Outcome of Restorative Surgery of Fecal Diversion, a Prospective Observational Study of 50 Cases in a Teaching Hospital
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Abstract
Background: An intestinal stoma is a planned opening made in the intestine to divert feces and flatus to the abdominal wall where they can be collected in external appliances. Either colostomy or ileostomy, most of the time acts as the best lifesaving surgical procedure for certain emergencies as well as routine small intestinal and colorectal surgery.
Objective: To see the outcome of intestinal stoma closure surgery and the factors that influence the outcome of surgery.
Study Design: This is a descriptive type of-cross sectional study. Department of Surgery, Bangabandhu Sheikh Mujib Medical University Hospital (BSMMUH), Dhaka, Bangladesh, which were done over a period of twelve months from April, 2012 to March, 2013.
Results: 50 patients with intestinal stoma were admitted in different surgical wards of BSMMUH, Dhaka for intestinal stoma closure surgery. Out of 50 patients 30 patients presented with ileostomy & 20 patients presented with colostomy. After restoration of bowel continuity, in case of ileostomy closure, out of 30 patients 23(77%) patients were recovered uneventfully & 7(23%) patients recovered with some complications. Out of complicated cases, 2(7%) patients developed febrile illness, 2(7%) patients’ intestinal obstruction, 1(3.33%) patient developed anastomotic leakage, 1(3.33%) urinary retention & 1(3.33%) patient post-operative ileus. In case of colostomy closure, out of 20 patients 14(70%) patients were recovered uneventfully & 6(30%) recovered with some events; 3(15%) patients developed wound infection, 1(5%) patient post-operative ileus, 1(5%) patient diarrhea & 1(5%) patient febrile illness. Over all Out of 50 patients, post-operative recovery of 37 (74%) patients were uneventful & 13(26%) patients were recovered with complications. 3(6%) patients developed febrile illness, 3(6%) patients wound infection, 2 (4%) patients’ adhesive obstruction, 2(4%) patients post-operative ileus, 1(2%) patient developed anastomotic leakage, 1(2%) patient urinary retention & 1(2%) patient developed diarrhoea. Conclusion: Complications of Intestinal stoma reversal surgery is associated with nutritional status of the patients, anaemia, electrolyte imbalance, acquired complications in stoma site, duration of stoma, nature of operation and last of all surgical skill. So Intestinal stoma closure surgery should be performed after adequate nutritional build up, correction of anaemia, correction of electrolyte imbalance, stoma with adequate duration and by a surgeon who is technically skilled and experienced to minimize the incidence of post-operative complication.
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References
I. Colwell JC, Beitz J. Survey of wound, ostomy and continence (WOC) nurse clinicians on stomal and peristomal complications: a content validation study. Journal of Wound Ostomy & Continence Nursing. 2007 Jan 1;34(1):57-69.
II. Edwards DP, Leppington‐Clarke A, Sexton R, Heald RJ, Moran BJ. Stoma‐related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial. British Journal of Surgery. 2001 Mar;88(3):360-3.
III. Fasth S, Hulten L, Palselius I. Loop ileostomy--an attractive alternative to a temporary transverse colostomy. Acta Chirurgica Scandinavica. 1980 Jan 1;146(3):203-7.
IV. Freund HR, Raniel J, Muggia-Sulam M. Factors affecting the morbidity of colostomy closure: a retrospective study. Diseases of the Colon & Rectum. 1982 Oct 1;25(7):712-5.
V. Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Journal of British Surgery. 2005 Sep;92(9):1137-42.
VI. Burch J, editor. Stoma care. John Wiley & Sons; 2008 Sep 15.
VII. Wong KS, Remzi FH, Gorgun E, Arrigain S, Church JM, Preen M, Fazio VW. Loop ileostomy closure after restorative proctocolectomy: outcome in 1,504 patients. Diseases of the colon & rectum. 2005 Feb 1;48(2):243-50.
VIII. García-Botello SA, García-Armengol J, Garcia-Granero E, Espi A, Juan C, López-Mozos F, Lledó S. A prospective audit of the complications of loop ileostomy construction and takedown. Digestive surgery. 2005 Feb 21;21(5-6):440-6.
IX. Senapati A, Nicholls RJ, Ritchie JK, Tibbs CJ, Hawley PR. Temporary loop ileostomy for restorative proctocolectomy. Journal of British Surgery. 1993 May;80(5):628-30.
X. Hyland JM, Grant DC, Barry MK. Defunctioning loop ileostomy: a prospective audit. Journal of the American College of Surgeons. 1999 Jan 1;188(1):6-9.
XI. Tonolini M. A closer look at the stoma: multimodal imaging of patients with ileostomies and colostomies. Insights into imaging. 2019 Dec;10:1-5.
XII. Robertson I, Leung E, Hughes D, Spiers M, Donnelly L, Mackenzie I, Macdonald A. Prospective analysis of stoma‐related complications. Colorectal Disease. 2005 May;7(3):279-85.
XIII. Tilson MD, Fellner BJ, Wright HK. A possible explanation for postoperative diarrhea after colostomy closure. The American Journal of Surgery. 1976 Jan 1;131(1):94-7.
XIV. Park JJ, Pino AD, Orsay CP, Nelson RL, Pearl RK, Cintron JR, Abcarian H. Stoma complications: the cook county hospital experience. Diseases of the colon & rectum. 1999 Dec;42:1575-80.
XV. Pokorny H, Herkner H, Jakesz R, Herbst F. Mortality and complications after stoma closure. Archives of Surgery. 2005 Oct 1;140(10):956-60.
XVI. Bakx R, Busch OR, Bemelman WA, Veldink GJ, Slors JF, Van Lanschot JJ. Morbidity of temporary loop ileostomies. Digestive surgery. 2004 Oct 1;21(4):277-81.
XVII. Chow A, Tilney HS, Paraskeva P, Jeyarajah S, Zacharakis E, Purkayastha S. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. International journal of colorectal disease. 2009 Jun;24:711-23.
XVIII. Maddern GJ, Nejjari Y, Dennison A, Siriser F, Bardoxaglou E, Launois B. Primary anastomosis with transverse colostomy as an alternative to Hartmann's procedure. Journal of British Surgery. 1995 Feb;82(2):170-1.
XIX. Mala T, Nesbakken A. Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Disease. 2008 Oct;10(8):785-8.
XX. Ahmad QA, Saeed MK, Muneera MJ, Ahmed MS, Khalid KA. Indications and complications of intestinal stomas–A tertiary care hospital experience. Biomedica. 2010 Jul;26(2):144-7.