Development of an original method for the repair of paracolostomy hernias

The proposed surgical procedure was studied on six unfixed male human cadavers. The removal of the end colostomy and paracolostomy hernia with subsequent intra-abdominal implantation of a previously prepared hernioprosthesis from the xenopericardium were modeled on the corpses. The use of the proposed method for the repair of paracolostomy hernias, including the use of a xenopericardial plate as an endoprosthesis according to an original technique, has shown its consistency and prospects for use on clinical material. Further studies associated with the use of the proposed technique of paracolostomy hernia repair in clinical practice seem promising. Key words: Colostomy, paracolostomy hernia, implantation, hernioprosthesis, xenopericardium.

Chronic Fistulas of Thigh Presenting Unusually in an Operated Patient of Carcinoma Rectum. More Than What Meets the Eye!

Chronic skin lesions of the thigh (wounds, fistulas etc) are relatively uncommon, vis-à-vis, their notorious cousins over the distal limb. Even when present, the cause is usually obvious, mostly as trauma or a systemic affliction. We present an unusual case of chronic fistulas over the right thigh in a patient of carcinoma rectum for which anterior resection and an end colostomy was done 4 years earlier. Postsurgical pelvic abscesses finding their way into the thigh are a known entity, but they are usually accompanied by systemic/local features and their presentation is within a shorter time span. The novelty of our case lies in its manifestation (as a cluster of chronic fistulas and not a frank abscess), its late presentation as well as in the absence of any systemic/local inflammatory signs. Our primary objective is to educate wound physicians about the origin of such fistulas whenever they deal with patients who have had a preceding surgical intervention of the abdomen. In our humble opinion, this will ease out many diagnostic and management dilemmas, that such patients can potentially pose.

P001 IS PROPHYLACTIC MESH IS ROUTINELY REQUIRED FOR STOMA CONSTRUCTION? IDENTIFICATION OF THE ‘TARGET GROUP’

Background Evidence to support routine prophylactic mesh insertion during stoma construction is conflicting. The PREVENT randomised controlled trial (RCT) suggested lower incidence of parastomal hernia (PSH) with prophylactic mesh but with no quality of life or cost benefit. Another two RCTs has shown no prophylactic benefit (STOMAMESH & STOMA-const). Although European Hernia guidelines recommends routine prophylactic mesh in end-colostomy, NICE guidelines suggest mesh on individual basis not routinely. Aim To identify the group with higher risk to develop a symptomatic PSH when prophylactic mesh should be considered Material and Methods A single center retrospective review of all stoma formed. Younger patient than 18 years and patients who had less than 6 months’ follow-up were excluded. Development of PSH was confirmed by radiological evidence or direct intra-operative visualization Results 194 patients between January 2015 till December 2019 were included with mean follow-up of 15.7±13.5 months where 91 patients developed PSH. On multivariate analysis, older age (>65) (OR 2.3, 95% CI 1.08 – 4.99, p 0.03) and Obesity (OR 5.8, 95% CI 2.53 – 13.57, p 0.00) were risk factors of developing PSH. Among the PSH group, 28 were symptomatic (31%). Symptomatic subgroup had higher ASA (ASA >2) than asymptomatic subgroup (50% Vs 27%, p 0.05) Conclusions Obese patients older than 65 years are at increased risk of PSH. IF their ASA >2 this PSH is likely to become symptomatic. This is the group who should benefit the most from prophylactic measures including mesh insertion and should be targeted for future trials

The Effect of Body Mass Index on the Creation of an End-Colostomy in Rectal Cancer Patients

With the increasing prevalence of obesity, there has been a parallel increase in the incidence of rectal cancer. The association of body mass index (BMI) and end-colostomy creation versus primary anastomosis in patients undergoing proctectomy for rectal cancer has not been described. This is a retrospective study of patients with rectal cancer from 2012 to 2018 using data from the National Surgical Quality Improvement Project. 16,446 (92.1%) underwent primary anastomosis and 1,418 (7.9%) underwent creation of an end-colostomy. Patients with a BMI of 25-29.9 (overweight) comprised the most frequent group to have a proctectomy (reference group), but the least likely to have an end-colostomy. Patients with severe obesity (BMI 50+) had an adjusted odds ratio for end-colostomy of 2.7 (95% CI 1.5-4.7) compared to the reference group. Patients who have severe obesity should be counseled regarding the likelihood of an end-colostomy and may benefit from medical weight management or weight-loss surgery.

EP.WE.117Colovaginal fistula from neglected vaginal pessary; Fallouts from the COVID-19 pandemic

An 86 year old lady was admitted with a one week history of feeling unwell, polyuria, dysuria, urinary and faecal incontinence. She had previously been treated for recurrent UTIs by her GP. On examination she had suprapubic tenderness but no peritonism. Observations revealed tachycardia of 122bpm with a temperature of 36.3*C. Inflammatory markers were raised with a white cell count of 22.0x106/L and CRP 129 mg/L. Urine cultures grew Pseudomonas aeruginosa. She was managed for urosepsis with intravenous antibiotics. Past medical history included vaginal pessary for uterine prolapse, congestive cardiac failure, hypertension, polymyalgia and osteoporosis. She lived alone with no package of care. On admission she improved with intravenous antibiotics however she had a perineal examination due to ongoing faecal and urinary incontinence and was noticed to be passing faeces per vaginam. A colo-vaginal fistula was suspected and she was reviewed by the gynaecologist who noted her pessary had been in-situ for up to a year and her routine appointment to have it changed was cancelled due to the COVID-19 pandemic. An MRI Pelvic scan confirmed a 3x2cm rectovaginal fistula. She was reviewed by the general surgery team and the decision was made for her to be defunctioned to prevent her episodes of recurrent UTIs and improve her quality of life. She successfully had a laparoscopic end colostomy with an uneventful post-operative period. This case highlights the harms caused from the cancellation of appointments and demonstrates a rare cause of rectovaginal fistula.

TP10.1.9End Colostomy Formation: Change in Practice during the Covid-19 Pandemic

Aim Intercollegiate guidance favoured the increased stoma formation during the early phases of the Covid-19 pandemic due to uncertainty around the availability of critical care beds and peri-operative impact of SARS-CoV-2. This study assessed the impact the Covid-19 pandemic and changing guidance had on end colostomy formation. Methods Data were reviewed from a prospectively collected database on the number of end colostomies formed over a 10-month period from 1st March to 31st December 2020. Comparison was made with the same period in 2019. Details were confirmed using clinical letters. Results There was an overall 11.5% increase in the number of end colostomies formed in the in the same 10-month period in 2020 compared with 2019 (87 vs 78). The increase in end colostomy formation was most marked in the 3-month period of March to May, with 36.8% more end colostomies formed in 2020 than in 2019 (26 vs 19). The number of end colostomies formed in the remaining 7-month period of June to December was similar in the two years (61 vs 59). Conclusions There was a change in surgical practice in favour of stoma formation, which peaked in the period of March to May 2020. This coincided with a time of maximum uncertainty surrounding the Covid-19 pandemic and changing intercollegiate guidance. The change in practice has implications for patients longer term and may impact on the service in the post-Covid recovery period with patients requesting reversal procedures.

Retrospective analysis of factors associated with emergency colostomy: an institutional experience

<p class="abstract"><strong>Background:</strong> Colostomy is one of the commonest lifesaving procedures done worldwide with an intention of either decompression of an obstructed colon or diversion of stool. This study tries to assess the pattern of emergency colostomy and factors associated with its complication in adult patients at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.</p><p class="abstract"><strong>Methods:</strong> Retrospective reviews of charts were done of all adult patients who underwent colostomy procedure from December 1, 2016 to May 30, 2019. </p><p class="abstract"><strong>Results:</strong> There were 149 adult patients that underwent colostomy procedure in the study period and the majorities were male (83.2%). Majority of the procedures were done for indication of LBO secondary gangrenous sigmoid volvulus (49%). The most common comorbidity identified were renal disease (5%) and diabetes mellitus (3%). All patients who presented with gangrenous sigmoid volvulus underwent end colostomy procedure and 16.8% of them died. Generally, 69 patients among 149 (46.3%) developed certain type of complication. Presence of complication was significantly associated with increased chance of death by eight times than those who had no complication after the procedure. End colostomy was significantly associated with development of complication when compared to loop colostomy. Among the study participants 87.9% of them were discharged improved. The main cause of death was multi organ failure secondary to septic shock, which accounted to 52.9% of all deaths.</p><p class="abstract"><strong>Conclusions:</strong> Gangrenous sigmoid volvulus, colorectal cancer and trauma were leading indications for colostomy. Presence of complication and type of colostomy were factors significantly associated with outcome.</p>

719 Colovaginal Fistula from Neglected Vaginal Pessary; Fallouts from the COVID-19 Pandemic

An 86-year-old lady was admitted with a one-week history of feeling unwell, polyuria, dysuria, urinary and faecal incontinence. She had previously been treated for recurrent UTIs by her GP. On examination she had suprapubic tenderness but no peritonism. Observations revealed tachycardia of 122bpm with a temperature of 36.3*C. Inflammatory markers were raised with a white cell count of 22.0x106 /L and CRP 129 mg/L. Urine cultures grew Pseudomonas aeruginosa. She was managed for urosepsis with intravenous antibiotics. Past medical history included vaginal pessary for uterine prolapse, congestive cardiac failure, hypertension, polymyalgia and osteoporosis She lived alone with no package of care. On admission she improved with intravenous antibiotics however she had a perineal examination due to ongoing faecal and urinary incontinence and was noticed to be passing faeces per vaginam. A colo-vaginal fistula was suspected, and she was reviewed by the gynaecologist who noted her pessary had been in-situ for up to a year and her routine appointment to have it changed was cancelled due to the COVID-19 pandemic. An MRI Pelvic scan confirmed a 3x2cm rectovaginal fistula. She was reviewed by the general surgery team and the decision was made for her to be defunctioned to prevent her episodes of recurrent UTIs and improve her quality of life. She successfully had a laparoscopic end colostomy with an uneventful post-operative period. This case highlights the harms caused from the cancellation of appointments and demonstrates a rare cause of rectovaginal fistula.