university of szeged (hungary) faculty of medicine. surgery clinic. departement b

University of Szeged (Hungary)Faculty of Medicine. Surgery Clinic.

Departement B.

Umbilical End Colostomy

The Solution of Peristomal Hernia

Baradnay Gy. Csíkos M.

„ I tell you that wich you yourselves do know, show you sweet Caesar’s wounds,poor poor dumb mounths, and bid them speak for me!” „ Mondom, ami tudva van. Itt felfödöm kedves Ceasar sebeit,ez árva néma szájakat, s hagyom helyettem szólani.”W.Shekaspeare: Julis Ceasar III.felv.Ford.:Vörösmarty M.

Complications of Colostomies:

Anus sigmoideus (traditional)Stricture 1-13%Prolapse 30%Parastomal HerniasOne out of every 4 Stomies ends in aComplication!!Reoperation Rate betwenSuccess Rate of late Reoperation isbetween

(Andivot T. Ann.Chir. 1996)

11-48%

13-33%

63-74%

Umbilical End ColostomyMaterial

Number of Cases 317

1984 01 01-2007 06 30 (24 Years)Female Male

116(60.5 years) 201 (65years)The Umbilical Colostomies were

created in Connection with Abdomono-Perineal Resestion and

Hartmann Operation

Umbilical End Colostomy No. 317Complications requiers Reoperation

Early LateRetraction 3 (0.9%) ---------Prolapses ----------- 4( 1.2%)Strictures ----------- 15(5%)Parastomal Hernias--- 4(1.2%)…………………………………………………………………… 3(0.9%) 23(7.4%)Total 26(8.1%)Ileus 0 0Mortality (in Connection of Colostomy) 0

Umbilical End Colostomy Technique:

Midline skin incision with semi-circular incision 5 cm distance around the umbilicus Removal of umbilicus with a circular incision Cross-shaped incision of de fascia Stapled and mobilized oral sigmoid stump pulled through the stoma opening, and stiched with interrupted sutures in two layers to the fascia and skin.

„The use of the umbilical site is not a unique concept, some surgeons prefer to

create the colostomy in the umbilicus initially.

Raza and colleagues evaluated 101 patients in whom they performed an

umbilical colostomy….. only four patients required reoperation.

There where no peristomal hernias and no prolapses in their experience.”

Corman.M.L.:Colon and Rectal Surgery. Lippincott 1984.645 p.

Raza, SD., Portin BA. etc.: Dis.Colon Rect. 20.223-230. 1977

Umbilical End ColostomyConclusions

An Umbilical Colostomy does not hinder the patients from dressing.

It provides an exellent function for irrigationThe number and ratio of acute and late

complication is idealA pre-formed opening in abdominal wall is

used to create the colostomyThe patients were satisfied with the Umbilical

Colostomy: None of them asked for its transfer

Hajdúszoboszló, 2008 Oct. 16

Thank you for your attention !