Appendicostomy an alternative to Ileostomy or Colostomy

Prakash Saharia, MD, Farr Nezhat, MD

Winthrpe University Hospital, Mineola, NY 11501

Introduction: Tube appendicostomy offers an alternative for Ileostomy or proximal colostomy following low anterior resection with minimal morbidity in high risk low colorectal anastomosis.

Methods: We embarked on a pilot study in high risk patients for anastomotic leaks in low anterior resections. We selected 8 patients over last 5 yrs. which would normally get Ileostomy or proximal colostomy to protect the low colorectal anastomosis. A Foley catheter size 24 French was advanced through the appendicostomy into the cecum for proximal drainage. Post- operative course of these patients was carefully monitored for morbidity.

Results: The study comprised of 8 patients who were high risk for post –operative anastomotic leak. Average age was 71.4 yrs. Two had pre-op chemo-radiation for rectal lesions. Two patients had complete colonic obstruction from descending colon lesion, and unprepared bowel. One for colo-vesical fistula and three for recurrent diverticulitis. One patient had abscess of the anterior abdominal wall from necrosis of the appendicular stump. One patient developed incisional hernia at the site of appendicostomy. Rest of the patients did well. Average stay in the hospital was 7 days. Patients were discharged home with a dry 4×4 over the Appendicostomy. It was closed as an outpatient within 6-8 weeks.

Conclusion: Our data support that appendicostomy is a safer procedure with minimal morbidity and shorter hospital stay. The closure of appendicostomy usually requires out- patient cauterization of the mucosa with silver nitrate sticks or using the staple from outside under local anesthesia and approximates the skin.

Session: Poster Presentation

Program Number: P104

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