Proximal colostomy: Still an effective emergency measure in obstructing carcinoma of the large bowel

Abstract

Large bowel obstruction constitutes an emergency abdominal condition and necessitates prompt surgical treatment. The optimal approach is still controversial as to whether to perform a diverting colostomy only or a tumor resection with or without primary anastomosis. Seventy-one elderly and high-risk patients were treated by proximal diverting colostomy through a right upper abdominal incision. The operative mortality was 8.5%, with an additional morbidity of 20.5%. Stomal complications appeared in 6.1% of the survivors. Seventy-five percent of surviving patients underwent successful resection and closure of colostomy within 3 months without additional mortality. Others were not operated because of metastatic disease or severe concomitant disease. We conclude that although primary resection should be attempted in good risk patients, for those patients who are elderly and at high risk, a simple life-saving procedure, such as fecal diversion, could alleviate obstructions with relatively low morbidity and mortality and improve the patient's prospects for subsequent definitive surgery.

Loop Ileostomy and Colostomy—A Comparison between Supporting Plastic Rods and Epicutaneous or Subcutaneous Silicon Drains

“…This shows the need for further improvements in surgical techniques. The complication rate of this study (29%) is well in line with previous research [4,[19][20][21][22][23][24][25][26]. In a large registry study, Cottam, et al identified 34% of 3970 stomas as problematic [4].…”

Evaluation of P-POSSUM in Surgery for Obstructing Colorectal Cancer and Correlation of the Predicted Mortality With Different Surgical Options

“…Traditional three-staged resection is out of favor nowadays because only 70 to 80 percent could undergo subsequent resection. 19 Resection of the tumor without anastomosis, i.e., two-staged resection or Hartmann's operation, is a safe option for most surgeons. Recently, promising results on one-staged resection and anastomosis with segmental resection after antegrade on-table irrigation or subtotal colectomy have been reported.…”

Hartmann Procedure: Is It Still Relevant Today?

“…When the cumulative morbidity and mortality are taken into account, an initial loop colostomy does not offer any survival advantage and has the disadvantages of a prolonged hospital stay and exposure of patients to repeated operations 11 . This procedure has been largely reserved for the patient who is unstable during surgery or when the surgical team is inexperienced 12 .…”