Londono-Schimmer EE, Leong AP, Phillips RK, et al.
Diseases of the colon and rectum. Date of publication 1994 Sep 1;volume 37(9):916-20.
1. Dis Colon Rectum. 1994 Sep;37(9):916-20.
Life table analysis of stomal complications following colostomy.
Londono-Schimmer EE(1), Leong AP, Phillips RK.
Author information:
(1)Department of Surgery, St. Mark's Hospital, London, United Kingdom.
PURPOSE: This study was designed to evaluate the long-term complication rate of
left iliac fossa end sigmoid colostomies and to determine etiologic factors.
METHODS: A retrospective chart review and actuarial analysis were performed.
RESULTS: The crude and actuarial risks of paracolostomy complications in 203
patients were 51.2 percent and 58.1 percent at 13 years, respectively.
Paracolostomy hernia was the most common complication (36.7 percent at 10 years).
Siting the stoma through the belly of the rectus abdominis muscle did not reduce
the risk of hernia, but an extraperitoneal course had a significantly lower risk
of herniation when compared with a transperitoneal course and intestinal
obstruction was marginally less frequent. Paracolostomy hernias were otherwise
more likely in the elderly, and in those with other abdominal wall hernias.
Mesenteric fixation did not reduce the subsequent chance of prolapse. The
reduction in the risk of intestinal obstruction when lateral space closure was
employed was not statistically significant (4 percent vs. 10 percent, P < 0.1),
and all three patients with stomal retraction had had lateral space closure.
CONCLUSION: The evidence in this study that spans a 22-year period questions much
surgical technical dogma and raises the possibility that parastomal hernias may,
like inguinal hernias, represent a failure in the transversalis fascia that might
technically be avoidable.
DOI: 10.1007/bf02052598
PMID: 8076492 [Indexed for MEDLINE]
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