A continent colostomy: The magnetic stoma cap.

An apparatus to create continence in an end left-sided colostomy in dogs is assessed. The device consists of a samarium-cobalt magnetic ring encased in methyl methacrylate and a magnetic cap. The ring is implanted in the abdominal wall and the colon delivered through it and matured to the skin. The stoma is later obturated by the magnetic cap to provide continence. Ten dogs exposed to "uncoated" samarium-cobalt magnets for periods of up to eight months showed no elevation of cobalt levels in the serum or tissues and no histopathologic changes on postmortem examination. In twelve dogs, magnetic rings were used to create continent colostomies. Eleven of twelve dogs followed for periods up to eight months were continent and tolerated the appliance well. One ring was extruded after a peristomal skin dehiscence occurred. Two skin strictures appeared and were readily controlled by digital dilatation. Sinus, fistula, or infection were not seen. Clinical application of this device is discussed.     

自制小儿肠造口扩肛器及人工肛门袋用于造口护理

目的预防小儿肠造口处肠管狭窄,降低吻合口处感染发生率。方法采用随机数字表法将行暂时性结肠造口患儿40例分为观察组和对照组各20例。观察组采用自制小儿肠造口扩肛器配合人工肛门袋进行造口护理,每天扩肛治疗1次。对照组采用常规造口护理方法,肠造口排便后使用康乐宝儿童型人工造口袋,常规使用手指润滑后扩肛。观察两组造口肠管狭窄、造口周围皮肤情况等。结果观察组造口皮肤完好率、排便通畅率及患儿家属对造口护理满意度显著高于对照组,造口狭窄发生率显著低于对照组(P<0.05,P<0.01)。结论自制小儿人工肛门袋配合肠造口扩肛器扩肛的应用,可有效预防肠造口术后并发症;起到堵住造口,训练定时排便,改善造口患儿长期使用造口袋的不便。     

Miles手术的结肠造瘘口并发症防治

目的 探讨Miles手术结肠痿口并发症的原因和防治措施。方法 回顾性分析126例Miles手术所出现的造口并发症。结果 造口并发症发生98例,其中造口坏死5例、造口回缩7例、造口脓肿、脱出各l例、造口狭窄9例、造口切口旁疝7例和造口周围皮肤炎症97例。结论 并发症常由于术中或术后处理不当引起。     

Transverse colostomy or loop ileostomy as diverting stoma in colorectal surgery

This study summarizes the clinical results after 61 operations including diverting stomas in 56 patients. 29 transverse colostomies and 32 loop ileostomies were constructed over a 2-year period. Two thirds of the operations were performed on acute indications. The patients were followed up with regard to closure rate and complications up until the end of 1985. Within this period there was a closure rate of 38% and a stoma-related complication rate of 21% without any significant difference between the two different groups of stomas. The complications following ileostomy appeared to be more serious than those after transverse colostomy.     

Extraperitoneal colostomy in laparoscopic abdominoperineal resection using a laparoscopic retractor

Although extraperitoneal colostomy is often performed to prevent postoperative parastomal hernia formation following an open abdominoperineal resection of lower rectal cancer, it has not been widely employed laparoscopically because of the difficulty associated with the extraperitoneal route. This paper describes a laparoscopic extraperitoneal sigmoid colostomy using the Endo Retract? Maxi instrument. This surgical technique is easy, and helps to prevent the development of parastomal hernias.     

The theoretically ideal donor site dressing.

Many of the choices for managing split-thickness skin graft donor sites are satisfactory, but none is ideal. Epidermal regeneration in a donor site is readily available for clinical study. We have reviewed experimental studies of epidermal regeneration and applied those results to the clinical study of a new donor site dressing. This dressing is a vapor-permeable, transparent, polyurethane film with a polyvinyl ether adhesive. Used on 100 patients, it was found to be safe and effective in allowing rapid and painless healing. Although the dressing is occlusive and theoretically could promote infection in a contaminated wound, no infections were encountered. Comparison was made with 15 patients managed by other methods. No marked difference in healing time was noted clinically. The striking advantage of the new dressing was painless healing.     

Incisional hernia at the site of a stoma

Objective  Incisional hernia at the site where a patient had previously had a stoma has not been clearly studied. The aim of this study is to determine the incidence and associated factors that may lead to an incisional hernia related to the reversal of an intestinal stoma. Patients and methods  An analysis was made of 70 cases of intestinal reconnection. All patients received Cefotaxime or Ceftazidime during anaesthesia induction and two more doses at 1–8 h in the post-operative period. In all of the cases, closure of the stoma site was effected as a primary closure using no. 1 polyglycolic acid continuous suture. There followed wound lavage with iodopovidone, and the skin was closed with simple sutures using polypropylene 3/0. No drain was left in situ in any of the cases. The study considered the following aspects: demographic characteristics of the study group; illnesses giving rise to the need for stoma formation; the stoma site itself; clinical aspects, including body mass index (BMI); the incidence of incisional hernia; and any complications involving the surgical wound. Results  At this hospital, the cause of requiring treatment with stoma formation was diverticular disease of the colon principally, and the age of the patients varied from 36 to 87 years (median 61). The incidence of incisional hernia at the stoma site was 22 cases (31.4%), presenting equally in both sexes and with greater frequency under the following circumstances: during the first year of follow-up and in patients with concomitant illnesses, principally diabetes. Local complications involving the surgical wound occurred in six cases (8.5%). Conclusion  The incidence of incisional hernia at the stoma site was found to be 31.4% in this study, which is a high incidence of hernias with simple repair.     

Parastomal hernia in relation to site of the abdominal stoma

Parastomal hernia is a common late complication of enterostomy, especially colostomy, and sometimes requires surgical treatment. A possible contributory factor, location of the stoma in relation to the rectus abdominis muscle, was studied by examination of 130 patients with permanent intestinal stoma. The bowel had been brought out through the rectus abdominis muscle in 107 patients and lateral to it in 23 patients. The respective prevalence of parastomal hernia in these groups was 2.8 per cent and 21.6 per cent. The highly significant difference indicates that enterostomy should be constructed through the rectus abdominis muscle, not lateral to it.     

Laparoscopically inserted button colostomy as a venting stoma and access port for the administration of antegrade enemas in African degenerative leiomyopathy

African degenerative leiomyopathy (ADL) is a rare incurable disorder seen in African children, predominantly in southern and south-eastern Africa. ADL presents as chronic intestinal pseudo-obstruction. Management is traditionally conservative, with surgery restricted to the management of complications. We have placed Malone antegrade continence enema (MACE) stomas in the grossly dilated colon to vent accumulated gas and administer antegrade bowel enemas. This is done mainly for relief of gaseous distension and constipation in an attempt to provide symptomatic relief and improve quality of life. In this article, we present our preliminary results of laparoscopically assisted technique to insert a Mic-Key gastrostomy device as a 'button colostomy' in 8 patients over the past 6? years.     

Two-stage laparoscopic approaches for high anorectal malformation: Transumbilical colostomy and anorectoplasty

BackgroundTrans-umbilical colostomy (TUC) has been previously created in patients with Hirschsprung's disease and intermediate anorectal malformation (ARM), but not in patients with high-ARM. The purposes of this study were to assess the feasibility, safety, complications and cosmetic results of TUC in a divided fashion, and subsequently stoma closure and laparoscopic assisted anorectoplasty (LAARP) were simultaneously completed by using the colostomy site for a laparoscopic port in high-ARM patients.MethodsTwenty male patients with high-ARMs were chosen for this two-stage procedure. The first-stage consisted of creating the TUC in double-barreled fashion colostomy with a high chimney at the umbilicus, and the loop was divided at the same time, in such a way that the two diverting ends were located at the umbilical incision with the distal end half closed and slightly higher than proximal end. In the second-stage, 3 to 7 months later, the stoma was closed through a peristomal skin incision followed by end-to-end anastomosis and simultaneously LAARP was performed by placing a laparoscopic port at the umbilicus, which was previously the colonostomy site. Umbilical wound closure was performed in a semi-opened fashion to create a deep umbilicus.ResultsTUC and LAARP were successfully performed in 20 patients. Four cases with bladder neck fistulas and 16 cases with prostatic urethra fistulas were found. Postoperative complications were rectal mucosal prolapsed in three cases, anal stricture in two cases and wound dehiscence in one case. Neither umbilical ring narrowing, parastomal hernia nor obstructive symptoms was observed. Neither umbilical nor perineal wound infection was observed. Stoma care was easily carried-out by attaching stoma bag. Healing of umbilical wounds after the second-stage was excellent. Early functional stooling outcome were satisfactory.ConclusionsThe umbilicus may be an alternative stoma site for double-barreled colostomy in high-ARM patients. The two-stage laparoscopic approaches for high-ARM, TUC and stoma closure with simultaneously LAARP are both technically feasible and safe with excellent cosmetic result.     

Techniques for determining the efficacy of treatment of osteoporosis

Summary Each of the presently available noninvasive methods used to determine the nature and degree of changes in skeletal mass has significant advantages and limitations. Dual photon absorptiometric techniques generally have a very low radiation dose. They are also less expensive to construct than other systems. However, they provide information only on a highly localized portion of the axial skeleton. Computed tomography offers significant potential advantages over other techniques, but requires further work for the solution of inherent technical problems. Similarly, considerable additional work is required for the Compton scattering technique; the technical problems associated with this are even more formidable. Neutron activation analysis permits the direct in vivo measurement of total calcium content of the body and hence, skeletal mass. However, while there is vast clinical and research experience with partial body and total body neutron activation, the techniques are generally not routinely available for application in clinical centers. The question as to whether DPA of the spine, or total body calcium measurement best reflects changes in bone mass after therapy has not been resolved.     

Laparoscopic appendicectomy: the ideal procedure for laparoscopic skill training for surgical registrars

OBJECTIVE: Appendicectomy is a very common surgical procedure performed by registrars. It is mainly carried out by surgical registrars as an open procedure in many government hospitals. We aimed to evaluate laparoscopic appendicectomy as a laparoscopic training skill in a clinical setting for our registrars. METHODS: A retrospective analysis of all attempted laparoscopic appendicectomies over 12 months by experienced surgeons and registrars was done. Factors evaluated were operating time, conversion rate, postoperative hospital stay, morbidity and mortality. RESULTS: There was no statistically significant difference in operating time for surgeons and registrars (mean, 53 minutes vs. 60 minutes), conversion rate (10% vs. 11%). Mean hospital stay for patients operated on by surgeons was 3.1 days and 3.2 days for registrars. Morbidity was equal with both surgeons and registrars. CONCLUSION: We conclude that laparoscopic appendicectomy is a safe laparoscopic training tool for registrars with basic laparoscopic knowledge who have had a proper apprenticeship, and can be done in a clinical setting.