Evaluation of the Outcome of Local Surgery for Stomal Prolapse

We reviewed the results of local surgical treatment of stoma prolapse, a long-term complication of stoma construction. Fifteen patients treated for stomal prolapse between 2009 and 2020 at the authors’ and affiliated hospitals were included in this study. The treatment comprised local laparotomic stomal reconstruction (LLSR) in nine patients and stapling repair (SR) in six. We compared and evaluated the clinical and surgical information and postoperative complications. Operation time was significantly shorter in the SR group than in the LLSR group: 20 and 53 min, respectively (p = 0.036). The duration of postoperative hospitalization was shorter in the SR group than in the LLSR group: 5.5 and 8 days, respectively; the difference was not significant (p = 0.088). No short-term complications were found in either group. Regarding long-term, postoperative complications, parastomal hernias developed after 2.5 years in one patient in the LLSR group and after 6 months in one patient in the SR group; both patients had histories of parastomal hernia surgery and had relatively high body mass indices. Local surgery for stomal prolapse was minimally invasive and performed safely. In patients with a history of surgery for parastomal hernia, attention must be paid to the potential of parastomal hernia developing as a postoperative complication.

Comparison between the Extraperitoneal Route with the Transperitoneal Route for the Permanent Colostomy: A Meta-Analysis with Rcts and Systematic Review

AimTo assess the efficacy of extraperitoneal colostomy(EPC) in the prevention of stoma-related complications.BackgroundTransperitoneal colostomy (TPC) is still a widely used surgical approach. However, TPC has been reported with highly incidence of stoma-related complications, like parastomal hernia, stomal retraction, stomal prolapse.The purpose of EPC is to prevent these complications. But it is still lack of evidence-based basis.Material and methodsMEDLINE, EMBASE, Web of Science, Scopus, MOOSE, Pubmed, Google Scholar, Baidu Scholar, and the Cochrane Library were searched to conduct a systematic review and meta-analysis with RCTs. Revman 5.4 was performed in the meta-analysis.ResultsA total of 5 RCTs were eligible in this study. Compared with TPC, EPC group had lower incidence in Parastomal Hernia (RR, 0.14; 95% CI, 0.04–0.52, P=0.003, I2=0%), Stomal Prolapse (RR, 0.27; 95% CI, 0.08–0.95, P=0.04, I2=0%) and a higher rate of defaecation Sensation (RR, 3.51; 95% CI, 2.47–5.0, P＜0.00001, I2=37%). No statistical difference was observed in Stoma Retraction, Colostomy Construction Time, Stoma Ischemia, and Necrosis.ConclusionAn extraperitoneal colostomy is associated with a lower rate of postoperative complication compared to transperitoneal colostomy. Randomized controlled trial meta-analysis showed better results in permanent colostomy after abdominoperineal resection.

SHORT TERM OUTCOME OF DIVERSION LOOP COLOSTOMY IN CHILDREN OF ANORECTAL MALFORMATION.

Purpose: Colostomy for patients with anorectal malformations decompresses an obstructed colon, avoids fecal contamination of the urinary tract, and protects a future perineal operation. The procedure is associated with several signicant complications. Objective: To study relation of various demographic factors, clinical features, complications and patient related factors with outcomes. Methods-All necessary data of these 50 patients were obtained from case sheets and attendants of patients admitted in SNCU, NICU and wards of department of paediatrics and surgery. All the details (demographic, patients related, surgery) of patient was lled in predesigned structured proforma. Results- More than half of babies were males (68%). The male to female ratio was 2.1:1. The mean weight at post-operative 7 days was 4.74±0.21 kgs which increased to 5.19±0.41 kgs at post-operative 1 month, 5.73±0.88 kgs at post-operative 2 months and 6.28±0.6 kgs at post op 3 months. There was signicant (p=0.001) increase in weight from post-operative 7 days to postoperative 1 month, 2 months and 3 months. Peri stomal skin excoriation was seen in 8% at post-operative 7 day, 14% at postoperative 1 month, 12% at 2 months and 4% at 3 months. Stomal prolapse was seen in 2% patients at post-operative 7 days and in 4% patients at 1 month & 2 months and became nil at 3 months post-operatively. There was signicant (p=0.001) difference in weight gain from 7 days to 3 months post-operative between groups of age <30 days (1.67±0.33 kgs) and ≥30 days (1.08±0.65 kgs). Conclusion- Minimal post-operative complications of diversion loop colostomy in children of anorectal malformation and hence we can conclude that loop colostomy is safe in patients with anorectal malformations. we recommend, a study with a large sample size and longer duration of follow up, needs to be done to have a more effective and rationale conclusion.

Surgery for Complicated Stomal Prolapse: Is the Altemeier Technique an Option? A Report of Three Cases

Introduction The incidence of stomal prolapse ranges from 2% to 22%. The risk factors include colostomy, the short length of the stoma, obesity, emergency surgery, and the improper (or even absence of) marking of the preoperative site for the stoma. Complicated stomal prolapse associated with severe mucosal irritation, ischemic changes, or bleeding requires surgical intervention. Objective To describe the use of the Altemeier technique in the management of cases of complicated prolapsed stoma after failure of the local medical measures and manual reduction. Methods Case series of three patients with past history of abdominoperineal resection of rectal cancer and permanent end colostomy presented with irreducible prolapse of the stoma. After the failure of the local measures and manual reduction, urgent surgical intervention using the modified Altemeier technique was necessary. Results The modified Altemeier technique is simple, presents low risk of operative and postoperative complications, besides enabling an early recovery, with a lower risk of recurrence during the first 6 months after the repair. Conclusion The modified Altemeier technique may be a valid therapeutic modality in the setting of complicated prolapsed stoma.

Clinical study of post-operative complications of various stomas (ileostomy versus colostomy) for obstructing distal colorectal malignancies in an emergency setting: a prospective hospital-based study

Background: This study aims to provide an overview of all complications that may occur after construction of an ileostomy or colostomy (loop or end) for obstructing distal colorectal malignancy in emergency setting.Methods: It was a prospective observational study. Forty-eight patients were included in this study. Patients were divided into two groups, group (A) included patients with ileostomies (number of patients=24) and group (B) included patients with colostomies (number of patients=24).Results: Most common age group in both groups was >60 years, Peristomal skin irritation occurred in 33% of patients who have undergone ileostomy and 13% of patients who had undergone colostomy. 4% of patients who had undergone ileostomy developed retraction of the stoma. None of the patients who underwent colostomy developed retraction of stoma, 17% of patients who had undergone colostomy developed stomal prolapse; Stoma prolapse was seen in only 5% of patients who had undergone ileostomy.Conclusions: Stoma formation is a frequently performed surgical procedure. Ileostomy and colostomy are the most commonly made stomas in surgical practice. Ileostomies have slightly higher complication rate than colostomies. Peristomal skin irritation is the most common complication among all the complications. The second most common complication is stomal prolapse.

Prospective evaluation of early local complications of stoma and their risk factors

Background: Bowel stoma namely ileostomy and colostomy are frequently performed procedure and often associated with complications. Aim of this study was to assess early local complications and association with any risk factors.Methods: A total of 99 patients undergoing ileostomy or colostomy were analysed prospectively over a period 18 months. Comorbidity, preoperative clinical data, operative time, local complications within 12 weeks and hospital stay were documented. Univariate and multivariate analysis were used to find out any association.Results: Sixty-four ileostomies and 35 colostomies were analysed in our study. Median age was 55 years in both groups. Nontraumatic bowel perforation (42%) and colorectal malignancy (48.6%) were most common etiology for ileostomy and colostomy formation respectively. 64% of ileostomy and 68% of colostomy had one or more complications. Skin excoriation (31%) was most common complication in ileostomy group and it was stomal prolapse (17%) in colostomy group. Poor stoma care was prevalent in both groups. We found diabetes to have significant association with skin excoriation (p=0.002).Conclusions: Diabetes was identified as significant risk factor for skin excoriation in ileostomy group. Further long term data and larger population are needed for better evaluation of stomal complication and their risk factors.