Colostomy Site Research Articles

Single-port laparoscopic reversal of Hartmann's procedure through the colostomy site: technical aspects and early postoperative outcomes.

Single-port laparoscopic surgical approaches offer improved cosmetic outcomes and enhance recovery following surgery. The purpose of the study was to assess the reliability and efficacy of a single-port laparoscopic Hartmann's reversal(SPL-HR) through the colostomy site. Prospective data from consecutive patients who underwent SPL-HR between 2020 and 2024 was analysed. Once the colostomy was detached from abdominal wall, a single-port device was introduced through the colostomy site. After mobilizing the rectal stump and afferent colon, colorectal anastomosis was carried out using a circular stapler transanally under laparoscopic vision. Postoperative care and discharge decisions were made following the ERAS protocol. Patient demographics, details of Hartmann's procedure, intraoperative outcomes, and early postoperative outcomes were evaluated. SPL-HR was successfully performed in 23 of 27 patients (85.1%), with a median operation time of 92 (50-172) min and a median blood loss of 100 (10-360) mL. Five patients (21.7%) experienced a postoperative complication. Two of them experienced grade 3a complications according to Clavien-Dindo classification: one with an intraabdominal abscess and one with a hematoma at the colostomy site, both requiring drainage under local anaesthesia. Anastomotic leak or mortality wasn't observed in patients. Functional recovery measures such as first flatus time and time to resuming a soft diet were favourable, with a median length of hospital stay of 4 (2-9) days. The SPL-HR technique is a reliable and efficient method that is easy to perform. It has acceptable complication rates while improving postoperative recovery and reducing the length of hospital stay.

Colostomy fistula caused by segmental absence of intestinal musculature: a case report

BackgroundSegmental Absence of Intestinal Musculature (SAIM) is a rare condition associated with intestinal obstruction and perforation. Colostomy fistula as a presentation of SAIM and their association with anastomotic failure have not been previously reported. This case report aimed to raise awareness of this unique manifestation and its potential implications.Case presentationA 58-year-old male with a history of type 2 diabetes, hypertension, and lumbar hernia presented with diarrhea. Lower gastrointestinal endoscopy revealed a tumor in the rectum, for which he was diagnosed with a well-differentiated adenocarcinoma. The patient underwent a laparoscopic Hartmann operation. After the operation, an entero-entero-fistula was identified at the sigmoid colostomy site. Subsequently, laparoscopic reconstruction of the colostomy was performed, and the patient had a favorable postoperative course without complications. Histopathological examination confirmed the localized absence of the muscularis propria in the resected colon, with fibrosis and nearby ganglion cells.ConclusionsThis case highlights the rarity of a colostomy fistula as a manifestation of SAIM and emphasizes the need to consider SAIM in the differential diagnosis for such cases. The presence of SAIM-affected lesions poses a risk of anastomotic failure, underscoring the importance of assessing the risk of complications during future surgeries. Surgeons should be aware of the etiology and potential implications of SAIM to ensure appropriate management and minimize postoperative morbidity. Further studies are warranted to explore the underlying mechanisms and optimize surgical strategies for patients with SAIM and its associated complications. Increased awareness among clinicians is crucial for timely diagnoses and tailored interventions to improve patient outcomes.

V-041 ROBOTIC MONOLATERAL TAR FOR LATERAL INCISIONAL HERNIA IN PREVIOUS COLOSTOMY SITE

Abstract Background Novitsky described the Transversus Abdominis Muscle release (TAR) extending the retromuscolar plane (RMP) improving the midline restoration (MR) with high morbidity. The robotic approach seems to have the same effectiveness reducing wound complications. Video's comment A 58-year-old male submitted to Hartmann procedure for acute diverticulitis, developed an incisional hernia (IH) (3cm width) on colostomy site, L2-W1 according to IH-EHS classification and an umbilical IH of 2cm width (EHS classification: M3-W1), after Hartmann reversal. We planned the abdominal wall repair with R-TAR by drawing on the skin the dimension of the mesh with an overlap of 7cm from the defect, helping us to orient the dissection using transfascial needles. After the pneumoperitoneum created and the lateral-right sided-docking of Da Vinci Xi, we incised the lateral edge of right posterior rectus sheet (PRS) and dissected the RMP. The incision of the medial edge of the PRS and the identification of the linea alba allows the crossing-over to the contralateral RMP. We reduced the umbilical IH and dissected completely the left RMP to the flank defect and the Neurovascular Boundles. We started the division of TA fibers and we dissected the preperitoneal plane beyond the IH sac and to the arcuate line. We closed the defects with a 0-vloc and the peritoneum with a 3/0-vloc both barbed. We implanted a 15×30 Progrip selfigripping mesh and we closed the peritoneal-flap with a 2/0-vloc barbed suture. The patient was discharged in 2 days and any complication were recorded after 30 days.

OC-039 PROPHYLACTIC NEGATIVE PRESSURE WOUND THERAPY FOR COMPLEX VENTRAL HERNIA REPAIR, A CASE SERIES

Abstract Aims Presenting our 1-month results in 20 patients with prophylactic negative pressure (pNPWT) applied in complex ventral hernia repairs. Material & Methods pNPWT was applied when high surgical site occurrences (SSO) risk factors and when colorectal procedures, huge panniculectomies, active cutaneous/mesh infections or loss of domain are associated. Our results are compared with SSO incidence calculated with HW-RAT score. Results 10 men and 10 women with 67.55 (43–84) year-old. BMI 32.01 kg/m2 (24–55). 55% ASA III, 35% II, 10% I. Most relevant risk factors: 3 stoma closures, 3 loss of domain, 2 paraestomal, 2 peritonitis, 2 W3, 2 multi-recurrences, 1 infected mesh, 1 synchronic colonic fistula. HW-RAT SSO score (1-less risk- to 5 -maximum-): 3 II, 3 III, 12 IV and 2 V. pNPWT was applied to 17 midline wounds, 1 bilateral subcostal, 1 colostomy site and 1 midline+colostomy for 6–10 days (mode 7). 12 patients (60%) had 19 complications, 3 grade IIIB and one IVa. Only 1 patient (5%) had surgical site infection (SSI): 1 infected seroma presenting at 16th postoperative day requiring readmission, drainage, and negative pressure (grade IIIA). Global HW-RAT estimated SSI incidence: 15.76%. Two patients had other causes postoperative peritonitis, none of which affected the wound. At 1 month another 2 seromas (1 grade I, 1 grade III) and one 3cm haematoma appeared. Conclusions pNPWT in high-risk patients is safe and can significantly reduce SSI and SSO (in our series from 15% to 5%). Estimated NNT for preventing 1 SSI in the literature is 9 patients.

Cutaneous mucormycosis involving a colostomy site.

Cutaneous mucormycosis is a rapidly advancing fungal infection that most commonly occurs due to airborne spread or direct inoculation and requires early detection and prompt treatment for optimal survival. Major risk factors include diabetes, transplantations, malignancies, surgical procedures, and HIV. Diagnostic criteria are based on microscopy and culture. We present an immunocompromised patient with cutaneous mucormycosis that developed in a peristomal ulcer following a hemicolectomy procedure. Histopathologic evaluation was indicative of mucormycosis. Intravenous posaconazole treatment was initiated, but unfortunately, the patient's condition deteriorated and he passed away.

A Synchronous Robotic Resection of Colorectal Cancer and Liver Metastases-Our Initial Experience.

Synchronous robotic colorectal and liver resection for metastatic colorectal cancer (mCRC) is gaining popularity. This case series describes our initial institutional experience. A retrospective study of synchronous robotic colorectal and liver resections for metastatic colorectal cancer (March 2020 to December 2021). Eight patients underwent synchronous robotic resections. The median age was 59 (45-72), and the median body mass index was 29 (20-33). Seven received neoadjuvant chemotherapy, and five rectal cancers received neoadjuvant radiotherapy. One patient had a low anterior resection with major hepatectomy, two had low anterior resection with minor hepatectomy, and one had abdominoperineal resection with major hepatectomy. One patient had a left colectomy with minor hepatectomy, and two had right colectomies with minor hepatectomy. We used five robotic 8/12 mm ports in all cases. Extraction incisions were Pfannenstiel in four patients, colostomy site in two patients, one perineal incision, and one supra-umbilical incision. The median estimated blood loss was 200 mL (25-500), and the median operative time was 448 min (374-576). There were no intra-operative complications or conversions. Five patients had the liver resection first, and two of six anastomoses were performed before the liver resection. The Median length of stay was 4 days (3-14). There were two post-operative complications, prolonged ileus and DVT, with a Clavien-Dindo complication grade of I and II, respectively. There were no readmissions or reoperations. All colorectal and liver resection margins were negative. Synchronous robotic colorectal and liver resection can be performed effectively utilizing one port configuration with acceptable short-term outcomes and quality of oncologic resection.

A Case of Subcutaneous Colon Perforation at the Site of Colostomy 4 Years after Hartmann’s Operation

A Case of Subcutaneous Colon Perforation at the Site of Colostomy 4 Years after Hartmann’s Operation

A case of laparoscopic resection of carcinoma arising at a colostomy site

症例は72歳，女性。穿孔性S状結腸癌に対して腹腔鏡下結腸部分切除及び単孔式人工肛門造設を施行された。再発なくフォロー終了されていたが術後25年経過しS状結腸人工肛門部に腫瘍を認め，精査にてリンパ節転移を伴う人工肛門部癌と診断された。人工肛門部皮膚を全周性に切開して同部位にApplied Alexis® Wound Retractorを装着して腹腔鏡手術を施行した。D3リンパ節郭清及び脾弯曲結腸を授動して左半結腸を切除し人工肛門を再造設した。人工肛門部癌に対する腹腔鏡下手術は低侵襲にリンパ節郭清や腸管授動を施行でき，有用な術式と考えられたため報告する。

Primary Adenocarcinoma at Colostomy Site: Report of a Clinical Case

AbstractColorectal cancer (CRC) is the fourth most frequently diagnosed cancer in the United States and it is found in 17% of patients thought to have complicated diverticular disease. However, primary adenocarcinoma rarely occur in the colostomy site and the risk of developing malignancy is similar to that of any other colonic segment. Polyps found in CRC screenings can be divided into the following types: hyperplastic polyps, polyps with no malignant potential, adenomatous polyps, polyps with malignant potential, and malignancies. Local complications of the colostomy can appear in the immediate, early, or late postoperative period, with an incidence ranging from 15 to 30%; neoplasia is even less common.

Colostomy orifice complications: a case report of a prolapsed colostomy with necrosis of the eviscerated greater omentum.

Evisceration and necrosis of the greater omentum at the site of a prolapsed colostomy is a rare situation. Considered an early stoma complication, it often occurs during the first month after surgery. We report the observation and our attitude to such a situation in a 56-year-old patient who underwent initial surgery for a locally advanced rectal adenocarcinoma after receiving neoadjuvant radio-chemotherapy. A loop colostomy for decompression was performed due to large bowel obstruction. On the 10th day after surgery, he was readmitted for an oedematous prolapsed colostomy and a necrotic end of the greater omentum, which eviscerated through the colostomic hole, secondary to severe ascites. Emergency re-intervention involving resection of the prolapsed stoma with the necrotic segment of the omentum was performed. The three factors associated with the development of this rare peri-colostomy complication were: emergency surgery, locally advanced rectal tumor, and increased intra-abdominal pressure.

Hirschsprung’s Disease in a Twin Neonate With One Suffering From Multiple Skip Segments

This is a new case, affecting a twin that both with Hirschsprung’s disease, one was suffering from long-segment Hirschsprung’s disease with skip segmented. Our surgeon suspected the absence of abnormal vessel tortuosity in the transitional zone; thus, the appendix was sent for permanent pathology. There were ganglion cells in the colostomy site but no ganglion was found in the appendix. Complete biopsies from different parts of the intestine demonstrated positive ganglion cells in the transverse colon, ascending colon, and the distal ileum, jejunum, and duodenum, and negative ganglion cells in the rectum, sigmoid, descending colon, appendix, and 5 cm far from the ileocecal valve were observed. Therefore, the Kimura procedure was done. The most important key in such cases is the surgeons’ observation during operation.

Trans-Colostomy Placement of a Button Gastrostomy Tube for Malignant Bowel Obstruction in Patients with Peritoneal Carcinomatosis

Abstract Purpose The aim of the study is to evaluate the feasibility, safety, and efficacy of the trans-colostomy placement of a button gastrostomy tube for patients with malignant bowel obstruction due to peritoneal carcinomatosis. Material and Methods Data from seven consecutive patients who presented with malignant bowel obstruction due to peritoneal carcinomatosis involving the colostomy site and underwent trans-colostomy button gastrostomy tube placement between 2013 and 2020 were retrospectively reviewed. We assessed technical and clinical success rate, procedure time, duration of improvement, and complication rate. Results The technical success rate of the trans-colostomy button gastrostomy tube placement was 100%, and average procedure time was 25 minutes. Clinical symptoms of malignant bowel obstruction resolved in four out of seven (57%) patients. Average duration of improvement in the four patients with clinical success was 170.8 days. There were no complications associated with the procedure. Conclusion Trans-colostomy button gastrostomy tube placement might be a safe and feasible treatment option for patients with malignant bowel obstruction due to peritoneal carcinomatosis.

Colostomy Reversal in a Patient with an LVAD: A Case Report

Introduction Patients with existing Left Ventricular Assist Device (LVAD) who undergo non-cardiac surgery have a 9% risk of surgical site infection and up to a 44% chance of peri- and post-operative bleeding. This, along with the hemodynamic compromise of advanced heart failure, often makes LVAD patients prohibitively high risk for non-emergent surgeries. We present a successful case of an LVAD implanted into a patient with prior colostomy, who then later underwent a technically difficult colostomy reversal and parastomal hernia repair, without any of the aforementioned complications. Case Report A 44-year-old male with a history of non-ischemic cardiomyopathy (LVEF 20%) subsequently suffered perforated diverticulitis which was treated with a sigmoid colon resection with end colostomy. Later that year, he required LVAD (HeartMate 3™ Abbott) placement for cardiogenic shock requiring chronic inotropic support. Prior to his LVAD placement, colostomy reversal was considered to reduce the risk of post-operative LVAD driveline infection. Ultimately, colostomy reversal was deferred due to concern that a colorectal anastomosis may leak due to poor perfusion. However, he then developed a parastomal hernia with loss of domain which hindered colostomy care. Because he was weaned off inotropes and had clinically improved after his LVAD placement, it was felt he would be hemodynamically stable to tolerate colostomy reversal and subsequent parastomal hernia repair. His anticoagulation with warfarin was held for bridging enoxaparin one week before surgery. The colostomy site fascial defect was closed primarily and a sublay of synthetic mesh was placed. The surgical dissection at the old colostomy site was done to ensure there was adequate distance between the surgical field and LVAD driveline. The presence of the LVAD driveline along the right abdominal wall limited the ability to perform a right sided component separation but it was done on the left side to gain intra-abdominal domain. He remained stable during and after the procedure. Warfarin was re-started post-operative day one. Summary This demonstrates feasibility to receive an LVAD with an existing colostomy, despite risk of infection. It also highlights that patients with an LVAD can undergo colostomy reversal and parastomal hernia repair, despite risk of poor anastomosis healing, bleeding, subcutaneous infection, and LVAD driveline infection.

A Case Report of Laparoscopic Surgery for Metachronous Adenocarcinoma Occurring at the Site of Colostomy after Hartmann's Procedure forRectal Carcinoma

A Case Report of Laparoscopic Surgery for Metachronous Adenocarcinoma Occurring at the Site of Colostomy after Hartmann's Procedure forRectal Carcinoma

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.

Laparoscopic Hartmann's Reversal: Application of a Single-Port Approach Through the Colostomy Site.

Purpose Recently, laparoscopic reversal of Hartmann’s colostomy was performed with favorable outcomes by many surgeons. We partially applied the concepts of single-port laparoscopic procedure through the colostomy site to remove intraperitoneal adhesion during initial step of the laparoscopic Hartmann’s reversal. This study aimed to evaluate the feasibility and safety of the laparoscopic reversal of Hartmann’s colostomy with the application of single-port laparoscopic techniques through the colostomy site.Methods From October 2008 to November 2018, the laparoscopic Hartmann’s reversal was attempted in 20 patients. After colostomy take-downs, the single-port device was installed at the colostomy site and the single-port laparoscopic procedure was performed to remove intraperitoneal adhesions to provide space for additional trocars. After additional trocars were inserted, the descending colon and rectal stump were mobilized, and the colorectal anastomosis was completed. We retrospectively reviewed the medical records and analyzed the data to identify the perioperative complication rates as the primary outcome.Results Of the 20 patients, 3 patients (15.0%) had open conversions due to severe adhesions. Intraoperative small bowel injuries occurred in 2 patients (10.0%) and these were repaired through the colostomy site. Postoperative complications developed in 4 patients (20.0%) and were managed with medical treatments or wound closures under local anesthesia.Conclusion The single-port laparoscopic procedure through the colostomy site is sufficiently safe in order to complete the Hartmann’s reversal. We recommend that the colostomy site should be used as the access route into the abdominal cavity for the Hartmann’s reversal.

Clinical and Radiologic Predictors of Parastomal Hernia Development After End Colostomy.

OBJECTIVE. Parastomal hernia (PSH) is a common complication that can occur after end colostomy and may result in considerable morbidity. To select the best candidates for prophylactic measures, knowledge of preoperative PSH predictors is important. This study aimed to determine the value of clinical parameters, preoperative CT-based body metrics, and size of the abdominal wall defect created during end colostomy and measured at postoperative CT for predicting PSH development. MATERIALS AND METHODS. Sixty-five patients who underwent permanent end colostomy with at least 1 year of follow-up were included. On preoperative CT, waist circumference, abdominal wall and psoas muscle indexes, rectus abdominis muscle diameter and diastasis, intra- and extraabdominal fat mass, and presence of other hernias were assessed. On postoperative CT, size of the abdominal wall defect and the presence of PSH were determined. To identify independent predictors of PSH development, univariate analysis with the Kaplan-Meier method and multivariate Cox regression analysis were performed. RESULTS. PSH developed after surgery in 30 patients (46%). Three independent risk factors were identified: chronic obstructive pulmonary disease (COPD) as a comorbidity (hazard ratio [HR], 6.4; 95% CI, 1.9-22.0; p = 0.003), operation time longer than 395 minutes (HR, 3.9; 95% CI, 1.5-10.0; p = 0.005), and maximum aperture diameter of more than 34 mm (HR, 5.2; 95% CI, 2.1-12.7; p < 0.001). PSH developed in all nine patients with a maximum abdominal wall defect diameter of more than 50 mm at the ostomy site. CONCLUSION. COPD, longer operation time, and larger abdominal wall defect at the colostomy site can predict PSH development. Intraoperative creation of an abdominal wall ostomy opening that is more than 34 mm in diameter should be avoided.

Colostomy site recurrence in rectal cancer.

Colostomy site recurrence in rectal cancer.

Profile of Hirschsprung’s disease cases diagnosed in tertiary care teaching hospital: a retrospective observational study

Background: To date, there are very few studies of Hirschsprung’s disease. Hence, the study was conducted to profile Hirschsprung’s disease in a tertiary care setting.Methods: This is a retrospective observational study that evaluated the admitted patients with Hirschsprung’s disease in the pediatric surgery department. Biopsy was taken from the patient in the form of the full thickness of intestine, seromuscular biopsy, resection from the colostomy site when doing closure and or appendix was taken and subjected to histopathological study with routine eosin and haematoxylin stain.Results: Among the study population, 21(28.8%) children were aged less than one month, and only 10(13.7%) were aged 11 years and above. There were 45(61.6%) participants were male and 28(38.4%) female. Most common biopsy site was appendix in 33(46.2%), followed by Ileum full-thickness biopsy in 6(8.2%) , Ileum Seromuscular biopsy in 5(6.8%%) ,Colon full-thickness biopsy in 4(5.6%) subjects. Among the 73 participants, 46(63%) were clinically suspected cases, and the remaining 27(36.9%) were clinically established cases. Among clinically suspected, the majority (50.7%) had ganglionic cells only in proximal segments.Conclusions: the Hirschsprung's disease diagnosis was established mostly in younger males.

A Case of Mucinous Adenocarcinoma Arising from a Colostomy Site 35 Years after Amputation of the Rectum for Rectal Cancer

A Case of Mucinous Adenocarcinoma Arising from a Colostomy Site 35 Years after Amputation of the Rectum for Rectal Cancer