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Table of Contents
SURGICAL TECHNIQUE
Year : 2022  |  Volume : 5  |  Issue : 2  |  Page : 27-29

Transcolostomy colectomy: A stoma revision technique to treat complex stoma prolapse


Department of Surgical Oncology, Netaji Subhas Chandra Bose Cancer Hospital, Kolkata, West Bengal, India

Date of Submission13-May-2021
Date of Decision16-Dec-2021
Date of Acceptance01-May-2022
Date of Web Publication04-Jan-2023

Correspondence Address:
Dr. Soumen Das
Om Skylark, 59, B.T. Road, Kolkata - 700 002, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcs.ijcs_6_21

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  Abstract 

Colostomies are commonly performed operation in colorectal surgery. These are not free of complications which vary from acute retraction, and malfunction to delayed stoma prolapse. Prolapse is an annoying complication that may lead to excoriation, obstruction, and gangrene. There are various ways of treating stoma prolapse. Here, we discuss and report one simple technique of stoma revision, called transcolostomy colectomy.

Keywords: Correction of prolapse, stoma prolapse, transcolostomy colectomy


How to cite this article:
Das S, Rakshit K, Nag A, Purkait S, Dutta R. Transcolostomy colectomy: A stoma revision technique to treat complex stoma prolapse. Indian J Colo-Rectal Surg 2022;5:27-9

How to cite this URL:
Das S, Rakshit K, Nag A, Purkait S, Dutta R. Transcolostomy colectomy: A stoma revision technique to treat complex stoma prolapse. Indian J Colo-Rectal Surg [serial online] 2022 [cited 2023 Jan 30];5:27-9. Available from: https://www.ijcrsonweb.org/text.asp?2022/5/2/27/367036


  Introduction Top


Colostomies are one of the most commonly performed operations in colorectal surgery. Like other surgeries, it has its own complications.[1] Colostomy prolapse is a delayed but annoying complication. This can lead to local skin problems, difficulty in stoma evacuation, intestinal obstruction, strangulation, etc.[1] Small prolapse without any complication can be treated conservatively, but larger prolapse or complicated prolapse needs surgical management.[2] Conventionally, stoma refashioning is the most commonly performed procedure used to treat this condition. Here, we present a simpler way to treat stoma prolapse, which can even be done under local or regional anesthesia.


  Case Report Top


A 56-year-old woman with a known history of diabetes, hypertension, and hepatitis B positivity presented with bleeding per rectum, recurrent vomiting, abdominal distension, tenesmus, and weight loss. After evaluation, colonoscopy and magnetic resonance imaging (MRI) pelvis showed a proliferative locally advanced growth at 4 cm from the anal verge with intestinal obstruction. Colonoscopicy biopsy confirmed adenocarcinoma rectum. MRI showed T3N1 disease. Then, she was planned for Chemoradiotherapy (CT/RT) after diversion colostomy. After preoperative optimization, transverse loop colostomy was done.

She recovered well in the postoperative period. She reported to the outpatient department with a stomal prolapse 2 months after the surgery. It was a 6-cm full-thickness symptomatic prolapse through the proximal opening [Figure 1]. She was planned for stoma revision with “transstomal colectomy” under local anesthesia to correct the prolapse. This operation can be under local, spinal, or general anesthesia.
Figure 1: Prolapsed transverse colon

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Surgical technique

This procedure can be done under regional or local anesthesia, depending on the site of the stoma and patient profile. In the case of local anesthesia, pericolostomy infiltration of 2% lignocaine is done in a ring block manner.

A circumferential incision is made 2 cm inner to the mucocutaneous junction of the colostomy. This incision is deepened through the wall of the ostomy colon up to the plane between two layers of the prolapsed colon [Figure 2].
Figure 2: Dissection between outer and inner colon

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Considering prolapse as intussusception, there are two layers of the colon at the site of prolapse. Once through-and-through resection of the outer colon is done, the mesentery of the colon inside is exposed (mesentery of the intussusceptum, considering stoma prolapse – an everted intussusception). The redundant part of colon is brought out through ostomy wound. This redundant part, along with its mesentery is resected out. Then, the inner colon cut edge is anastomosed with the outer colon cut edge [Figure 3].
Figure 3: After resection

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  Discussion Top


Colostomies are the commonly performed procedure in colorectal surgery. Permanent colostomy is done after abdominopelvic resection. Temporary diversion colostomy is done in f locally advanced obstructing rectal cancer cases to protect against colo-anal anastomosis following low anterior resection. Early complications of colostomy are improper site selection, vascular compromise, stoma retraction, peristomal skin irritation, acute parastomal hernia, bowel obstruction, etc.[3] The delayed complications are parastomal hernia, stoma prolapse, etc. Stoma prolapse can lead to malfunction of stoma, morbidity, skin excoriation and intestinal obstruction, gangrene, etc.

Treatment of stoma prolapse varies. This ranges from local treatment to stoma refashioning or stoma reversal. Local treatment with compression, manual reduction, application of appliances, etc., can give temporary benefits. Local surgical treatment with a stapler or local resection can provide good results.[4],[5]

Transcolostomy colectomy (TCC) with end-to-end anastomosis is a simple but effective method of stoma prolapse correction. The advantages are as follows: this can be done under local anesthesia, day-care surgery is possible, less pain, and it does not require skin incision laparotomy. However, this requires larger long-term studies to prove its sustainable benefit.


  Conclusion Top


TCC with end-to-end anastomosis is an easy, reproducible method of stoma prolapse correction. However, larger studies are required to establish it as a standard of care.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kann BR. Early stomal complications. Clin Colon Rectal Surg 2008;21:23-30.  Back to cited text no. 1
    
2.
Monette MM, Harney RT, Morris MS, Chu DI. Local repair of stoma prolapse: Case report of an in vivo application of linear stapler devices. Ann Med Surg (Lond) 2016;11:32-5.  Back to cited text no. 2
    
3.
Masumori K, Maeda K, Koide Y, Hanai T, Sato H, Matsuoka H, et al. Simple excision and closure of a distal limb of loop colostomy prolapse by stapler device. Tech Coloproctol 2012;16:143-5.  Back to cited text no. 3
    
4.
Papadopoulos V, Bangeas P, Xanthopoulou K, Paramythiotis D, Michalopoulos A. Stoma prolapse handmade repair under local anesthesia with variation of Altemeier method in severe patients: A case report and review of the literature. J Surg Case Rep 2017;2017:rjx027.  Back to cited text no. 4
    
5.
Abulafi AM, Sherman IW, Fiddian RV. Délorme operation for prolapsed colostomy. Br J Surg 1989;76:1321-2.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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Discussion
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