following total pelvic exenteration

Comparison of outcomes of double-barrelled wet colostomy vs ileal conduit and end colostomy for urinary and faecal diversion following total pelvic exenteration

Exenteración pélvica con resección rectal por neoplasias de distinto origen en dos centros de referencia

IntroductionPelvic exenteration (PE) offers the best chance of cure for locally advanced primary or recurrent pelvic organ malignancies invading adjacent organs. The aims of this study were to analyse results for any pelvic exenteration that includes rectal resection and the analysis of results of fecal and urinary reconstruction. MethodFrom January 2000 to April 2014, 111 PE with rectal resection for any pelvic cancer were analysed retrospectively at two national tertiary referral centers. ResultsThirty-six colorectal anastomosis were performed. Urologic reconstructions performed were 30 double barrelled wet colostomy (DBWC), 14 Bricker ileal conduit (BIC), and 2 ureterocutaneostomies. Postoperative complications occurred in 71 patients (64%). Six deaths (5.4%) occurred within 30 postoperative days. Five-year overall survival following R0 resection was 62.6%; R1: 42.7%; R2: 24.2% (P=.018). The resection margin status was associated with overall survival, local recurrence and distant recurrence. ConclusionPelvic exenterations for any cause need to be performed in referral centers and by specialized surgeons. Anastomosis after modified supralevator pelvic exenteration for ovarian cancer, is safe. DBWC can be considered a valid option for urologic reconstruction. The most important prognostic factor after pelvic exenteration for malignant pelvic tumors is the status of surgical margins.

Robotic Pelvic Exenteration (Cystoprostatectomy and Combined Abdominoperineal Resection) with Double-Barreled Wet Colostomy

Introduction: Patients with locally advanced pelvic carcinoma or severe radiation sequelae may be managed with pelvic exenteration, which requires both fecal and urinary diversion. Double-barreled wet colostomy (DBWC) represents a simultaneous diversion through a single ostomy as opposed to a separate terminal colostomy and urostomy.1–4 This has been described through an open approach; however, literature on the technique and safety of a robotic approach is scarce. This video shows a combined robotic cystoprostatectomy and abdominoperineal resection with creation of a DBWC for locally recurrent prostate cancer with rectal invasion. Materials and Methods: Using a high-definition recording system and iMovie software, we created a video of our technique for robotic cystoprostatectomy and abdomnioperineal resection with creation of a DBWC using the Surgical Intuitive Da Vinci Xi robot. Lithotomy position is used to access the perineum. Four robotic and one assistant port are placed allowing access to the descending colon and pelvic structures. Key steps include (1) mobilizing the sigmoid colon and rectum from the pelvic sidewall and brim to the splenic flexure; (2) bowel transection at the mid descending colon; (3) bilateral pelvic lymph node dissection (PLND), beginning at the bifurcation of the aorta and including the common iliac vessels, external iliac obturator, and hypogastric lymph nodes, including the triangle of Marcille; (4) transecting the bladder pedicles; (5) dropping the bladder and entering the space of Retzius; (6) dissecting the endopelvic fascia and lateral prostate; (7) transecting the dorsal vein complex and urethra; (8) dissecting the posterior plane of the rectum along the sacrum; (9) en bloc removal of the specimen through the perineal incision; (10) creating a ureteroenteric anastomosis with double J ureteral stents placement in the urinary reservoir; and (11) wet colostomy site creation 10–15 cm from the colonic suture line and brought up to the skin. Results: The operative time was 480 min (60 min abdominoperineal resection) and estimated blood loss was 250 mL. The final pathology report demonstrated a pT4N1 Gleason 9 prostate cancer and invasion of the rectum, bladder, and pelvic wall. Postoperatively, the DBWC functioned well, without complications of ascending pyelonephritis or electrolyte imbalance. At 6 months follow-up, the PSA is undetectable on leuprolide and the creatinine level is 1.4 (baseline of 1.0). Conclusions: This video presents an initial experience with robotic cystoprostatectomy and abdominoperineal resection with creation of a DBWC. Robotic pelvic exenteration and DBWC are feasible and safe for locally advanced pelvic malignancies. The dissection allows excision of the bladder, prostate, sigmoid colon, rectum, and anus en bloc while performing an extensive PLND. The open DBWC literature demonstrates shorter operative time and decreased blood loss and length of stay than separate ostomies. The most common complications include ascending pyelonephritis in 7–16% of cases as well as case reports of metabolic disturbances. Our early follow-up shows good functional outcomes without complications. Patients most likely to benefit from this procedure are those seeking greater ease of care and those patients with a higher risk of fistula as there is no need for further bowel anastomoses. No competing financial interests exist. Runtime of video: 8 mins 14 secs

Back-to-Front Hemicorporectomy with Double-barreled Wet Colostomy for Treatment of Squamous Cell Carcinoma of a Pressure Ulcer

Back-to-Front Hemicorporectomy with Double-barreled Wet Colostomy for Treatment of Squamous Cell Carcinoma of a Pressure Ulcer

Double-barrelled wet colostomy: is one stoma better than two?

A wet colostomy is a relatively ‘old’ operation, first performed in 1948. Over the years, it has been updated and the technique improved, with patients having better outcomes. A double-barrelled wet colostomy (DBWC) is a simultaneous urinary and faecal diversion surgery, performed as an alternative to creating two separate stomas in a patient. Instead of an ileal conduit, which would typically be in the right iliac fossa (RIF), and a colostomy, typically in the left iliac fossa (LIF), there is a single abdominal stoma brought out through the abdominal wall in the LIF. This article gives an overview of the surgical procedure and includes a case study of a patient and his wife as they adapt to a life following the formation of a DBWC. It also describes the stoma care nurse's experience in caring for this patient and the appliances used.

Double-Barreled Wet Colostomy versus Ileal Conduit and Terminal Colostomy for Urinary and Fecal Diversion: A Single Institution Experience

The aim of this study was to compare the feasibility and early postoperative outcomes between patients undergoing double-barreled wet colostomy and patients undergoing terminal colostomy and ileal conduit for simultaneous urinary and fecal diversion. Between 1995 and 2012, we had 181 patients in whom it was necessary to make simultaneous urinary and fecal diversion. This is a retrospective study and patients were divided into two groups, depending on the technique applied for the fecal and urinary diversion. The first group consisted of patients undergoing ileal conduit and terminal colostomy and the second group consisted of patients undergoing double-barreled wet colostomy. Ileal conduit and terminal colostomy was performed in 77 (43%) cases, while wet colostomy was performed in 104 (57%) cases. Median length of stay was shorter for double-barreled wet colostomy (13.1 vs 18.1, p < 0.0001). Median operating times for urinary and fecal diversion were shorter for double-barreled wet colostomy (32 vs 64 min, p < 0.0001). The morbidity was lower for double-barreled wet colostomy (11.5% vs 23.4%, p = 0.0432), retrospectively. The mortality was 3.8% for double-barreled wet colostomy and 10.3% for ileal conduit and terminal colostomy group (p = 0.1282). Double-barreled wet colostomy is a safe, fast, and simple alternative to traditional ileal conduit and terminal colostomy diversion. The technique is relatively easy to learn, and it reduces the time for urinary and fecal diversion, length of stay, and morbidity rate.

Double barreled wet colostomy: initial experience and literature review.

Background. Pelvic exenteration and multivisceral resection in colorectal have been described as a curative and palliative intervention. Urinary tract reconstruction in a pelvic exenteration is achieved in most cases with an ileal conduit of Bricker, although different urinary reservoirs have been described. Methods. A retrospective and observational study of six patients who underwent a pelvic exenteration and urinary tract reconstruction with a double barreled wet colostomy (DBWC) was done, describing the preoperative diagnosis, the indication for the pelvic exenteration, the complications associated with the procedure, and the followup in a period of 5 years. A literature review of the case series reported of the technique was performed. Results. Six patients had a urinary tract reconstruction with the DBWC technique, 5 male patients and one female patient. Age range was from 20 to 77 years, with a medium age 53.6 years. The most frequent complication presented was a pelvic abscess in 3 patients (42.85%); all complications could be resolved with a conservative treatment. Conclusion. In the group of our patients with pelvic exenteration and urinary tract reconstruction with a DBWC, it is a safe procedure and well tolerated by the patients, and most of the complications can be resolved with conservative treatment.

557 Late functional results of Double-barreled wet colostomy after 169 procedures: Single-institution experience

557 Late functional results of Double-barreled wet colostomy after 169 procedures: Single-institution experience

Complications after double-barreled wet colostomy compared to separate urinary and fecal diversion during pelvic exenteration: Time to change back?

ObjectiveTo assess complications associated with double-barreled wet colostomy (DBWC) in the first six months after pelvic exenteration as compared to separate urinary and fecal diversion (SUD). MethodsA single institution retrospective chart review was conducted of all patients who underwent a pelvic exenteration between 2000 and 2011. Patients were included if the procedure involved at least a urinary diversion and a perineal phase. Patient demographics and complications in the first 6months after surgery were recorded. ResultsThirty-three patients met inclusion criteria (12 DBWC and 21 SUD). The majority of patients had recurrent cervical cancer (58%) followed by vaginal, vulva, and endometrial cancer. All patients had previously received radiation. 10/12 patients with a DBWC and 67% of SUD had pelvic reconstruction. Median length of stay (LOS) was shorter for DBWC (14.5 vs. 20days, p=.01). Median operating times were shorter for DBWC (610 vs. 702minutes, p=.04). No urinary conduit or anastomotic bowel leaks occurred in the DBWC group compared to 5 (24%) and 2 (9.5%), respectively, in the SUD group (p=.06 for any leak). 58% of the DBWC and 62% of the SUD group required re-operation, and there were no 30-day peri-operative deaths. ConclusionsDBWC can be performed safely at the time of pelvic exenteration. We found reduced operating times, shorter LOS, and a trend toward fewer urinary conduit and/or bowel anastomotic leaks in DBWC exenteration patients. DBWC may be favorable over more technically challenging SUD in this heavily radiated population that generally has a limited overall survival.

Complications After Double-Barreled Wet-Ostomy Compared to Separate Urinary and Fecal Diversion During Pelvic Exenteration: Time to Change Back?

Objectives: The objective of this study is to assess complications and morbidity associated with double-barreled wet colostomy (DBWC) in the first six months after pelvic exenteration as compared to separate urinary and fecal diversion.

Complications after double-barreled wet-ostomy compared to separate urinary and fecal diversion during pelvic exenteration: Time to change back?

Objective: The objective of this study is to assess complications and morbidity associated with double-barreled wet colostomy (DBWC) in the first six months after pelvic exenteration as compared to separate urinary and fecal diversion.

Single Institution Experience Comparing Double-barreled Wet Colostomy to Ileal Conduit for Urinary and Fecal Diversion

To compare outcomes and feasibility of double-barreled wet colostomy and ileal conduit (IC) in patients undergoing total pelvic exenteration (TPE). Between 2004 and 2010, 54 patients underwent TPE for pelvic malignancies. Of those patients, 53 had complete records available for analysis. Two groups were identified based on the technique used for urinary diversion, either by way of an IC or a double-barreled wet colostomy (DBWC). Demographics, comorbidities, complications, length of stay, operative times, morbidity, and mortality were compared between the 2 groups. Forty-three patients (81%) underwent a DBWC and ten patients (19%) underwent an IC. The 2 groups were similar in terms of age, gender, and comorbidities. Eighteen patients underwent an R0 resection (39%) and twenty-eight (61%) patients had a non-R0 resection. Seven patients (13%) had a complete response to therapy with no evidence of malignancy. A majority of the patients (68%) undergoing TPE had colorectal histology. Thirty-day morbidity directly related to complications of urinary or fecal diversion was 78% in the DBWC group and 58% in the IC group. There was no perioperative mortality in either group. DBWC is a safe and feasible alternative to the traditional IC for urinary diversion. This technique is easy to learn and is associated with similar operative times, length of stay, morbidity, and mortality compared with IC.

Single-institution experience comparing double-barreled wet colostomy to ileal conduit for urinary and fecal diversion.

542 Background: Patients with advanced primary or recurrent colorectal cancers that undergo total pelvic exenteration for cure or palliation require proximal urinary and fecal diversion. The most commonly used diversion technique is use of an ileal conduit (IC) and end colostomy. At our institute, the double-barreled wet colostomy (DBWC) has been shown to be have similar outcomes and technically feasible. Methods: Between 2004 and 2010, 37 patients underwent total pelvic exenteration for advanced primary or recurrent colorectal cancer. Two groups were identified based on the technique used for their urinary diversion, either by way of an IC (n = 4) or DBWC (n = 33). Demographics, periprocedural events, and outcomes were compared between the two groups. Results: The two groups were similar in the terms of age, gender, and comorbidities. Thirty-three patients (89%) underwent a DBWC and four patients (11%) underwent an IC. All of these patients underwent a total pelvic exenteration for advanced primary (27%) or recurrent colorectal cancer (73%) either for cure or for palliation. Twenty patients underwent R0 resection (54%), and 17 patients had non-R0 resection (46%). Complications, length of stay, and operative times between both groups were similar. Median survival for both groups showed no statistical difference. Conclusions: DBWC is a safe and feasible alternative to the traditional ileal conduit for urinary diversion. It provides a single stoma to care for, and an intact contralateral abdominal muscle to use as a vertical rectus abdominus musculocutaneous flap for reconstruction. This technique is easy to learn and is not associated with higher operative times, length of stay, morbidity, or mortality. [Table: see text] No significant financial relationships to disclose.

Revisiting the double-barreled wet colostomy for simultaneous urinary and fecal diversion—an Indian experience

Pelvic exenteration in advanced malignancies is usually a curative procedure aimed at improving quality of life. We analyzed the perioperative data and outcomes in 12 patients who underwent simultaneous urinary and fecal diversion with a double-barreled wet colostomy after total pelvic exenteration. Eight males and four females aged between 25 and 73 years underwent the procedure with mean operative duration of 350 min and mean postoperative stay of 15 days. Three patients developed early complications while four developed late complications. During follow up ranging from 6 to 64 months, four patients died of disease progression while four died of unrelated causes. One lady was lost to follow up, the remaining had a mean survival of 32.9 months. None had deterioration in renal function or peristomal dermatitis and all were well accustomed to managing one stoma. Our results show that double-barreled wet colostomy is technically simple and reduces surgical morbidity while providing satisfactory outcomes and patient comfort.

Follow-Up of Double-barreled Wet Colostomy After Pelvic Exenteration at a Single Institution

Double-barreled wet colostomy consists of simultaneous urinary and fecal diversions into a lateral colostomy and is indicated after pelvic exenteration or in palliative operations, when complete intestinal and urinary reconstruction is not possible. We report experience at our institution with Double-barreled wet colostomy regarding postoperative and long-term morbidity and mortality. All patients who underwent double-barreled wet colostomy construction at our institution from 1980 through 2008 were included in the study. Medical records were reviewed for type and history of the malignant tumor, previous treatments, comorbidity according to the American Society of Anesthesiologists' score, type and length of surgery, length of hospital stay, and postoperative (within 30 days after the operation) and long-term morbidity and mortality. The study comprised 41 patients. The underlying disease was a malignant pelvic tumor in 30 patients (primary in 6 and recurrent in 24 patients) and a nonmalignant disease in 11 patients. Surgical mortality was 2.4%, and the postoperative morbidity rate was 65.9%. Double-barreled wet colostomy-related morbidity observed during follow-up included pyelonephritis (9.8%, with renal deterioration due to chronic pyelonephritis in 2.4%), stenosis of the uretero-colonic anastomosis (2.4%), and lithiasis in the urine reservoir (7.3%). Follow-up was discontinued after a mean of 18.6 (SD, 19.9) months in 14 patients who had been referred from other centers. A total of 27 patients were followed in our center for a mean of 32.2 (range, 1-156) months. Of these, 7 patients are currently alive, 1 with recurrent disease; 14 patients died from local or distant recurrence; and 6 patients died of causes other than malignancy. Double-barreled wet colostomy is a safe alternative for patients who need simultaneous urinary and fecal diversion, although the risk of ascending urinary infection must be taken into consideration.