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At least 19 recordsLinked to original sources
PubMed1990

[Complications of colostomies and colostomy closure].

Three hundred and sixty patients underwent 369 colostomies over 7 years, 66 for benign and 303 for malignant disease, and were followed up for an average of 20 months. Stomas were made electively in 246 cases and urgently in 123. Thirty-seven stomas were brought out through incision and 332 from separate sites. End colostomy was made in 179 cases, loop colostomy in 136 and double barrel colostomy in 54. There were 102 complications in 85 patients (27.6%). The most common complication was wound infection (10.8%). The total number of complications was not related to the urgency of the procedure, the disease process, or the stoma site. Wound infection, however, increased in incisional stomas. Extraperitoneal tunneling of end colostomy did not decrease the complication rate of parastomal hernia or intestinal obstruction. Sixteen cases (4.3%) received another operation for complications. Eighty-five patients the colostomy closed on an average of 3.4 months after its creation. Four patients had 5 complications (5.9%). Two patients required another operation. Complications increased with Hartmann closures and may be related to the timing of the colostomy closure.

Adolescent↗
PubMed1987

Temporary colostomy for trauma. A new method to simplify colostomy closure.

A technique for construction of a functional loop colostomy is described for the management of colonic injuries in which complete fecal diversion is not required. The colostomy and mucous fistula are converted into a functional loop colostomy at the initial procedure and exteriorized through a single stoma. Subsequent colostomy closure is simplified. Intraperitoneal colostomy closure can usually be performed by mobilizing the colon at the stoma site without resorting to formal laparotomy.

Colon↗
PubMed1986

The colostomy plug: a new disposable device for a continent colostomy.

A new disposable device for colostomy control is described. It is a two-piece system consisting of an adhesive base plate and a disposable colostomy plug, attachable to the plate. The plug is made of a soft, pliable plastic material with open cells, containing a carbon filter which allows flatus to pass odour-free. It is packed and compressed in a water-soluble film, which disintegrates immediately after insertion, allowing the plug to expand and prevent the passage of faeces. The device has been tested in 53 patients. Faecal continence and the passage of flatus without noise or odour was achieved in 90%. The median application period until the plug became obstructed with mucus or faeces was 8 h (range 5-24 h or more), the application period being somewhat longer for patients who used bowel irrigation. Patients not using bowel irrigation applied a colostomy bag during the night.

Adult↗
PubMed1977

Colostomy and colostomy closure.

A series of 181 adult patients subjected to colostomy was studied, almost all of whom had disease rather than injury. The complication rate was 28 per cent. One hundred of these patients had a subsequent colostomy closure with a complication rate of 17 per cent. Of the patients who had both procedures, 35 (35 per cent) had one or more significant complications. The causes and prevention of these complications are described.

Adult↗
PubMed1989

[Colostomy patients--well cared for, if counseled. Experiences of a colostomy counselling center].

The postoperative care of stoma patients concerns the surgeon, the nurse, the relatives as well as the family doctor. In past years, specialized stomatherapy services became more important, and they represent a real necessity for the patients, according to our own experience. We plead for a broad stoma patient care including stomatherapy services in all cases, either during hospitalization or as an out-patient service after having left hospital.

Adult↗
PubMed1989

The true cost of protective loop colostomy.

Transverse loop colostomies are commonly used to "protect" low colorectal anastomoses after anterior resection for rectal carcinoma. However, anastomotic leaks occur despite proximal decompression. We studied 61 consecutive patients who underwent anterior resection to evaluate the cost of loop colostomy as reflected by morbidity, mortality, and length of post-operative hospital stay. Colostomy patients had significantly greater blood loss (736 vs. 500 ml, p = 0.004), more blood transfusions (1.55 units vs. 0.41 units, p less than 0.001), and longer operations (238 vs. 193 min, p = 0.005). They were also older (68 vs. 65, p = 0.13), had lesions closer to the anal verge (10.2 vs. 11.4 cm, p = 0.07), and had more infectious complications (13.6% vs. 2.6%, 0.05 less than p less than 0.1) than patients without colostomies. Colostomy was not related to sex or stage. There were no anastomotic leaks among those with colostomies and only one among those without colostomies; there were no associated mortalities. Patients with colostomies stayed an additional 10 days, on average, when readmitted for colostomy closure. The 22 patients who received loop colostomies had postoperative stays averaging one-third longer than patients without colostomies (16 vs. 12 days, p = 0.004). In both groups, the 8th postoperative day was the mean for resumption of a regular diet; all patients were eating a regular diet by the 12th postoperative day. The delay in discharging colostomy patients was due to the additional time necessary for patients to learn to change their appliance and irrigate their stoma. Proximal diverting colostomies may more than double the total dollar cost of anterior resection, although DRG reimbursement is the same with or without a colostomy. This additional cost could be reduced by initiating ostomy teaching in the preoperative period and by reducing the use of unnecessary colostomies.

Adenocarcinoma↗
PubMed1992

The present role of colostomy in the management of trauma.

The role of colostomy in the treatment of abdominal trauma has changed over the past several decades. Primarily as a result of its successful use in military settings, colostomy initially was the mainstay of treatment for penetrating injury to the colon, rectal injury, and some forms of blunt trauma. Subsequent civilian experience with the techniques of primary repair of penetrating colon injury resulted in a decrease in the number of colostomies performed. Coupled with this experience, early data on adverse outcome from colostomy closure tended to support the trend of the ever-diminishing place of colostomy for trauma. Colostomy has always been used for two purposes in trauma care: prevention or arrest of fecal contamination of the peritoneal cavity and diversion of the fecal stream. Despite the decreased need for colostomy in some forms of penetrating colon injury, there are several conditions that still utilize colostomy to accomplish one or both of these purposes. Indications for colostomy can now be regarded as absolute or relative depending upon the need for diversion or the requirement to prevent contamination. There are relatively few contraindications to colostomy use. Present results of colostomy closure do not represent excessive risk to the patient and should not impact negatively on the decision to perform a colostomy for trauma.

Abdominal Injuries↗
PubMed1990

Rates of morbidity and mortality after closure of loop and end colostomy.

The purported ease and safety of closure of loop colostomy are cited as reasons for avoiding end colostomy, with or without resection. However, data comparing the complications of loop colostomy closure and end colostomy takedown and anastomosis are sparse. We analyzed data from 93 consecutive colostomy closures, of which 62 were loop and 31 were end colostomies. The two groups were comparable with respect to age, the underlying disease and risk factors, such as coronary artery disease, diabetes, hypertension, steroid dependence, hypoalbuminemia and smoking. Closure of end colostomies took longer and was associated with more loss of blood than closure of loop colostomies. However, the mortality rates for closure of loop (4.8 per cent) and end (3.2 per cent) colostomies were not significantly different. The complication rates were identical (16 per cent). Although none of the other risk factors were associated with increased rates of mortality or morbidity, the detrimental effects of steroid dependence and preoperative hypoalbuminemia were striking. All four of the deaths and 60 per cent of the complications occurred in patients with steroid dependence or hypoalbuminemia, or both. The rates of wound infection after primary or secondary closure of the stoma site were not significantly different. We concluded that loop colostomy closure is not associated with fewer complications than closure of end colostomy, even though the latter takes longer and is more difficult. Hypoalbuminemic and steroid-dependent patients should undergo colostomy closure with caution, if at all. Primary closure of the stomal site is safe and reduces the length of hospital stay.

Adrenal Cortex Hormones↗
PubMed1986

Raising a colostomy--results of a prospective surgical audit.

A prospective surgical audit of all colostomies fashioned over a 1-year period in one hospital was conducted. Of one hundred and ten colostomies there were 56 loop and 52 end stomas. Following the formation of the colostomy a proforma was completed and the surgeon interviewed to document the precise surgical technique employed. Whilst in hospital the patients were regularly reviewed and the colostomies assessed by a surgeon and stomatherapist using a scoring system. Follow up was continued until closure of the colostomy or for a minimum period of 1 year. Only 53 (48%) of patients saw a stomatherapist preoperatively. This rate was higher in elective (86%) than in urgent cases (15%). The surgial technique used did not appear to influence the outcome of any given colostomy. However, failure to cruciate the posterior rectus sheath may predispose to stomal stenosis and the use of a subcutaneous polyethylene rod to support a loop colostomy often led to infection. Tension of the colostomy led to complications in 29 cases (26%), this was often the precipitating event to other complications and led to the only colostomy-related death. Registrars with experience of fewer than 5 colostomies received their training largely from other registrars rather than consultants. This prospective surgical audit has disclosed that fashioning a colostomy carries significant stoma related morbidity, most of which is potentially avoidable. Appropriate audit can contribute to the maintenance and improvement of surgical standards.

Colostomy↗
PubMed1985

Complications of colostomy closure.

The records of 83 patients with 85 colostomy closures at Charity Hospital, New Orleans from January 1976 through June 1981 were reviewed. There were 47 complications in 30 patients (36 percent) with no deaths. The material used for anastomosis and fascial closure, the precipitating or underlying disease, the site of colostomy, and the length of operation did not influence the complication rate. The major factor affecting the complication rate was the interval of time from creation of the colostomy to its closure. Those patients who underwent closure after a 90 day interval had a lower overall complication rate than comparison groups with less than a 30 day interval and 30 to 90 day intervals (p less than 0.05). Other factors that appeared to influence the complication rate were as follows: loop colostomies had a lower suture line complication rate than divided colostomies, patients who underwent relaparotomy and closure had a higher complication rate than those whose closures were confined to the colostomy site, and wounds left open or that underwent delayed primary closure had a lower infection rate than wounds closed primarily. Thus, loop colostomies appear to have fewer complications at the time of closure than divided stomas. This is most likely related to the necessity for relaparotomy in some of the patients with divided stomas and the need for minimal mesenteric dissection required for most loop colostomy patients. Divided stomas should still be created if indicated, but when a choice exists, loop colostomies are preferable. Contaminated wounds are best managed with secondary closure or delayed primary closure. Because of the significant difference in complication rates between intervals from formation to closure of a colostomy, all patients should have their colostomies closed only after a minimum of 90 days has elapsed.

Adolescent↗
PubMed1992

Loop colostomy for management of rectal tears and small-colon injuries in horses: 10 cases (1976-1989).

Loop colostomy was performed in 10 horses as treatment for grade-III rectal tears (n = 6 horses), small-colon infarction (n = 2 horses), perirectal abscess and stenosis (n = 1 horse), and small-colon stricture (n = 1 horse). In 7 horses, the colostomy was constructed through a single incision low in the left flank, with closure of the incision around the stoma (single-incision technique). In 3 horses, 2 of which had colostomy performed as a standing procedure, the selected segment of small colon was placed from a flank incision into a separate, small incision low in the left flank (double-incision technique). Five horses underwent colostomy reversal (at 18 to 63 days) and 2 of these horses, both with grade-III rectal tears, recovered completely. Of 8 horses that did not survive, 6 died from the primary disease or associated complications. Technical problems associated with colostomy accounted for death of 2 horses. One horse had gastric rupture attributable to suture occlusion of the small intestine after colostomy reversal, and another horse had complications of incisional infection after repair of a peristomal hernia. Small-colon prolapse through the stoma necessitated premature reversal of the colostomy in a horse that was euthanatized because of worsening laminitis. Minor complications of the colostomy procedure were partial stomal dehiscence (n = 4 horses), partial dehiscence of the flank wound after colostomy reversal (n = 2 horses), and small ventral midline hernia after colostomy reversal (n = 1 horse). Loop colostomy may be of benefit to horses with rectal tears, provided it is done soon after the tear occurs.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Colostomy as treatment for complications of spinal cord injury.

We reviewed our experience with colostomy performed in 20 spinal cord injury (SCI) patients to determine the effectiveness and safety of colostomy when it is performed for a late complication of SCI. Objective evaluation of gastrointestinal function, ie, colonic transit time and anorectal manometry, was performed in six patients with chronic gastrointestinal complaints to identify the site and severity of bowel dysfunction. Twelve patients had colostomy performed for chronic gastrointestinal problems, seven as an adjunct in the treatment of perineal pressure ulcers, and one for rectal cancer. When patients with difficult bowel evacuation or incontinence were considered, colostomy reliably simplified bowel care, relieved abdominal distention, and prevented fecal incontinence. The amount of time spent on bowel care decreased from an average of 98.6 min/day to 17.8 min/day (p less than .05) after colostomy. When performed as an adjunct in the treatment of pressure ulcers, colostomy provided a dry, clean environment, and seven of seven ulcers healed. Colostomy was well accepted by all patients; all patients with chronic gastrointestinal complaints reported that colostomy improved the quality of their lives. Objective testing differentiated between failure of the colon to adequately transport material to the rectum and inability to adequately evacuate the rectum. Testing was useful in choosing the level at which a colostomy was created, and, in one instance, it identified a specific syndrome (ischemic proctitis) which required colostomy.

Colostomy↗