Revisiting the double-barreled wet colostomy for simultaneous urinary and fecal diversion—an Indian experience

Abstract

Pelvic exenteration in advanced malignancies is usually a curative procedure aimed at improving quality of life. We analyzed the perioperative data and outcomes in 12 patients who underwent simultaneous urinary and fecal diversion with a double-barreled wet colostomy after total pelvic exenteration. Eight males and four females aged between 25 and 73 years underwent the procedure with mean operative duration of 350 min and mean postoperative stay of 15 days. Three patients developed early complications while four developed late complications. During follow up ranging from 6 to 64 months, four patients died of disease progression while four died of unrelated causes. One lady was lost to follow up, the remaining had a mean survival of 32.9 months. None had deterioration in renal function or peristomal dermatitis and all were well accustomed to managing one stoma. Our results show that double-barreled wet colostomy is technically simple and reduces surgical morbidity while providing satisfactory outcomes and patient comfort.

Double Barreled Wet Colostomy: Initial Experience and Literature Review

“…In the group of patients analyzed in this series, almost all but one patient were operated for colorectal adenocarcinomas, just one with a prostate neuroendocrine tumor. We have found that it is a safe procedure even in patients 70 years old or older, as other authors that have performed the procedure in patients in the eight decade of life with good perioperative results [ 2 , 13 – 15 ] ( Table 1 ).…”

“…Urinary stones have been reported in the colonic urinary reservoir. Other early complications with lower incidence are the ones associated with the perineal wound, postoperative ileus, and central venous access infection [ 2 , 3 , 10 , 13 – 15 ]. Only Carter has reported the presence of a metabolic acidosis associated with the urinary reservoir, complication that can be seen in any patient with an intestinal urinary reservoir [ 8 , 10 , 17 ].…”

“…Only Carter has reported the presence of a metabolic acidosis associated with the urinary reservoir, complication that can be seen in any patient with an intestinal urinary reservoir [ 8 , 10 , 17 ]. Another late complication reported in the DBWC is stomal complications [ 2 , 13 ]. In our group of patients, the most frequent complication was the pelvic abscess, present in 3 patients, followed by postoperative ileus in 2 patients, and sepsis related to central line infection (2 patients).…”

Double barreled wet colostomy. Case report and description of the surgical technique

“…9 DBWC is used in pelvic exenteration for gynecologic, urologic or colorectal cancer. 2,3,[8][9][10][11][12][13][14] Large groups have demonstrated the safety of this surgery and are even extending the age limit, doing surgery on octogenarian patients. 2,[9][10][11][12][13][14] Several complications have been associated to urinary diversion.…”

“…Perineal wound infection, post-operative ileus, vascular access infection, among other complications have been reported in this type of procedure. 2,3,9,[12][13][14] Metabolic acidosis is another possible complication in patients with a urinary reservoir. 7,9,16 Perioperative mortality for this type of surgery is reported from 0% to 11.56%.…”