Loop Stoma Research Articles

The Reversal of Stoma Following Open Abdomen Management.

Bowel stoma formation is very often required during open abdomen (OA) management; we aim to report our stoma reversal series following OA management retrospectively. A retrospective analysis of 31 patients who underwent the reversal of the stoma created during OA management between January 2008 and September 2014 was performed. Twenty-eight of these 31 patients were included in this study. The stoma-related complications are more common after OA management during waiting time interval for reversal. At this time interval, patients with jejunostomy had more stoma-related complications than patients with ileostomy (p = 0.008) and colostomy. (p = 0.001). Waiting time interval was shorter for reversal of jejunostomy than reversal of ileostomy (p = 0.014) and colostomy (p = 0.001). Operation time for jejunostomy (p = 0.016) and colostomy reversal (p = 0.001) were significantly longer than the ileostomy reversal. There was no difference between early and late reversal of stoma regarding morbidity and mortality. The stoma-related complications are more common following OA management during waiting time interval for stoma reversal. The reversal time is more critical for this kind of patients especially with life-threatening complicated jejunostomy. For loop stoma created during OA management, the reversal may be performed after average 50days without increasing morbidity and mortality. The reversal of end stoma created during OA management has high morbidity. If it is possible, loop stoma should be preferred during OA management.

Spontaneous closure of stoma.

Intestinal loop stoma is a common surgical procedure performed for various benign and malignant abdominal problems, but it rarely undergoes spontaneous closure, without surgical intervention. Two male patients presented to our emergency surgical department with acute abdominal pain. One of them was diagnosed as having rectosigmoid perforation and underwent diversion sigmoid loop colostomy after primary closure of the perforation. The other was a known case of carcinoma of the rectum who had already undergone low anterior resection with covering loop ileostomy; the patient underwent second loop ileostomy, this time for complicated intestinal obstruction. To our surprise, both the loop colostomy and ileostomy closed spontaneously at 8 weeks and 6 weeks, respectively, without any consequences. Spontaneous stoma closure is a rare and interesting event. The exact etiology for spontaneous closure remains unknown, but it may be hypothesized to result from slow retraction of the stoma, added to the concept of a tendency towards spontaneous closure of enterocutaneous fistula.

RESULTS OF RESTORATIVE OPERATIONS USING MODIFIED METHOD OF FORMATION OF TEMPORARY LOOP INTESTINAL STOMAS

The article estimated the results of excision of temporary loop colo- and ileostomas using method of their formation with erfixation of parietal peritoneum to aponeurosis of abdominal external oblique muscle in 18 patients. The authors concluded that the formation of temporary loop stoma with fixation of parietal peritoneum to aponeurosis had many advantages and could ter mprve he rsuls of the resoraive operation.

Surgical methods of treatment of intestinal passage disturbances with the characteristics of constipation in patients with intestinal stoma based on own experience

Stoma is an intestinal fistula created in emergency or by elective indications, and it is done to drain out the digestive tract content. In some patients there is a disturbance passage of gastric contents through the stoma, which may take the form of chronic constipation or even periodic subileus that will sooner or later require surgical treatment. The aim of the study was the assessment of the causes and method of treatment of constipation in patients with intestinal stoma. A total of 331 patients with stoma followed by Ostomy and Proctology Outpatient Clinic were included in the study in the years 2011-2014. The study included 146 women and 185 men and the average age was 61.3 ± 12.7 years. Within the entire froup, 273 patients had the end stoma performed whereas in 58 patients the loop stoma was created. The highest percentage of patients were the ones with diverticulosis and colorectal cancer, i.e. 132 and 114 patients respectively. A stoma was created in 35 patients due to inflammatory bowel disease (IBD), in 23 patients because of cancer, in 14 as a result of injuries and in 13 due to rectovaginal fistula. Out of the entire group subject to study (331 patients) 93 patients (28.1%) suffered from constipation. 50 patients with constipation required surgical intervention. The most common indication for surgical treatment was the parastomal hernia (36 patients, 72%), other indications were the narrowing of the stoma (5 patients, 10%), its collapse (6 patients, 12%) or prolapse (3 patients, 6%). Parastomal hernia was responsible for 84% of constipation within the stoma and 86.1% were treated with laparotomy (31 out of 36 patients). Other causes of constipation were the stomal stenoses (5 patients), collapse of the stoma (6 patients) and stomal prolapse (3 patients). All patients were treated surgically with a good final result. Constipation associated with dysfunction of the stoma in most cases should be treated surgically. Parastomal hernia is the most common cause of constipation in the stoma. Treatment should be performed in due time because of the possibility of developing complications, especially dangerous one is a strangulated parastomal hernia and ischemia of stoma.

Standardized technique for single port laparoscopic ileostomy and colostomy

Single site laparoscopic techniques and technology exploit maximum usefulness from confined incisions. The formation of an ileostomy or colostomy seems very applicable for this modality as the stoma occupies the solitary incision obviating any additional wounds. Here we detail the principles of our approach to defunctioning loop stoma formation using single port laparoscopic access in a stepwise and standardized fashion along with the salient specifics of five illustrative patients. No specialized instrumentation is required and the single access platform is established table-side using the 'glove port' technique. The approach has the intra-operative advantage of excellent visualization of the correct intestinal segment for exteriorization along with direct visual control of its extraction to avoid twisting. Postoperatively, abdominal wall trauma has been minimal allowing convalescence and stoma care education with only one parietal incision. Single incision stoma siting proves a ready, robust and reliable technique for diversion ileostomy and colostomy with a minimum of operative trauma for the patient.

La stomie de dérivation réduit le taux de fistule symptomatique après résection antérieure basse du rectum. Une étude multicentrique randomisée

ObjectiveThe aim of this randomized multicenter trial was to assess the rate of symptomatic anastomotic leakage in patients operated on with low anterior resection for rectal cancer and who were intraoperatively randomized to a defunctioning stoma or not.Summary Background DataThe introduction of total mesorectal excision surgery as the surgical technique of choice for carcinoma in the lower and mid rectum has led to decreased local recurrence and improved oncological results. Despite these advances, perioperative morbidity remains a major issue, and the most feared complication is symptomatic anastomotic leakage. The role of the defunctioning stoma in regard to anastomotic leakage is controversial and has not been assessed in any randomized trial of sufficient size.MethodsFrom December 1999 to June 2005, a total of 234 patients were randomized to a defunctioning loop stoma or no loop stoma. Loop ileostomy or loop transverse colostomy was at the choice of the surgeon. Inclusion criteria for randomization were expected survival > 6 months, informed consent, anastomosis < or = 7 cm above the anal verge, negative air leakage test, intact anastomotic rings, and absence of major intraoperative adverse events.ResultsThe overall rate of symptomatic leakage was 19.2% (45 of 234). Patients randomized to a defunctioning stoma (n=116) had leakage in 10.3% (12 of 116) and those without stoma (n=118) in 28% (33 of 118) (odds ratio: 3.4; 95% confidence interval, 1.6–6.9; P < 0.001). The need for urgent abdominal reoperation was 8.6% (10 of 116) in those randomized to stoma and 25.4% (30 of 118) in those without (P < 0.001). After a follow-up of median 42 months (range, 6–72 months), 13.8% (16 of 116) of the initially defunctioned patients still had a stoma of any kind, compared with 16.9% (20 of 118) those not defunctioned (not significant). The 30-day mortality after anterior resection was 0.4% (1 of 234) and after elective reversal a defunctioning stoma 0.9% (1 of 111). Median age was 68 years (range, 32–86 years), 45.3% (106 of 234) were females, 79.1% (185 of 234) had preoperative radiotherapy, the level of anastomosis was median 5 cm, and intraoperative blood loss 550 mL, without differences between the groups.ConclusionDefunctioning loop stoma decreased the rate of symptomatic anastomotic leakage and is therefore recommended in low anterior resection for rectal cancer.

A Patient who Detached a Loop Stoma, Resected a Portion of the Small Intestine Outside the Body as Self-Mutilation, and Underwent Emergency Surgery: A Case Report

A Patient who Detached a Loop Stoma, Resected a Portion of the Small Intestine Outside the Body as Self-Mutilation, and Underwent Emergency Surgery: A Case Report

Managing high-output stomas: module 2 of 3

All patients with short bowel should be provided with some lumenal source of nutrition if it is safe to do so. Dietary needs are very complex, and support and education through a dedicated dietetics team is pivotal and will improve clinical outcome (Culkin et al, 2009). Energy requirements are higher than in normal people if patients are to be maintained on enteral nutrition alone. These requirements can be met by eating highenergy food, having oral sip feeds, or high-energy enteral feeds at night via a naso-gastric or gastrostomy tube. If increasing the enteral intake fails to meet the requirements or leads to an unacceptable amount of diarrhoea/stoma output, parental nutrition (PN) is indicated (Nightingale and Woodward, 2006). Enteroclysis or fistuloclysis, which is the infusion of enteral feed into the distal limb of a loop stoma or enterocutaneous fistula, might be a viable alternative in some cases (Levy et al, 1988; Teubner et al, 2004). Dietary advice will differ according to the intestinal anatomy that the patient has. There are three main categories of patients with short bowel syndrome: mid-ileal resection, jejunocolic anastomosis and jejunostomy (or high-output enterocutaneous fistula) (Figure 1). Patients with a mid-ileal resection rarely run into nutritional or fluid balance problems. Vitamin B12 is absorbed in the terminal ileum and this will need to be supplemented in these patients. Bile acid malabsorption can also be a cause of Simon Gabe

ANAL CANCER MANAGEMENT AND OUTCOMES IN NORTHERN IRELAND 2002-2006

IntroductionAnal cancer is a relatively uncommon malignancy and requires a multidisciplinary management approach.Aims/BackgroundThe aim of this study was to review the surgical and oncological management and outcomes for anal cancer...

Two-stage repair of low anorectal malformations in girls

Background / purpose Anorectal malformations (ARMs) affect 1 in 4000–5000 births. Low ARMs are nowadays treated in the first stage rather than at second or third stages. However, reports suggest problems with continence in these children because of wound dehiscence and infection; thus, protective colostomy may still be recommended. Colostomies do have complications, but the question is whether these disadvantages outweigh the protective effect on wound healing after anal reconstruction. The aim of this study was to define whether two-stage repair of low ARMs in girls is truly a setback or whether it is beneficial. Patients and methods During the period of June 2008–June 2012, 30 female patients suffering from low ARMs were admitted to Mansoura University Children Hospital. Their ages at the time of surgery ranged from 3 to 11 months (mean age 6.2) and they were divided into two equal groups. The fistula location was defined either anocutaneous or anovestibular according to the Pena classification. The choice of management was totally randomized; thus, patients of group A underwent a two-stage posterior sagittal anorectoplasty and group B patients underwent a one-stage posterior sagittal anorectoplasty operation. Data recorded included age, fistula location, associated anomalies, operation performed, operative time, length of hospital stay, approximate cost, and postoperative complications. Results A comparison of data showed that treatment of patients of group A involved more time and money and they had a longer duration of hospital stay than did patients of group B. Seven patients (47%) in group A and nine patients (60%) in group B showed postoperative complications. Wound infection occurred in three patients (20%) of group A and in eight patients (53%) of group B. More importantly, two (13%) wound disruptions occurred among the three cases with wound infection in group A, whereas six (40%) disruptions occurred among the eight patients (53%) with wound infections in group B. The incidence of redo operation in group B was found to be significantly higher than in group A. Mucosal prolapse occurred in only one patient (7%) of group B. Complications related to colostomy occurred in group A only; five patients (33%) suffered skin excoriation around the stoma and one patient (7%) showed a prolapsed distal stoma loop. Constipation was noted during follow-up in five patients (33%) of group A and in six patients (40%) of group B. Conclusion Two-stage repair of low ARM in girls is truly beneficial, as we could perform a successful operation and achieve continence in the child regardless of the complications of colostomy, which are temporary and tolerable. Keywords : anorectal malformations, colostomy, posterior sagittal anorectoplasty, two-stage repair of low anorectal malformation

Skin Bridge Loop Stoma in a Gynecologic Oncology Unit

Abstract Objective: The aim of this study was to determine the feasibility and safety of the skin bridge loop technique for colostomy and ileostomy in a gynecological oncology unit. Design: The study's design is a prospective observational case series of skin bridge loop stoma formation. Materials and Methods: All patients in a gynecologic oncology unit requiring defunctioning ileostomy or colostomy as an independent surgical procedure from October 2010 to February 2012 were included in this study. The setting was a tertiary referral center for gynecological oncology and minimal access surgery in Dublin, Ireland. The skin bridge loop enteric and colonic stoma formation technique involves carving a permanent skin bridge within the stoma site. The skin bridge is then fashioned under the loop and tensioned to the required level of elevation. Results: No stomal complications arose in this series of 16 patients in follow-up to 73 weeks. Stomal education was commenced from the first postoperative day, and self-...

ストーマ再造設で改善した創感染合併ループストーマ管理困難の１例

ストーマ再造設で改善した創感染合併ループストーマ管理困難の１例

Simple Laparoscopic Technique of Transverse Loop Colostomy Prolapse

Prolapse of loop colostomy or ileostomy is a common complication and markedly reduces patient quality of life. Many techniques have been reported for surgical or nonsurgical management of prolapse. We here report a simple laparoscopic technique for loop stoma prolapse. The prolapsed intestine (usually distal limb) was fixed to the abdominal wall by laparoscopic suturing. This technique should represent a good option for management of loop colostomy prolapse and can be applied to loop ileostomy or single stoma prolapse.

Prevention of parastomal hernia by intraperitoneal onlay mesh reinforcement at the time of stoma formation

Parastomal hernia (PSH) is a very frequent complication after creation of a permanent colostomy. The aim of this study is to assess the safety and prophylactic effect of intraperitoneal onlay mesh (IPOM) reinforcement of the abdominal wall at the time of primary stoma formation to prevent PSH occurrence. This multicentre prospective study concerned 20 patients operated for low rectal carcinoma between 2008 and 2010. Those patients had an elective and potentially curative abdominoperineal excision associated with IPOM reinforcement of the abdominal wall with a round composite mesh centred on the stoma site and covering the lateralised colon. There were 8 men and 12 women with a median age of 69years (range: 44-88) and a body mass index of 27 (range: 21-35). The major outcomes analysed in the study were operative time, complications related to mesh and PSH occurrence. Patients were evaluated 1month after surgery and then every 6months with physical examination and computed tomography scan (CT-scan). For PSH, we used the classification of Moreno-Matias. Surgery was performed by laparoscopy in 17 patients and by laparotomy in 3; 12 had an extraperitoneal colostomy, and 8 had a transperitoneal colostomy. The median size of the mesh was 15cm (range: 12-15). The median operative time was 225min (range: 175-300), and specific time for mesh placement was 15min (range: 12-30). One month after surgery, one patient presented with a mild stoma stenosis that was treated successfully by dilatation. With a median follow-up of 24months (range: 6-42), no other complication potentially related to the use of the mesh was recorded and no mesh had to be removed. On clinical examination, one patient (1/20=5%) had a stoma bulge that appeared a few months after surgery, but was not associated with symptoms. CT-scan evaluation confirmed that all the patients with a normal clinical examination had no PSH and revealed that the patient with the stoma bulge had a stoma loop hernia (type 1a hernia). This patient was followed up for 36months, no clinical or radiological aggravation of the stoma loop hernia was observed, and he remained totally asymptomatic. With 95% of excellent results, IPOM reinforcement at the time of end colostomy formation in selected patients is a very promising procedure. A drawback of this technique is the possibility of developing a stoma loop hernia due to sliding of the exiting colon between the covering mesh and the abdominal wall. However, this risk is low, and no adverse clinical consequence for the patient was noted in our series.

Closing the audit loop—stoma complications within 3 weeks of surgery

Following the 2005 nationwide prospective audit of stoma complications (which identified 34% of stomas as problematic), Jude Cottam and Karen Richards set out to identify the incidence of stoma complications in the UK, to highlight any dissimilarity from centre to centre and to ascertain if the height of the stoma is a predisposing factor. The audit was commenced in February 2010 and completed in January 2011. Unfortunately, the data are not comparable to the 2005 audit due the lack of centres participating (96 in 2005 vs 44 in 2010) and numbers of stomas (3970 in 2005 vs 1197 in 2010).

Technique for constructing an incisionless laparoscopic stoma

Minimally invasive surgery continues to evolve, and with the advent of single-port laparoscopic access incisionless stoma, creation is possible. Outlined below is the technical approach to the incisionless stoma. It can be applied to the construction of ileostomies as well as colostomies, end, or loop stomas. Our early experience reveals favorable outcomes. This is perhaps one of the least technically demanding procedures that can be performed through a single incision laparoscopic port.

Modified triangulating stapling technique for closure of a temporary loop stoma

To describe a new stapling technique for closure of a temporary loop stoma and report the results of a retrospective investigation of its efficacy. Thirty-nine patients underwent a total of 40 loop stoma closure procedures, performed by the same surgeon using the same method, between 2004 and 2009. Thirty-six procedures were performed after rectal surgery, 1 was done for rectal malignant lymphoma, 2 were performed in the same patient after resection of rectal gastrointestinal stromal tumor, and 1 was performed after colonic surgery. The short-term outcomes were evaluated retrospectively. For this technique, after the minimum necessary dissection of both limbs of the bowel from the abdominal wall, the everted part of the oral limb is returned to its proper anatomy. The stoma is closed in the vertical direction using two lines of staples in an everted fashion. The stoma was located in the terminal ileum (n = 36), transverse colon (n = 3), or sigmoid colon (n = 1). The mean operating time was 55 min and the estimated blood loss was 32 g. There were two postoperative wound infections and one anastomotic stenosis. Stapling closure of a temporary loop stoma with two lines of staples may be a feasible alternative that decreases morbidity and reduces the operating time.

Diversion stoma after colorectal surgery: loop colostomy or ileostomy?

The total rate as well as the clinical outcome of anastomotic leakage in colorectal and coloanal anastomosis necessitates a loop stoma for fecal diversion. The aim of this study was to determine the outcome of loop transverse colostomy compared to loop ileostomy as a temporary defunctioning stoma following colorectal surgery with colorectal or coloanal anastomosis. Data of 200 patients between January 2003 and January 2009 were analyzed in this two-center study to determine the surgical outcome in patients with loop colostomy (n = 100) in comparison to loop ileostomy (n = 100) for fecal diversion including outcome of stoma creation and complication rates during stoma reversal. During stoma placement, dermatitis and renal insufficiency occurred significantly more often in the loop ileostomy group than in the loop transverse colostomy group (15% vs. 0%; p < 0.001 and 10% vs. 1%; p = 0.005). During stoma reversal, wound infection occurred significantly more often in the loop transverse colostomy group than in the loop ileostomy group (27% vs. 8%; p < 0.001). Time to first defecation was significantly shorter in the loop ileostomy group after both placement and reversal (4 ± 2 vs. 2 ± 1; p < 0.001 and 3 ± 2 vs. 2 ± 1; p < 0.001). Hospital stay was significantly shorter in the loop ileostomy group than in the loop transverse colostomy group after stoma closure (18 ± 15 vs. 13 ± 6; p < 0.001). Both methods provide a good operative outcome with low complication rates. We do recommend the loop ileostomy in all patients in which dehydration is not to be expected since wound infection rate is lower and hospital stay is shorter during stoma reversal.

Loop Ileostomy and Colostomy—A Comparison between Supporting Plastic Rods and Epicutaneous or Subcutaneous Silicon Drains

Purpose: Beside the conventional plastic rods, different techniques and materials have been proposed in the last years to prevent the loop from retraction into the abdominal cavity. The aim of this retrospective comparative study was to assess three different techniques of loop support. Methods: The study included 65 pa- tients who had loop ileostomy or colostomy formed. Depending on the decision of the operating surgeon, one of three techniques was chosen to fixate the stoma loop: an epicutaneous plastic rod (group 1, n = 14), an epicutaneous suture-fixated silicone drain (group 2, n = 27), or a subcutaneous silicone drain (group 3, n = 24). Results: The majority of patients (85%) received loop ileostomy. Pain intensity was significantly (p = 0.0014) different among the three groups. A total of 19 patients (30%) suffered a complication. There was a tendency towards less complications if the stoma was secured by a silicone drain with epicutaneous fixation. Comfort with stoma care was significantly different, with group 3 experiencing the best results. Conclusions: Using a subcutaneously tunnelled silicon drain as a stoma bridge results in less complications, less pain and higher satisfaction as compared to the conventional plastic rod. Conventional plastic rods should be avoided.

Laparoskopische Reparation der parastomalen Hernie

Parastomal hernias are a common complication after stoma formation. An exact evaluation of the history of the patients reveals clinically impairing symptoms in the majority of patients. The surgical treatment should generally be based on the augmentation or even replacement of the abdominal wall by non-resorbable meshes. The laparoscopic repair can be performed using the intraperitoneal placement of a mesh according to Sugarbaker with a wide lateralization of the stoma loop, the keyhole-technique, which means an incised mesh placed around the stoma loop, or the combination of both techniques (sandwich-technique). By far the best results can be achieved with the sandwich-technique. The recurrence rate in our series is less than 3% with an acceptable complication rate. The literature demonstrates high recurrence rates after keyhole-repair and the Sugarbaker-technique was also shown to be ineffective by our own data. In summary the laparoscopic sandwich-technique is a technically challenging but very successful method for long-lasting repair of parastomal hernias leading to an astonishingly low recurrence rate.