Perineal colostomy: an alternative to avoid permanent abdominal colostomy: operative technique, results and reflection

Abstract

BackgroundThe most common injury to indicate definitive stoma is rectal cancer. Despite advances in surgical treatment, the abdominoperineal resection is still the most effective operation in radical treatment of malignancies of the distal rectum invading the sphincter and anal canal. Even with all the effort that surgeons have to preserve anal sphincters, abdominoperineal amputation is still indicated, and a definitive abdominal colostomy is necessary. This surgery requires patients to live with a definitive abdominal colostomy, which is a condition that modify body image, is not without morbidity and has great impact on the quality of life.AimTo evaluate the technique of abdominoperineal amputation with perineal colostomy with irrigation as an alternative to permanent abdominal colostomy.MethodRetrospective analysis of medical records of 55 patients underwent abdominoperineal resection of the rectum with perineal colostomy in the period 1989-2010.ResultsThe mean age was 58 years, 40 % men and 60 % women. In 94.5% of patients the indication for surgery was for cancer of the rectum. In some patients were made three valves, other two valves and in the remaining no valve at all. Complications were: mucosal prolapse, necrosis of the lowered segment and stenosis.ConclusionThe abdominoperineal amputation with perineal colostomy is a good therapeutic option in the armamentarium of the surgical treatment of rectal cancer.

Sexual Health Problems and Discussion in Colorectal Cancer Patients Two Years After Diagnosis: A National Cross-Sectional Study

“…The psychological impact of ostomy, notably on self-esteem and body image have ever been highlighted [30,31]. However, for long, digestive surgeons have worked to develop surgical procedures that do not require the wearing of a definitive stoma [32][33][34]. For this reason, rectal cancer surgery with anterior resection and colo-anal anastomosis is presented as better preserving sexual quality of life than abdominoperineal amputation, imposing the wearing of a definitive stoma.…”

Perineal colostomy prolapse: a novel application of mesh sacral pexy

“…The incidence of mucosal prolapse with perineal colostomy is 0-21% in eight reports that include 14-146 patients. [1][2][3][4][5][6][7][8] Simple mucosal resection under local anaesthesia appears effective in this situation. To the best of our knowledge, fullthickness perineal colostomy prolapse has not been previously reported.…”

Perineal colostomy: advantages and disadvantages

“…Once in place, the colostomy is matured through the anal aperture [5,7]. Another utilized technique is that of constructing valve-like stenoses in the colonic segment, by making circumferential incisions through the seromuscular layer, which are then approximated by invaginating sutures, in order for the protruding mucosa, to create a valve-like structure within the lumen [8,9].…”

“…Then, the bowel is placed as described above, tension-free, within the perineum. The distance between the incisions is usually 10 cm, but some authors also suggest more continent results when the incisions are at 5 cm [8,10]. A much discussed issue is whether the omentum must be used to compensate for the tissue loss after total mesorectal excision -a process called omentoplasty [8,11].…”

“…The distance between the incisions is usually 10 cm, but some authors also suggest more continent results when the incisions are at 5 cm [8,10]. A much discussed issue is whether the omentum must be used to compensate for the tissue loss after total mesorectal excision -a process called omentoplasty [8,11]. Omentoplasty is usually necessary when adequate closure of the pelvic peritoneum cannot be achieved [10].…”