Loop Colostomy with Not Everted Fashion for Rectal Cancer

Kim, Kyung Ha; Kim, Hyun Tae; Ha, Tae Geun; Shin, Jin Yong; Kim, Woon Won; Hong, Kwan Hee

Abstract

PURPOSE: An anastomotic leak after resection of rectal cancer is a omnious complication. The diverting stoma is performed to avoid this serious complication. However, a diverting stoma and a stoma reversal are associated with significant morbidity and a small mortality. As stoma-related complications are associated with a delay of adjuvant therapy for advanced rectal cancer, minimal stoma-related morbidity is mandatory for rectal cancer patients. A safe and simple dissection of the stoma is known to be associated with less morbidity at stoma closure. Since in a loop colostomy of a not everted fashion, it is easy to construct and dissect the peristomal site at colostomy reversal, this study evaluated the usefulness of a protective loop colostomy of a not everted fashion in rectal cancer.
METHODS
We reviewed the clinical records of 71 cases of loop colostomy closure for rectal cancer between January 1996 and December 2004. The clinical data, including indications for the stoma, the clinicopathologic features of the patients and their general conditions, the data for patients receiving adjuvant therapy, stoma-related morbidity, stoma-closure-related morbidity, and perioperative data were examined.
RESULTS
Indications for stoma creation are the discretion of the surgeon (n=22), poor bowel preparation (n=21), unstable anastomosis (n=16), bowel obstruction (n=6), and anastomotic leakage (n=6). The stoma-related morbidity rate for a non-eversion colostomy was 5.6%. Morbidity events were peristomal erythema (n=2), prolapse (n=1), and parastomal hernia (n=1) requiring surgery. The stoma-closure-related morbidity rates was 9.9%. In the 45 patients undergoing adjuvant therapy, colostomy closure was performed during adjuvant therapy in 39 patients. Major complications, such as anastomotic leakage or abscess following reversal of the non-eversion colostomy, occurred in 1 of the 71 patients (1.4%). The average operating time and the blood loss for clostomy closure were 89.5 minutes and 202.3 ml, respectively. A simple closure of the loop colostomy was performed in 51 patients (71.8%).
CONCLUSIONS
Based on our results, a non-eversion colostomy may be considered due to the ease of construction and reversal if a temporary diverting stoma for rectal cancer is indicated.