Perineal colostomy prolapse: a novel application of mesh sacral pexy

Full thickness colonic prolapse following pseudocontinent perineal colostomy has not been previously reported. Possible contributing factors include a large skin aperture at the site of the perineal stoma, the absence of anal sphincters and mesorectal attachments and the presence of a perineal hernia. A novel application of sacral pexy combined with perineal hernia repair using two prosthetic meshes is described.

Perineal Colostomy Post Amputation of Rectum

The operation described by Miles in 1908, an effective method in the radical treatment of tumors of the anus and lower rectum [1], and with better survival, leaves the stigma of the definitive iliac colostomy that leads to various psychosocial disorders [2]. Seeking to reduce social and family rejection, in addition to gas elimination and lack of control of the stools by the absence of sphincter, several methods of stools retention have been described [3-6]. Dr. Lázaro Da Silva, in Brazil, made the first perineal valve colostomy in 1991, when performing 2 to 3 extra-mucosal circular seromiotomies with invaginating seromuscular synthesis, with the meso-redundant occupying the pelvis, the distal valve stayed extra peritoneal and the proximal fixed to the promontory, this prevents or delays the excretion of stools directly [7]. It is indicated in patients proposed for abdominoperineal resection post-neoadjuvant, benign lesions with extensive sphincter involvement, extensive or intractable stenosis after perineal radiotherapy. This procedure is reserved for young or older patients in good physical condition, good cognitive level and without indication of postoperative radiotherapy [8].

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.