Pirogovskyy V. Reconstructive surgery in loop colostomy

This paper presents the experience of surgical treatment of 153 patients with various types of loop colostomy. When covering particular surgery and postoperative management of patients. Objective: To improve the results of surgical treatment of patients with loop colostomy by examining the causes of postoperative complications, improving the preoperative preparation, development and implementation into clinical practice a new way of the reconstructive surgery. This thesis presented a retrospective analysis of treatment of 153 patients with various types of loop colostomy age 19-79 years, 81 (52.9 %) male and 72 (47.1 %) female. The term from ostomy forming to reconstructive surgery was not less than 3 months. G1 had 76 patients operated between 1999 and 2006, the closure of colostomy in this group was performed using a classic retroperitoneal approach. G2 had 77 patients operated between 2006 and 2013 using the original method. Results showed that in G1 anastomotic leakage occurred in 6 (7.9 %) patients and in G2 in 1 (1.3 %) patient who had severe comorbidities. Postoperative wound infection appeared in 6 (6.6 %) patients of G1 and in 4 (5.2 %) patients of G2. The proposed method of colostomy closure consists of several steps. First, when performing transanal colonoscopy the day before surgery, a PVC guide-tube is introduced to the disabled part of colon. During the surgery, colostomy is released from the tissue of the anterior abdominal wall to the level of peritoneum. Before complete suturing of colonic wall an intubation drainage is fixed to guide-tube's end that comes out of stoma. Colonic intubation is carried out when dragging the guide-tube thru rectum, and the proximal end of the drainage tube is introduced 10-15 cm. proximal to anastomosis site. Thus, during a minimally invasive surgery we were able to achieve decompression of colonic anastomosis. Skin wound is partially closed leaving the central part of it opened.