Complications and mortality following stoma formation

Abstract

Ann R Coll Surg Engl 2005; 87: 427-431 427The annual incidence of stoma formation in England is 20,800, 1 although recent literature would suggest that this figure is unnecessarily high. The management of obstructing left-sided colorectal cancer has changed in recent times, with increased use of on -table lavage with primary resection and anastomosis 2,3 and colorectal stenting 4 to avoid stoma formation. Sphincter preserving surgery for rectal cancer should also reduce permanent stoma rates. 5Persistently high morbidity and mortality rates associated with stoma creation and reversal are behind attempts to reduce their formation. Long-term complication rates of 58% in colostomies 6 and up to 76% in ileostomies 7 have been reported. It is also recognised that around 15% of temporary stomas created at the time of anterior resection become permanent. 8There has been much recent work examining risk factors for mortality in colorectal cancer surgery, 9 such as ASA grade and age, but whether the presence of a stoma affects mortality has not been previously examined. Studies have addressed the mortality following stoma reversal (0-4%), 10 but the literature is scant when stoma creation is concerned.We have examined whether the incidence of stoma formation is declining in the practice of a typical district general hospital, and investigated the prevalent morbidity and mortality associated with stoma creation, together with their risk factors. Patients and MethodsAll patients undergoing colostomy or ileostomy formation (elective and emergency) from January 1992 to December 2000 were identified. Data were collected from patient records maintained prospectively by the stomatherapy department, supported by information from operation notes and patient case records. Complications recorded were necrosis, prolapse, peristomal infection or abscess, retraction, stenosis, parastomal hernia, fistula and malignant change at the stoma site.Complications not included were skin excoriation and laparotomy wound problems.Operations were performed by one of seven consultant general surgeons or their registrars, three of whom had a declared interest in coloproctology. Patients undergoing bowel resection without stoma formation were not studied. Statistical analysisResults are expressed as the mean (SD) Stoma Care, Royal Glamorgan Hospital, Ynysmaerdy, Llantrisant, Mid-Glamorgan, UK ABSTRACT INTRODUCTION As stoma formation is thought to be declining, we performed a study to evaluate the rate of stoma formation and the impact on stoma complication rates, together with risk factors for complications.

Early complications after stoma formation: a prospective cohort study in 100 patients with 1-year follow-up

“…The majority of information is incomplete or based on retrospective data analysis. This may cause under-registration of complications in most studies [5][6][7][8]. The aim of this pragmatic prospective cohort study was therefore to provide an overview of all complications that may occur after construction of an ileostomy or colostomy (loop or end) in daily practice in a large teaching hospital in the Netherlands.…”

Stoma Prolapse

“…In contrast, Gooszen et al 8 reported in a randomized study prolapse rates of 42% and 2% for colostomy and ileostomy, respectively. Furthermore, Harris et al 10 have recently reported a higher prolapse rate with loop colostomy as compared with ileostomy (17.4% vs 2%, P ϭ 0.001).…”

“…However, more recent literature points to a higher prolapse rate with colostomies. 8,10 Of the colostomies, transverse loop colostomies has the highest rate of prolapse. 2…”

The modified Altemeier procedure for a loop colostomy prolapse

“…Stomal prolapse, which occurs in approximately 2-22 % of patients who undergo loop colostomy, is one of the most common complications after loop colostomy [2]. A stomal prolapse is associated with an impaired quality of life.…”