Late stomal complications and their surgical correction

Abstract

Aim. To conduct a detailed analysis of the causes of development of late stomal complications, to determine the indications for surgical correction, to evaluate the effectiveness of new methods of surgical treatment. Methods. Conducted was an analysis of the causes of late stomal complications in 141 patients with a stoma of the colon. Results. A parastomal hernia was diagnosed in 44 (31.2%), prolapse - in 29 (20.6%), stricture - in 9 (6.4%) patients. Introduced into practice were new methods of surgical correction of complicated stomas. Parastomal hernia was detected in 44 (31.2%) patients - 26 (59.1%) females and 18 (40.9%) males, all patients with this complication were older than 50 years, the age group 71-80 years included 43.5% of patients. Since 2005 performed were 17 reconstructive operations for parastomal hernias (Russian Federation patent №2406454 and №2395238). Stoma prolapse was observed in 29 (20.6%) patients, 10 cases - in patients aged 71 to 80 years. Most often this complication developed in patients with double-barreled transverse stomas - in 10 (76.9%) of 13 patients. 4 patients underwent surgery due to prolapse. Stoma stricture was diagnosed in 9 (6.4%) patients. In 7 patients with a stoma stricture in the early postoperative period registered was festering of the parastomal wound (4 cases), marginal necrosis of the stoma (2 cases), and stoma retraction (1 case). Correction with the use of stents for the prevention of recurrence (Russian Federation patent №2357681) was conducted in all cases. The so-called «lock-stoma» was diagnosed in 16.3% of cases (23 patients). Although this condition does not belong to stomal complications in its pure form, however in most cases it causes the inability to use the incontinence bag, reducing the quality of life. Conclusion. Despite the inevitability of the development of parastomal complications, provided proper surgical techniques can either prevent or delay their appearance; reconstructive operations for complicated stomas, conducted by moving the stoma to a new place with retroperitoneal conduction makes it possible to obtain satisfactory results, significantly improve the quality of life that promotes full social adaptation of stomal patients.

Treatment Methods of Patients With Postoperative Ventral Hernias and Created Intestinal Fistulas

“…При этом сложность в принятии решения состоит в том, что для устранения свища необходимо иметь четкое представление о расположении и проходимости дистального участка кишки, с которым будет восстановлена непрерывность желудочно-кишечного тракта [5]. При этом пластическое закрытие дефекта в брюшной стенке, обусловленного грыжей, нежелательно из-за наличия источника инфицирования тканей -свища [6,7]. Поэтому каждый вариант лечения пациента должен быть обоснован и целесообразен [8,9]…”

Current Technologies for the Prevention of Parastomal Herniation (Review)

“…Among the major causes of parastomal herniation, are technical errors in the process of stoma creation [31][32][33]. Hence, the problem can be solved by improving the stoma-related technique so to prevent the hernia formation [34].…”