Temporary Loop Colostomy Research Articles

Stomal Prolapse Due to Sidedness of Transverse Loop Colostomy: A Retrospective Cohort Study.

Stomal prolapse (SP) is one of the most common complications of loop colostomy and can impair a patient's quality of life. Herein, we evaluated the risk factors for SP to prevent its occurrence after a transverse loop colostomy. This retrospective study included 84 patients who underwent loop transverse colostomy between January 2016 and December 2020. We evaluated the incidence of SP and examined the relationship between perioperative factors and SP using univariate and multivariate logistic regressions. SP occurred in 11 (13.0%) patients. Median time to SP was 99 postoperative days. In the univariate analysis, a right side abdominal wall stoma site, perioperative chemotherapy, and anti-VEGF antibody therapy were associated with a significantly higher incidence of SP. Multivariate analysis identified that construction of a temporary loop colostomy in the right transverse colon during rectal cancer surgery (odds ratio, 5.07; 95% confidence interval, 1.12-22.86) is an independent risk factor. In this study, multivariate analysis showed that the right side of the transverse colon was a risk factor for SP. Therefore, when constructing a transverse colon loop stoma, the stoma should be constructed in the left transverse colon to prevent SP.

Adaptation to the Resource Available in Construction of Stoma in Pediatric Stoma Care in Bangladesh: A Descriptive Analytical Study

Background: Stoma construction is a routine operation in the field of pediatric surgery. Commercially accessible resources, such as ostomy bags (either disposable or with extended lifespans), are often employed to care for these stomas. These may be rather pricey, especially in places like Bangladesh, and it might be difficult to get ones in the right size. Objective: In this study our main objective is to evaluate the efficacy of resource available in construction of stoma in Pediatric stoma care in Bangladesh. Method: From January 2014 through December 2015, a total of 60 patients were included in a prospective research done by the pediatric surgery department at Dhaka Medical College and Hospital. The research group consisted of patients less than 12 years old who had temporary loop colostomy or ileostomy in the pediatric surgical units at Dhaka Medical College & Hospital throughout the study period. Zinc oxide paste was first administered to the Peristomal skin after stoma formation. The stoma was covered with a betel leaf, which had a glossy, smooth outside surface and a rough inner surface. The size of the hole in the betel leaf was adjusted to accommodate the stoma. The stoma is protected by an additional leaf that is still fully intact. When nature calls, one must remove the undamaged leaf above it and wipe away the feces before moving on. The cleaned leaves were put to further use. Ostomy bags (like those made by Convatec) and adhesive paste (Stomahesive) are used to seal the bag to the Peristomal skin. Results: During the study, both the stoma bag and betel leaf groups had a wide range of ages, from one day to 4,320 days. In addition, both group anorectal malformations found as common indication 70% vs 73.33% (stoma bag vs betel leaf) followed by in stoma bag group 23.33% had Hirschsprung’s disease and 6.67% had Colonic atresia. Where as in betel leaf group 20% had Hirschsprung’s disease and 6.67% had Colonic atresia? In stoma bag group majority had ......

Postoperative complications of umbilical loop colostomy for anorectal malformations in neonates compared with the conventional abdominal stoma: a non-randomized study

BackgroundWe previously reported a pilot study of temporary umbilical loop colostomy for neonates with intermediate-type anorectal malformations (ARM) and recommended this technique because of its cosmetic excellence. We herein report...

V12-12 ROBOTIC CYSTOPROSTATECTOMY WITH PUBECTOMY AND ILEAL CONDUIT FOR PATIENTS WITH OSTEOMYELITIS PUBIS

You have accessJournal of UrologyBladder Oncology and Diversion1 Apr 2017V12-12 ROBOTIC CYSTOPROSTATECTOMY WITH PUBECTOMY AND ILEAL CONDUIT FOR PATIENTS WITH OSTEOMYELITIS PUBIS Ahmad Shabsigh Ahmad ShabsighAhmad Shabsigh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3218AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Osteomyelitis pubis is a rare complication of pelvic radiation and prostate surgery. This chronic condition has substantial impact on quality of life. Medical therapy has limited role and surgical resection is usually needed. Open prostatectomy or cystoprostatectomy with pubectomy is associated with difficult post-operative recovery. We report our early experience in robotic cystoprostatectomy with pubis symphysis debridement METHODS We present an instructional video of a 77 y.o. male with history of prostate cancer. s/p open radical prostatectomy 19 years prior to his surgery, complicated with multiple Bladder neck contractures over the years. He underwent salvage radiation therapy for biochemical failure. Developed urinary incontinence. Later he underwent an attempted bladder sling placement, followed by AUS and Urolume urethral stent. Due to AUS pump erosion and eventual explanation few months later. Every 6 months thereafter he was repeatedly treated for stones encrusting. He then developed OM of the pelvic bone for the last 4 years, complicated by bacteremia and extended IV antibiotics. RESULTS Up to 2016 four patients with chronic post radiation osteomyelitis pubis underwent robotic cystectomy with pubic symphysis debridement and ileal conduit urinary diversion. One patient needed a temporary loop colostomy. Average robotic operative time: 175 minutes. Average hospital Stay 5.3 days. Median EBL 75 ± 40 ml. Antibiotics were stopped within 4 weeks. One had high grade complication and none had recurrence of the osteomyelitis. CONCLUSIONS Robotic cystectomy with pubic symphysis debridement is a feasible alternative to open cystectomy with open resection of pubis symphysis. It may provide faster recovery. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1375 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ahmad Shabsigh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Right-sided temporary loop colostomy: a simple and safe alternative to protective loop ileostomy after low rectal anastomosis

Kontis, Elissaios MD; Perrakis, Nikolaos MD; Politidis, Valeri MD; Maniatis, Christos MD; Ntatsis, Konstantinos MD; Nomikos, Iakovos N. MD, FACS Author Information

Temporary umbilical loop colostomy for anorectal malformations

Transumbilical surgical procedures have been reported to be a feasible, safe, and cosmetically excellent procedure for various pediatric surgical diseases. Umbilical loop colostomies have previously been created in patients with Hirschsprung's disease, but not in patients with anorectal malformations (ARMs). We assessed the feasibility and cosmetic results of temporal umbilical loop colostomy (TULC) in patients with ARMs. A circumferential skin incision was made at the base of the umbilical cord under general anesthesia. The skin, subcutaneous tissue, and fascia were cored out vertically, and the umbilical vessels and urachal remnant were individually ligated apart from the opening in the fascia. A loop colostomy was created in double-barreled fashion with a high chimney more than 2 cm above the level of the skin. The final size of the opening in the skin and fascia was modified according to the size of the bowel. The bowel wall was fixed separately to the peritoneum and fascia with interrupted 5-0 absorbable sutures. The bowel was opened longitudinally and everted without suturing to the skin. The loop was divided 7 days postoperatively, and diversion of the oral bowel was completed. The colostomy was closed 2-3 months after posterior saggital anorectoplasty through a peristomal skin incision followed by end-to-end anastomosis. Final wound closure was performed in a semi-opened fashion to create a deep umbilicus. TULCs were successfully created in seven infants with rectourethral bulbar fistula or rectovestibular fistula. Postoperative complications included mucosal prolapse in one case. No wound infection or spontaneous umbilical ring narrowing was observed. Skin problems were minimal, and stoma care could easily be performed by attaching stoma bag. Healing of umbilical wounds after TULC closure was excellent. The umbilicus may be an alternative stoma site for temporary loop colostomy in infants with intermediate-type anorectal malformations, who undergo radical anorectoplasty via a non-abdominal approach.

Two-stage treatment (Mukai's method) with hybrid 2-port HALS (Mukai's operation) for complete bowel obstruction by left colon cancer or rectal cancer

During the initial emergency operation, a temporary loop colostomy (TLC) was constructed at the oral border of the region for subsequent radical resection. Then, radical surgery was performed by hybrid 2-port HALS (Mukai's operation) using the TLC as the hand access site. Left hemicolectomy was done in three patients, sigmoidectomy in two cases, low anterior resection in one case, and Hartmann's operation in one case. Radical surgery was not done in one patient with multiple distant metastases. The mean operating time was 3 h and 7 min (ranging from 1 h and 55 min to 3 h and 47 min), the mean blood loss was 146.4 ml (7-354 ml), the mean duration from TLC to HALS was 11.3 days (8-16 days), and the mean hospital stay after HALS was 13.9 days (9-20 days). Mild wound infection occurred postoperatively in 2/7 patients and ileus occurred in one patient. However, there was no anastomotic leakage/stricture or conversion to conventional laparotomy. These results suggest that 2-stage treatment (Mukai's method with Mukai's operation) is also applicable to large obstructing left colon or rectal cancers. This method is safe, less invasive, and achieves excellent results, including a good cosmetic outcome.

Aortoiliac endograft-enteric fistula due to an ingested toothpick

Foreign body ingestion is not uncommon, but in most patients the object passes without sequelae. In very few patients, the ingested foreign objects may perforate the gastrointestinal tract, causing potentially life-threatening complications. Pointed ingested objects such as toothpicks are the most common. Vascular perforation due to toothpick ingestion has rarely been reported. We present a patient with lower gastrointestinal bleeding secondary to simultaneous perforation of the sigmoid colon and the right iliac limb of an aortobiiliac endograft by an ingested toothpick. This arterioenteric fistula was treated in two stages. First as a bridging operation, a stent graft was inserted into the ipsilateral limb of the previous aortoiliac endograft to control the bleeding. Second, the aortoiliac endograft was removed, the aorta was oversewn, and an extra-anatomic axillobifemoral bypass restored the flow to the lower limbs. The colon perforation was treated with a proximal temporary loop colostomy. To our knowledge, this the first case of aortoiliac endograft-enteric fistula after endovascular abdominal aortic aneurysm repair caused by this extraordinary mechanism.

Two-port hand-assisted laparoscopic surgery for the 2-stage treatment of a complete bowel obstruction by left colon cancer: A case report

A 69-year-old woman presented to her local clinic with vomiting and abdominal distension. Since a bowel obstruction by left colon cancer was suspected due to a marked dilation of the transverse colon, she was referred to our hospital. On admission, an enema disclosed a complete obstruction at the splenic flexure of the colon. An emergency operation was performed, and a temporary loop colostomy was fashioned on the left side of the transverse colon within the range of resection for 2-stage radical surgery. On hospital day 16, a left hemicolectomy D2 was performed by 2-port hand-assisted laparoscopic surgery (2P-HALS) using the stoma as the hand access site, and the tumor was resected along with the removal of the stoma. After surgery, a slight wound infection occurred at the hand access site, but this healed with conservative management. On day 36, she was discharged from hospital. The histological diagnosis was Type 2 circumferential well-differentiated adenocarcinoma with local peritoneal dissemination. Our experience suggests that 2-stage surgery combined with 2P-HALS is applicable even to a large obstructing left colon cancer. This method is less invasive, safe and achieves excellent results, including a good cosmetic outcome.

Is temporary loop colostomy of the right transverse colon appropriate for complete obstruction by colorectal cancer?

We experienced 12 consecutive cases of complete bowel obstruction due to primary colorectal cancer. Among these patients, temporary loop colostomy (loop C) was performed within the resection zone for the primary tumor in 10 cases, and Hartmann's operation was performed in two cases. The loop C was located in the sigmoid colon in five cases and on the left side of the transverse colon in five cases. The interval until radical resection was from 13 to 35 days (mean: 20 days), the duration of surgery was from 2 h 5 min to 4 h 55 min (mean: 4 h 7 min), and the length of resected bowel ranged from 22.5 cm to 51.2 cm (mean: 29.8 cm). Mild wound infection was observed in two cases. Dukes' clinical stage was as follows: A in 0 case, B in 5 cases, C in 6 cases and D (distant metastasis) in 1 case. We have achieved good results over the past two years without performing standard loop C on the right side of the transverse colon.

Extraperitonealization of the anastomosis and sacral drain in restorative surgery for rectal carcinoma: a safety mechanism in the absence of a covering stoma.

A retrospective 10-year study was conducted on 473 patients who underwent rectal cancer surgery, to evaluate a surgical procedure which has been generally abandoned, but which we believe has a significant potential to reduce the incidence of the severe and often fatal complications caused by anastomotic breakdown following low anterior resection, especially when a covering stoma is absent. This procedure involves separating the anastomosis and sacral drain from the abdominal cavity by suturing the parietal peritoneum to the colon and mesocolon, and placing the sacral drain outside the peritoneal cavity, whereby contamination of the abdominal cavity is avoided should anastomostic leakage occur. Sphincter preservation was possible in 343 patients (72.5%) while 116 (24.5%) underwent abdominoperineal resection (APR). Of 331 patients who underwent sphincter-saving resection (SSR), 31 (9.4%) had primary protective colostomies. Radical RO-resection according to the International Union Against Cancer (UICC) was performed in 405 patients, and 65 (19.6%) underwent extended resections. Anastomotic leakage became clinically manifest in 33 patients (10%; or 11% when those with primary colostomies were excluded). Only 1 patient required relaparotomy while 32 were successfully treated with temporary loop colostomy in the right epigastrium. No deaths occurred following anastomotic leakage breakdown. Overall operative hospital mortality was 3.0%; 2.7% and 2.6% in the SSR and APR groups, respectively. The adjusted 5-year survival rates were 60% for APR and 72% for SSR.

Temporary colostomy in supralevator pelvic exenteration. A comparative study between stapled loop and loop colostomy

A temporary loop colostomy is created in most patients undergoing total supralevator pelvic exenteration with low rectal anastomosis. We report 16 patients comparing two different types of loop colostomy. In half of them a normal loop colostomy was made and refashioning of the stoma was necessary in two patients because of faecal spillover in the presence of anastomotic leakage. In the other eight patients a functional terminal colostomy was created by application of a TA 55 stapler on the efferent loop. In this group no refashioning of the stoma was necessary and no difficulties were encountered on closure of this type of colostomy. Because of the high incidence of anastomotic leakage in this population, the stapled loop colostomy is the preferred method of choice because it eliminates any possible faecal spillover.

Functional assessment of coloanal anastomosis with reservoir and excision of the anal transition zone

Conservation of the anal transition zone (ATZ) has been deemed necessary for continence after coloanal anastomosis (CAA) with reservoir. Therefore, we have studied functional and manometric results after CAA with reservoir and excision of the ATZ in 18 consecutive patients (mean age, 65.2 years; ten males and eight females), 17.4 months after closure of a temporary loop colostomy (Study 1). Twelve of the 18 initial patients were studied again 30.2 months after closure (Study 2). In Study 1, all patients underwent 1) a standardized interview, 2) a manometric study with measurement of anal pressure at rest (PR), voluntary contraction (VC), inhibitor anal reflex (IAR), conscious sensation (CS), and maximum tolerable volume (MTV), and 3) a liquid continence test (LCT) with measurement of colonic reservoir pressure during infusion. In Study 2, patients underwent all the same tests except the LCT. Results were compared with those of six controls (mean age, 65.8 years; two females and four males). In Study 1, 14/18 patients were continent; PR, VC, and CS did not differ among continent patients, incontinent patients, and controls. MTV was significantly lower in incontinent patients (mean +/- SD, 165 +/- 46.5 ml) than in continent patients and controls (mean +/- SD, 261 +/- 50.8 ml vs. 250.7 +/- 83 ml). IAR was not observed in continent or incontinent patients but was observed in controls. Contraction waves in the colonic reservoir during LCT were more frequent in incontinent patients (4/4) than in continent patients (4/14), and their amplitudes were higher (119 vs. 32 mm Hg). In Study 2, 12/12 patients were continent; PR and MTV remained unchanged except in the two initially incontinent patients, in whom MTV was increased. VC was slightly increased (94.7 vs. 116 mm Hg). IAR remained absent in all patients. We conclude that 1) excision of the ATZ did not increase the risk of incontinence, and 2) poor functional results were mainly due to small MTV and contraction waves in the colonic reservoir.

Rectovaginal separation operation after a "cutback" procedure for anorectal anomalies.

The "cutback" procedure has been widely utilized over the 25 years for correction of mild forms of ectopic anus encountered in newborn females. As these children have become adolescents, some are troubled by the cosmetic appearance created by this procedure, recurrent urinary tract infections, and persistent vaginitis from continued fecal soiling. The rectovaginal separation procedure described (1) separates the rectum from the vagina by interposing adjacent tissues, (2) elongates the rectal canal, and (3) utilizes flaps of perineal skin to gain a normal degree of separation of the anus from the vagina. Five girls, ages 6 to 15 years, have undergone this procedure with a temporary loop colostomy to protect the perineum during healing. The long-term functional and cosmetic results three to seven years later have been excellent in four patients. The fifth girl has been observed only five months, but seems to have an excellent cosmetic result.