Section of Colon and Rectal Surgery, Division of General and Oncologic Surgery, Department of Surgery, University of Maryland Medical Center, University of Maryland School of Medicine, 22 South Greene Street, S4B10, Baltimore, MD 21230, USA.
Stomas are created for a wide range of indications such as temporary protection of a high-risk anastomosis, diversion of sepsis, or permanent relief of obstructed defecation or incontinence. Yet this seemingly benign procedure is associated with an overall complication rate of up to 70%. Therefore, surgeons caring for patients with gastrointestinal diseases must be proficient not only with stoma creation but also with managing postoperative stoma-related complications. This article reviews the common complications associated with ostomy creation and strategies for their management.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: The construction of colostomy is associated with decreased physical and psychological well-being as well as decreased quality of life. Cecostomy is the creation of an opening in the cecum to provide colonic decompression. Objective:This work was conducted to evaluate the efficacy of tube cecostomy as an alternative to colostomy in the managing patients with left-sided colonic carcinoma and rectal cancer in terms of occurrence of postoperative morbidity and mortality and the functional outcome. DESIGN: and Settings: Atotal number of 156 patients with colorectal cancer were enrolled in the study and were divided randomly into two equal groups. Patients:A group of 78 patients underwent tube cecostomy (group A) were compared with the other 78 patients who underwent loop colostomy (group B).The outcome parameters were the incidence of anastomotic leak, operative time, primary operation mortality rate, patient satisfaction and hospital stay. RESULTS: The mean operating time and the mean hospital slay was significantly shorter in tube cecostomy group when compared with loop colostomy group (P<0.05). The overall recorded morbidity for the primary operation was 12.8% and 29.5% for group A and B respectively [P ≥ 0.05] while the stoma related complications rate was 7.7% and 25.6% for each group respectively [P ≤ 0.05].Conclusion: Performing tube cecostomy instead loop colostomy in managing patients with left-sided colonic carcinoma and rectal cancer can decrease the anticipated postoperative morbidity, lowers prolonged hospital stay and provides adequate functional outcome Clinical trial registration:ACTRN12611000353998http://www.anzctr.org.au/ACTRN12611000353998.aspx.
International Journal of Surgery (London, England) 03/2013; 11(4). DOI:10.1016/j.ijsu.2013.02.024 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Parastomal hernia (PSH) is common after stoma formation. Studies have reported that mesh prophylaxis reduces PSH, but there are no cost-effectiveness data. Our objective was to determine the cost effectiveness of mesh prophylaxis vs no prophylaxis to prevent PSH in patients undergoing abdominoperineal resection with permanent colostomy for rectal cancer.
Using a cohort Markov model, we modeled the costs and effectiveness of mesh prophylaxis vs no prophylaxis at the index operation in a cohort of 60-year-old patients undergoing abdominoperineal resection for rectal cancer during a time horizon of 5 years. Costs were expressed in 2012 Canadian dollars (CAD$) and effectiveness in quality-adjusted life years. Deterministic and probabilistic sensitivity analyses were performed.
In patients with stage I to III rectal cancer, prophylactic mesh was dominant (less costly and more effective) compared with no mesh. In patients with stage IV disease, mesh prophylaxis was associated with higher cost (CAD$495 more) and minimally increased effectiveness (0.05 additional quality-adjusted life years), resulting in an incremental cost-effectiveness ratio of CAD$10,818 per quality-adjusted life year. On sensitivity analyses, the decision was sensitive to the probability of mesh infection and the cost of the mesh, and method of diagnosing PSH.
In patients undergoing abdominoperineal resection with permanent colostomy for rectal cancer, mesh prophylaxis might be the less costly and more effective strategy compared with no mesh to prevent PSH in patients with stage I to III disease, and might be cost effective in patients with stage IV disease.
Journal of the American College of Surgeons 09/2013; 218(1). DOI:10.1016/j.jamcollsurg.2013.09.015 · 5.12 Impact Factor
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