Why, When and How to Perform Manual Colostomy Reversal Following Wide Colorectal Resection at a Poorly Equipped Surgical Facility?

Objectives: The purpose of this research was to report manual colostomy reversals (MCR) techniques used after large colorectal resections (WCRR) as well as related early results. Context: The colostomy may follow a broad colorectal resection in temporary colostomy, the reversal of which may lead to difficulties such as after certain Hartmann colostomy. The colostomy reversal decision is typically not easy and always represents the preference of the patient, thoroughly analysed and accepted by the surgeon. This difficulty is greatly exacerbated by the inability of mechanical suturing instruments. Methods: This retrospective research was conducted at Lusaka University Teaching Hospital and the Lubumbashi University Clinics between 1 January 2007 and 31 December 2009. Data from operational theatre books, in-patient and out-patient clinic files were collected. Only fully reported cases were taken into account with consistent targeted parameters (demographic causes, colostomy indication, type of colostomy, reversal procedure, early outcomes and hospital stay). Results: During the study period , a total of 124 colostomies were performed; 98 were temporary. Of these 98 resections, 36 were wide and the MCR was achieved as follows: simple mobilisation of the colon (56%); additional symphysiotomy (28%), trans-sacral approach (11%) and ileo-colo-rectal transplantation (6%).In terms of sex and age distribution, there was no substantial difference. Sigmoid colon volvulus (58%); colorectal cancer (17%); perforated sigmoid diverticulitis (11%), amyobic perforations (18%) and rectal cancer (6%) were the triggers of WCRR. After good treatment of the following complications, all 36 patients (100 percent) were discharged: a faecal fistula in two patients, a surgical abdominal site infection in 3 patients and pelvic pain and discomfort. Conclusion: In selected and well-prepared patients with a great procedure, the MCR after WCRR is viable. Restrictions on cancer resections and patient protection per operative must be followed. Colorectal stapling devices should remain the perfect acquisition.

Author(s) Details

Prof. Dr. E. B. F. K. Odimba
University Teaching Hospital, Lusaka, Zambia.

M. Nthele
University Teaching Hospital, Lusaka, Zambia.

M. Mbambiko
University Teaching Hospital, Lusaka, Zambia.

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