Perineal colostomy: an alternative to avoid permanent abdominal colostomy: operative technique,results and reflection

Background

The most common injury to indicate definitive stoma is rectal cancer. Despite advances in surgical treatment, the abdominoperineal resection is still the most effective operation in radical treatment of malignancies of the distal rectum invading the sphincter and anal canal. Even with all the effort that surgeons have to preserve anal sphincters, abdominoperineal amputation is still indicated, and a definitive abdominal colostomy is necessary. This surgery requires patients to live with a definitive abdominal colostomy, which is a condition that modify body image, is not without morbidity and has great impact on the quality of life.

Aim

To evaluate the technique of abdominoperineal amputation with perineal colostomy with irrigation as an alternative to permanent abdominal colostomy.

Method

Retrospective analysis of medical records of 55 patients underwent abdominoperineal resection of the rectum with perineal colostomy in the period 1989-2010.

Results

The mean age was 58 years, 40 % men and 60 % women. In 94.5% of patients the indication for surgery was for cancer of the rectum. In some patients were made three valves, other two valves and in the remaining no valve at all. Complications were: mucosal prolapse, necrosis of the lowered segment and stenosis.

Conclusion

The abdominoperineal amputation with perineal colostomy is a good therapeutic option in the armamentarium of the surgical treatment of rectal cancer.     

Methods for siting emergency stomas in the absence of a stoma therapist

Introduction

Stomas often have to be sited in emergencies by trainees who may have had little training in this. Emergency stomas and stomas where the site has not been marked preoperatively by a stoma therapist are more prone to complications. These complications may severely affect a patient’s quality of life. Advice in the literature on how to best site stomas is conflicting. We compared two easy anatomical methods of siting stomas to sites chosen by a stoma therapist and looked at how this site was affected by the patients’ body mass index (BMI).

Methods

Patients undergoing elective colorectal surgery were seen either pre or postoperatively. Each patient’s BMI was recorded and the positions of three different potential stoma positions (site G: the gold standard, marked by a stoma therapist; site S: marked using a pair of scissors against the umbilicus; site H: halfway between the umbilicus and anterior superior iliac spine) were compared.

Results

The two fixed anatomical methods described (method S and method H) both gave poor results. The most common reason for poor siting was the proximity of a skin crease. There was a statistically significant correlation between the patient’s BMI and the laterality of the gold standard site.

Conclusions

The two simple anatomical methods described here do not provide a shortcut to effective siting. A more effective method may be calculating the laterality of the site using the patient’s BMI, and then moving up/down to avoid a skin crease and improve the patient’s view for changing the bag. This deserves further study.     

前矢状入路直肠肛门成形术在肛门闭锁中的应用效果观察

目的：分析前矢状入路直肠肛门成形术在肛门闭锁中的应用效果。方法选取本院2010年10月~2013年10月诊治的肛门闭锁患者70例作为研究对象,将患者随机分为观察组与对照组,每组各35例。对照组采用常规结肠造瘘术,观察组采用前矢状入路直肠肛门成形术治疗。比较两组的术中出血量、住院时间、并发症发生率以及整体疗效。结果对照组中显效25例,有效9例,无效1例,总有效率为97.14%;观察组中显效22例,有效12例,无效1例,总有效率为97.14%。观察组的术中出血量明显少于对照组,住院时间明显短于对照组（P＜0.05）。观察组中有1例发生切口感染,并发症发生率为2.86%,对照组中有6例（直肠回缩和肛门狭窄各1例,切口感染4例）发生并发症,并发症发生率为17.14%,观察组并发症发生率明显低于对照组（P＜0.05）。结论前矢状入路直肠肛门成形术在肛门闭锁中具有良好的应用效果,值得临床推广应用。     

Advanced rectal cancer

The best treatment of advanced rectal cancer remains uncertain. The aim of this study was to determine the outcome after palliative procedures in patients with advanced rectal cancer. One hundred and three patients treated over a seven-year period were identified, including 30 with local invasion, 18 with local metastases, and 55 with distant metastases. Patients were grouped into two groups: those who underwent palliative resection (68) and those who were treated without rectal resection (55). The nonresected group included patients who underwent diverting colostomies (28) and those who received multimodality therapy without surgery (7). The average age of all patients was 63.1 years. Patients in the nonresected group had more distant disease (68 percent) than the resected group (46 percent). Significant pelvic pain was a more common problem in the nonresected group (15 percent) than in the resected group (4 percent). Similarly, pelvic sepsis was more common in the nonresected group (14 percent) than in the resected group (9 percent). Postoperative mortality was 4.3 percent after palliative resection and 3.8 percent after diverting colostomy. Survival of the resected group at one year was 65 percent and at two years 20 percent. Survival of the nonresected group at one year was 20 percent and at two years 0 percent. Survival in the resected group was significantly (P<.01) better than the nonresected group but probably can be attributed to the more extensive disease generally present in the patients who did not undergo resection. These results suggest that patients with advanced rectal cancers should undergo palliative resection whenever possible because resection decreases pelvic complications and may improve quality of life. Read at meeting of the American Society of Colon and Rectal Surgeons, Anaheim, California, June 12 to 17, 1988.     

A Rare Stoma-Related Complication: Parastomal Evisceration

Defunctioning stoma is a commonly used colorectal surgical procedures. The stomal complications recorded are usually classified as early and late complications. Parastomal hernia is a common complication of stomal surgery. We present a very rare stoma-related complication developed after parastomal hernia and described parastomal evisceration.     

Quality of Life in Patients Living with Stoma

BackgroundBackground and Objective: Quality of life of patients can be affected a treatment. A good quality of life is essential to achieve a goal in treating patients. This study aims to assess stoma related quality of life.MethodsA cross-sectional study was done at St. Paul''s Hospital millennium Medical College from February 1 to July 31, 2019. A structured questionnaire was used to interview patients and review charts of patients to retrieve information on sociodemographic variables, type, and indications of the stoma. Data was collected using structured questionnaire adopted from the City of Hope and Beckman Research Institute after modifications to make it in line with the Ethiopian context.ResultsThe mean score for the overall quality of life for stomata was 7.42 ± 0.53. Around 70% of patients have adjusted their dietary style due to stoma. More than half of them reported feelings of depression following stoma surgery. Only 34% of patients resumed sexual activity and only 11% were satisfied with it. None of them were enrolled in stoma association or support group. Factors such as type of ostomy (temporary/permanent), adjustment in dietary style due to stoma, depression, change in diet for not passing gas in public, and change in clothing style had significant effects on overall quality of life and its subscales (P < 0.05).ConclusionsThis study demonstrated that living with stoma has a greater impact on the overall aspect of quality of life.     

Miles术后造口周围皮肤损伤的相关因素分析及对策

目的 通过对Miles术后造口周围皮肤损伤的患者进行调查分析,针对影响因素采取干预措施,探索减少Miles术后造口周围皮肤损伤的有效方法.方法 在110例门诊随访的永久性结肠造口患者中,出现造口周围皮肤损伤62例,对每例患者发生造口周围皮肤损伤的原因进行回顾性分析,以明确可能影响Miles术后造口周围皮肤损伤的相关因素.结果 Miles术后造口周围皮肤损伤的发生率为56.36％;经Logistic多因素回归分析,与Miles术后造口周围皮肤损伤相关的因素有6个,患者排泄物刺激、造口袋过敏、更换造口袋操作不当、潜在皮肤疾病、过度刷洗/擦皮肤、对造口护理知识不熟悉等是患者造口周围皮肤损伤的影响因素.结论 选用合适的造口护理用品和粘贴方法,详细指导患者及家属造口护理知识与技能,可明显降低Miles术后造口周围皮肤损伤的发生率.     

腹腔镜技术在外伤性结直肠穿孔治疗中的应用

目的：探讨腹腔镜技术在结直肠外伤穿孔患者治疗中的疗效及安全性。方法回顾性分析河南省安阳地区医院2005年3月至2013年3月间收治的42例结直肠外伤穿孔患者的临床资料,其中22例接受开腹手术治疗（开腹组）,20例行腹腔镜治疗（腹腔镜组）。手术方式包括单纯穿孔修补术和穿孔肠段切除、近端结肠造瘘、远端封闭术。比较两组患者术后并发症发生率及术后恢复情况。结果腹腔镜组患者较开腹组手术时间缩短[（72±36） min比（128±52） min],术中出血量减少[（21．2±3．6） ml比（62．6±8．8） ml],术后排气时间[（1．7±0．6） d比（3．5±1．2） d]加快,术后住院时间缩短[（7．3±1．8） d比（13．6±3．9） d],术后并发症发生率降低[35．0％（7／20）比72．7％（16／22）],差异均有统计学意义（均P＜0．05）。结论腹腔镜手术治疗结直肠外伤穿孔具有手术时间短、创伤小、恢复快及并发症发生率低等优点。     

结直肠预防性单双腔造口对比的Meta分析

目的 比较结直肠预防性单腔造口与双腔造口的并发症,探讨何种造口方式更具有优势.方法 检索PubMed,Springer,Embase数据库公开发表的比较结直肠损伤后单双腔造口的研究和相关文献.通过采用RevMan 5.2统计软件,合并及比较两者并发症,选择计算相对危险度(95％CI)作为效应尺度指标来评估这两种方式的有效性及安全性.结果 6篇回顾性研究符合纳入标准,共计1 999例患者,6篇非随机对照研究的Meta分析结果显示单腔造口组发生造口脱垂(RR:0.23,95％ CI:0.05～0.99,P=0.05)和由造口因素引起造口回缩(RR:0.21,95％ CI:0.04～0.99,P=0.05)的风险较小.对于其他并发症造口狭窄、造口旁疝及造口周围皮炎等,分析结果差异无统计学意义(P＞0.05);但在造口缺血、坏死概率方面,双腔造口明显低于单腔造口(RR:5.08,95％ CI:1.94～13.22,P=0.009).结论 在结直肠损伤后,两种预防性造口方式各有利弊,但相对于结肠双腔造口而言,单腔造口术后并发症相对较少,更有利于患者的恢复,在严格处理造口血供的情况下,我们更支持单腔造口.