Uncut Diverting End Colostomy: End of Nightmare
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ORIGINAL ARTICLE
Uncut Diverting End Colostomy: End of Nightmare Murat ÇAKIR 1 Received: 8 June 2019 / Accepted: 24 March 2020 # Association of Surgeons of India 2020
Abstract Ostomy is anastomosis of any segment of the gastrointestinal tract to the anterior abdominal wall. Several surgical complications may develop during the closing of the end colostomy. We define a new end colostomy technique that eases the closing procedure and minimizes surgical complications. We use this technique in cases that require temporary full diversion. The distal colon segment is closed without cutting where the ostomy will be opened, then followed by opening the ostomy proximally. This technique was performed on 96 patients. No major complications developed in patients whose end colostomies were opened and closed. The closure was done through an elliptic incision around the ostomy. This is a relatively easy technique for performing and closing an end colostomy from ostomy defect. Keywords End colostomy . Technique . Easy closure
Introduction
Methods
Ostomy is anastomosis of any segment of the gastrointestinal tract to the anterior abdominal wall [1]. The large intestine and small intestine segments can be used for ostomy. Depending on the purpose of the opening, ostomy may be permanent or temporary. Ostomies are classified according to the way they are anastomosed to the anterior abdominal wall. Ostomies can be loop or end in shape. The most significant difficulty in closure of end colostomy is finding the distal end. During the closure of the end colostomy, figuring out the anatomy generally takes a long time and iatrogenic intestinal organ injuries may occur [2, 3]. Surgery is postponed needlessly for the decrease of intraabdominal adhesion. Time intervals required for the closure of colostomy are variable. The interval for closure in loop ostomy is approximately 6–10 weeks while it is 6 months or longer in end colostomy [4–6]. We define a new end colostomy technique that alleviates the challenges of this demanding surgical dissection and rules out the possibility of failure to close the colostomy due to complications.
Ninety-six patients that presented for ostomy to our hospital between January 2015 and January 2020 were included in the study. Patients’ files were reviewed retrospectively. Surgical consent forms were obtained from all the patients following anesthesia preparation. The criterion in the selection of patients was designated to be requirement for diverting ostomy. These were the cases of patients who had undergone rectovaginal fistula and perianal area surgery for the treatment of perianal injuries or severe perianal infections (e.g., Fournier gangrene).
* Murat ÇAKIR [email protected] 1
Department of General Surgery, Meram Medical Faculty, Necmettin Erbakan University, 42080 Konya, Turkey
Technique A defect of 2–3 cm is formed in the previously marked ostomy site. A wound protector is placed at this site (Fig. 1). A glove or gel port is set onto the wound protector and then trocars are placed. Endosc
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