Elective Colostomy Research Articles

OUTCOME OF EARLY INITIATION OF POST-SURGERY FEEDING AFTER COLOSTOMY REVERSAL IN CHILDREN

Background: Children undergoing colostomy reversal surgery often face uncertainties regarding the optimal timing for reintroducing feeding postoperatively. Early initiation of post-surgery feeding is of interest due to its potential to hasten recovery and reduce hospital stay. The impact of early feeding initiation is unclear. Objective of this study was to find out the outcome in terms of hospital stay and post-surgery complications of early initiation of post-surgery feeding after elective colostomy reversal in children. Methods: From 6 Jun 2022 to 10 Oct 2023, a non-randomized controlled trial was conducted at Bahawalpur, analyzing 93 children under 15 years with status colostomy following elective reversal. Patients were allocated to Group-A (traditional oral feeding) or Group-B (early oral feeding) at the surgeon’s discretion, with outcomes including post-surgery hospital stay duration and complications. Results: Out of a total of 93 patients, 49 (52.7%) were boys and 44 (47.3%) girls. Overall, mean age was 4.86±3.27 years. Anastomotic shock was noted among 6 (6.5%) patients while 9 (9.7%) patients had superficial surgical site infection. None of the patients needed repeat surgery for any post-surgery complications. No significant difference in terms of anastomotic leak (p=0.3983), and superficial surgical site infection (p=0.4980) were observed. Significantly shorter duration of post-surgery hospital stay was recorded among patients of Group-B when to compared to Groups-A (6.49±1.14 vs 8.90±1.27, p<0.0001). Conclusion: Early initiation of enteral feeding post elective colostomy reversal in children resulted in significantly reduced duration of post-surgery hospital stay. Pak J Physiol 2024;20(1):30-2

Kto pierwszy wyłonił kolostomię?

The history of intestinal stoma surgery began in France in the 18th century. Initially the surgeons and the anatomists accumulated isolated personal experience and then they came to the realization of the possibility of exertion of feces bypassing the rectum. Creating an artificial anus as a treatment of various coloproctological diseases has been formed without ether anesthesia nor antiseptics. Despite this, many patients managed to prolonged or save their lives. French anatomist Alexis Littrè was the first who put forward two plans for dealing with rectal atresia. The first was to open the closed ends and stich them together; the second was to create an artificial anus. Another French surgeon Jean Mèry, probably for the first in the world formed a stoma in 1701. Jean Pillore performed the first elective colostomy (cecostoma) in 1776 on the patien with rectal cancer. In the 19th century, surgeons in Europe has been searching for the optimal surgery technique and tried to expand the indications for intestinal stomas.

OCCLUSION INTESTINALE AIGÜE PAR OBSTACLE TUMORAL DU BAS TRACTUS DIGESTIF : ASPECTS EPIDEMIOLOGIQUE, DIAGNOSTIQUE ET THERAPEUTIQUE AU CHU SOURO SANOU

Abstract Objective: to describe the diagnostic and therapeutic epidemiological profile of cancers of the lower digestive tract in occlusion. Methodology: This was a retrospective descriptive study in the Department of General and digestive Surgery of the Teaching Hospital of Sanou Sanou, from 1st of January 2017 to 30th of April 2019. She studied the epidemiological, diagnostic and therapeutic aspects of acute intestinal obstruction by tumoral stenosing of the anal canal, rectum or colon. Results: Occlusions by cancers of the lower digestive tract were found in 15 cases representing 0.3% of visceral emergency admissions and 37.5% of all cancers of this location diagnosed in the period. The sex ratio was 0.9. The mean age was 50.5 ± 13.3 [25 and 70 years], with a high proportion of subjects under 40 (33.3%). In 1/3 of the cases, the tumours were located in the canal, rectum and colon. Right hemicolectomy and transverse colectomy were performed for tumours located in these colonic segments. Elective left iliac colostomy was the most performed gesture (66,7%) for the other locations. Morbidity and mortality were respectively 20% (n = 3) and 6.6% (n =1). Conclusion: The complicated occlusive form is the circumstance of diagnosis in almost half of the cases ano-recto-colic cancers. The frequent anal location must challenge the importance of digital rectal examination. Elective colostomy is a beneficial gesture for left recto colic locations. Key words: anal canal cancer, rectal cancer, colon cancer, occlusion, BoboDioulasso

Sudden fatal bleeding from a uretero-arterial fistula combined with pre-existing uretero-colic and uretero-vaginal fistulas 7\u2009years after a cervical cancer surgery: a case report

BackgroundUretero-arterial fistulas (UAFs) are a rare cause of hematuria and could be fatal often due to a diagnostic delay despite recent advances in the treatment modalities.Case presentationA 52-year-old woman with a history of advanced cervical cancer developed a fever and was diagnosed with a left uretero-colic fistula. She also had a uretero-vaginal fistula and suffered from repeated urinary tract infections over 6 years. While waiting for an elective colostomy, she developed sudden perineal bleeding and died 14 h after the onset. The autopsy findings revealed that bleeding from a newly developed UAF spreads out to the extracorporeal space through the pre-existing fistulas.ConclusionsBleeding from a UAF complicated by other uretero-genital and/or uretero-enteric fistulas could proceed rapidly resulting in a fatal outcome because of a lack of a tamponade effect. Early recognition of a UAF in high-risk patients is crucial for a prompt diagnosis, which might lead to a treatment success.

Combined Hartmann's Reversal and Abdominal Wall Reconstruction: Defining Postoperative Morbidity

BackgroundVentral hernias are common after Hartmann's procedure and add complexity to Hartmann's reversal. Colostomy reversal and abdominal wall reconstruction may be performed in a staged or concurrent fashion, although data are limited as to which strategy is optimal. We aimed to define the complication profile of concurrent abdominal wall reconstruction with colostomy reversal as compared to either procedure alone. Materials and methodsFor this retrospective cohort study, we used the National Surgery Quality Improvement Project Database from 2012 to 2015. All patients undergoing elective colostomy reversal, abdominal wall reconstruction with component separation, or combined colostomy reversal with component separation were identified. Propensity score matching was used to compare outcomes among similar patients undergoing colostomy reversal alone versus combined procedure. Groups were evaluated for postoperative morbidity including reoperation. ResultsWe identified 11,689 patients; 6951 (64%) underwent component separation alone, 4563 (35%) colostomy reversal alone, and 175 (1%) combined component separation and colostomy reversal. The combined group, as compared to colostomy reversal alone, showed an increased overall complication rate (39% versus 25%; P < 0.01) and increased rate of reoperation (9% versus 5%; P = 0.03). Differences in overall complication rate (43% versus 24%; P < 0.01) and reoperation rate (9% versus 3%; P = 0.03) persisted on propensity matched analysis. ConclusionsThis analysis shows that in patients undergoing colostomy takedown, concurrent abdominal wall reconstruction is associated with increased morbidity including increased rate of reoperation, even when controlling for patient factors. Consideration may be given to a staged approach.

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.

Colostomy for anorectal malformation in a tertiary center in Nigeria

Background: Anorectal malformations constitute a wide spectrum of congenital anorectal abnormalities ranging from absent anus to anal membranes and fistulae. It is one major indication for the creation of colostomy in early neonatal life. This study was aimed at o describe and highlight the place of colostomy in the management of anorectal malformations. This article also reviews the issues relating to the choice of colostomy in anorectal malformation and common complications.Methods: The study was a prospective study carried put at a tertiary medical centre in Nigeria. It involved patients with a anaorectal malformation requiring the creation of colostomy.Results: A total of 19 neonates with anorectal malformation was seen over the period. The male to female ratio was approximately 1:2 with a female preponderance. Rectovestibular fistula was the commonest indication in females while recto-urethral fistula was commonest indication in males. Elective colostomy accounted for 78.9%.Conclusion: Anorectal malformation is the commonest indication for the creation of colostomy; this is closely followed by hircshsprungs disease. It is usually a part of the staged repair of anorectal malformation.The use of colostomy is acceptable as important in the initial management of patients with anorectal malformation. This affords the neonates the ability to feed and evacuate from the stoma. Complications are common and not life-threatening.Keywords: Colostomy, congenital, anorectal

Early elective colostomy following spinal cord injury.

Elective colostomy is an accepted method of bowel management for patients who have had a spinal cord injury (SCI). Approximately 2.4% of patients with SCI have a colostomy, and traditionally it is performed as a last resort several years after injury, and only if bowel complications persist when all other methods have failed. This is despite evidence that patients find a colostomy easier to manage and frequently report wishing it had been performed earlier. It was noticed in the author's spinal unit that increasing numbers of patients were requesting colostomy formation during inpatient rehabilitation following SCI. No supporting literature was found for this; it appears to be an emerging and untested practice. This article explores colostomy formation as a method of bowel management in patients with SCI, considers the optimal time for colostomy formation after injury and examines issues for health professionals.

Should Sleep-Deprived Surgeons Be Prohibited From Operating Without Patients' Consent?

Robert M. Sade, MD The effects of sleep deprivation on performance of physicians has been widely studied ever since the death of Libby Zion in 1984, the subsequent campaign by her parents and others to regulate physician work hours, and the passage of the so-called Libby Zion Law by New York State in 1989.[1] Impetus was added to investigations of the effects of sleep deprivation when the Accreditation Council for Graduate Medical Education (ACGME) adopted similar standards for accreditation of residency programs in the U.S. in 2003.[2] While sleep deprivation clearly affects mental and physical functioning, results of investigations of clinical outcomes have been mixed, some finding adverse effects on patient care, others finding no such effects.[3-6] The arguments for regulating work hours of residents have been extended to apply in a more limited way to attending surgeons. In a recent issue of the New England Journal of Medicine, sleep specialists published a paper that opens with this scenario: “A surgeon on overnight call responds to an 11 PM call from the hospital, where a patient has presented with an acute abdomen. After working up the patient for several hours, the surgeon decides to ... perform a bowel resection. By the time the procedure is completed ... it is time for morning rounds. The surgeon has not slept all night and is scheduled to perform an elective colostomy at 9 AM.”[7] The authors follow the vignette with a series of questions: “Does the surgeon have an obligation to disclose to the patient the lack of sleep during the past 24 hours and obtain new informed consent? “Should the surgeon give the patient the option of postponing the operation or requesting a different surgeon? “Should the hospital have allowed the surgeon to schedule an elective procedure following a night he was scheduled to be on call? “Should it allow a surgeon to perform elective surgery after having been awake for more than 24 hours?“ After discussion of the effects of sleep deprivation (fewer than 2 hours of sleep in the previous 24 hours), the authors answer these questions in the affirmative, with these statements: “...Patients awaiting a scheduled elective surgery should be explicitly informed about possible impairments induced by sleep deprivation and the increased risk of complications. “They should then be given the choice of proceeding with the surgery, rescheduling it, or proceeding with a different physician. “If patients decide to proceed, they should explicitly consent to do so — in writing, on the day of the procedure, in front of a witness, and ideally on a standardized form designed for this purpose.“ In the same issue of the Journal, three leaders of the American College of Surgeons, responded to this paper in a letter to the Editor, agreeing that sleep deprivation could be a problem for surgeons, but disputing the necessity or wisdom of mandating a signed informed consent document. They argued that, instead, surgeons should be better educated about the effects of sleep deprivation as well as other factors that may affect performance, enabling them to weigh all issues in order to provide the best patient care. “A call for mandatory disclosure,” they stated, “essentially eliminates the necessary judgmental latitude surgeons should possess to determine their fitness for providing optimal patient care.”[8] In the essays that follow, two authors of those publications, Dr. Charles Czeisler and Dr. Carlos Pellegrini, present arguments on either side of the question of whether sleep-deprived surgeons should be required to obtain informed consent from patients before elective surgery.

Wound infection after colostomy closure for imperforate anus in children: utility of preoperative oral antibiotics

Background/Purpose There is little published data on the efficacy of surgical infection prophylaxis in children. The purpose of this study was to assess wound infection rate in children undergoing colostomy closure for imperforate anus and evaluate the impact of bowel preparation and antibiotics. Methods Children younger than 18 years with imperforate anus who had a colostomy closure between January 1996 and December 2007 were identified. Data collected included demographics, bowel preparation, antibiotics, operative details, and postoperative infections. Comparison of mechanical bowel preparation and intravenous antibiotics with and without oral antibiotics was compared using χ 2 tests. Significance was defined as P < .05. Results A total of 118 patients were identified. Primary skin closure was done in 97%. Mechanical bowel preparation was used in 93%, intravenous antibiotics in 97%, and oral preoperative antibiotics in 52%. Wound infections occurred in 14% (n = 17). The addition of oral antibiotics to the standard regimen of mechanical bowel preparation with intravenous antibiotics did not alter infection rate (13% versus 17%, P = .64). Conclusion Wound infection in children undergoing elective colostomy closure for imperforate anus was 14%. Infection rate was not affected by use of oral antibiotics. Future studies may allow specific guideline development for infection prophylaxis in pediatric patients.

Limited Utility of Preoperative Studies in Preparation for Colostomy Closure

Numerous diagnostic and therapeutic practices are used in an attempt to reduce the morbidity of colostomy closures. Our principal aim was to evaluate the role of preoperative studies, specifically barium enemas and endoscopic examinations, performed before colostomy closures. Additionally, we wished to identify other practices involved in the perioperative management of patients undergoing colostomy closure that influenced morbidity. The records of 100 consecutive patients who underwent elective colostomy closure at University of Louisville Hospital between January 1989 and July 1995 were reviewed. Wound infection was the most common complication (12%). Various bowel preparations were equivalent in efficacy and did not influence the complication rate. Intermittent wound irrigation with antibiotics for 3 days postoperatively, via subcutaneous drains, was associated with a low incidence of incision infection. Preoperative barium enema or sigmoidoscopy were often performed but rarely useful. Performing these examinations merely increased hospital cost without a corresponding decline in morbidity.

Elective colostomy in the patient with a spinal cord injury: An ET nurse's perspective

The patient with a spinal cord injury presents significant challenges to the nurse seeking to promote an optimal state of physical wellness and maximum independence with self-care. This article describes the nature of spinal cord injuries and their long-term effects on the gastrointestinal system. The preoperative and postoperative needs that the WOC nurse must consider when designing a care plan for the patient with a spinal cord injury and a colostomy are discussed, as well as the indications and efficacy of elective colostomy surgery as a management alternative for the neuropathic bowel.

Elective Colostomy in the Patient with a Spinal Cord Injury

Elective Colostomy in the Patient with a Spinal Cord Injury

A convincing case for primary repair of penetrating colon injuries

Over the past 14 years, 146 patients with penetrating colon trauma were managed by primary repair with/without resection (PR, n = 55), and by diverting colostomy (DC, n = 91). These groups did not differ in terms of age, ISS (Injury Severity Scale), PATI (Penetrating Abdominal Trauma Index), a-AIS (abdominal Abbreviated Injury Scale), or preoperative hypotension. No intergroup differences were manifested in intra-abdominal complications (fistula/leak, abscess, pancreatitis, intestinal obstruction, wound dehiscence). The percentage of patients who experienced at least one major intra-abdominal complication did not differ statistically when the two groups were compared--12.7% in PR versus 11% in DC--although risk in both groups increased with the additional number of organs injured. Wound infection was significantly higher (p < 0.05) in the PR group (19.6%) compared with the DC group (9.4%). Mortality in the PR and DC groups was 0% and 3.6%, respectively. One hundred and ten patients who underwent elective colostomy closure following trauma had a 9.1% intra-abdominal complication rate and a 3.6% wound infection rate. These risks should be considered when colostomy is selected to manage patients with penetrating colon injury. These data support primary repair of all colon injuries, reserving skin closure for patients with limited collateral damage.

The Morbidity and Financial Impact of Colostomy Closure in Trauma Patients

During a 10-year period, 87 patients who had undergone elective colostomy closure at Bellevue Hospital were retrospectively reviewed in order to evaluate the morbidity of colostomy closure after traumatic injury and its financial impact. Sixty-two per cent of the colostomies were in the left colon and 38% were right sided. The interval from the original injury to colostomy takedown varied from 20 to 465 days, with a mean of 144 days. The mean postoperative hospital stay for the entire group was 15.13 days at a cost of $13,995. There were no deaths and no anastomotic leaks in the entire series, but a morbidity rate of 25% ensued. Small bowel obstruction was the most frequent significant complication, occurring in ten patients (11.5%) and resulting in a prolongation of hospital stay by 7 days at an additional cost of $6,500 per patient. One additional patient developed a subphrenic abscess which required operative drainage, necessitating an additional 24 days in the hospital at an increased cost of $22,200. Other complications which did not prolong hospital stay included eight superficial wound infections, one transient respiratory failure, and two patients who returned at a later date with incisional hernias at the stoma site. The 25% morbidity encountered in this series suggests that colostomy closure is not a low-morbidity procedure and should be considered as an important factor favoring primary repair. Coupled with the significant financial impact of both colostomy formation and takedown, ample justification exists for greater efforts in avoiding colostomy formation whenever feasible.

The Efficacy of Colostomy as a Bowel Management Alternative in Selected Spinal Cord Injury Patients

Although colostomy has been used to divert the fecal stream from pressure sore sites and to deal with fecal incontinence in patients with conus/cauda level injuries, its use on an elective basis to shorten and simplify the bowel routines of SCI patients to improve their quality of life has not normally been advocated. A questionnaire and two case histories were used to gather data relating to self-care and management of elimination in order to delineate criteria for consideration of elective colostomy. The study concludes that elective colostomy may be an appropriate alternative for some SCI patients, particularly those who have failed in self-care or for whom their vocation or avocation is impaired by prolonged bowel routines.

Colorectal laceration after manual-anal intercourse

Injuries and illnesses related to changing sexual behaviors are being reported with increasing frequency. A practice found predominantly in the homosexual community, "handballing," may result in occult but serious colorectal trauma. Described is the case of a 31-year-old man who presented with an acute abdomen due to colorectal laceration secondary to handballing. After emergency surgical repair, he had an uneventful recovery, and returned once for elective colostomy closure.