Creative Colostomy: A Simple, Very Cost-Effective Method of Creating Diverting Colostomy

Karukurichi S Venkatesh, MD1, P S Ramanujam, MD2, Sandra Yee, MD1. 1Tri-City Colo-Rectal Surgery, Ltd., 2West Valley Colon & Rectal Surgery

Aim: A simple, very cost-effective way of creating colostomy is performed with a single incision, through which the colon is brought out and colostomy is matured.

Material and Methods: 71 consecutive colostomies were performed over a 60 month period, by three colorectal surgeons, for the purpose of diversion due to non-healing perineal wound, ie decubitus ulcer, suppurative perineal infections, fecal incontinence, obstructing pelvic tumors like colorectal and gynecological malignancies, and in preparation of definitive surgeries for non-healing rectovaginal and rectouretheral fistulae. The age incidence varied between 26 and 86 years. BMI ranged from 20 to 41. There was a preponderance of females over males. A comparative analysis of patients' hospital stay and costs was performed between this method of creating the colostomy and laparoscopic-assisted colostomy during the same time period. The laparoscopic-assisted colostomies were performed by 3 colorectal surgical partners in our group. The procedure was performed with an excision of a circular piece of skin that was marked for the colostomy site and mobilizing the sigmoid colon and maturing the colostomy with occasional tightening of the fascia if necessary. The average surgical time was 28 minutes, ranging from 17 to 45 minutes. One patient did require midline 5 cm incision to release the adhesions to bring the colon up to the skin surface, and was considered a lone failure with this technique. There were no immediate complications. By the third post-operative day, all patients were discharged, transferred to an extended care facility, or were treated with definitive surgery. The operating room costs for our patients were significantly lower when compared to laparoscopic-assisted diverting colostomy done during the same time period at our hospital.

Complications: Three patients had prolapse of the colostomy, treated with a belt, and two patients developed a small bowel obstruction due to herniation at the colostomy site, one requiring surgery.

Conclusion: This simple method of creating colostomy is described, which is very cost-effective, safe, and reliable.

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