jr colostomy closure

8/9/2019 JR Colostomy Closure

1/34

COLOSTOMY CLOSURE:HOW TO AVOID COMPLICATION

ADVISOR : DANIEL A., MD SURGEON

PRESENTER : Novia Rahayu T (2008-61-007)

Andi Rizki (2008-61-059)

Michael Praditya (2008-61-155)

Lenny Syahnita (2009-61-334)

JOURNAL READING

Bischoff A. Levitt MA. Lawal TA. Pena A.

Pediatr Surg Int. Aug 16TH

2010


2/34

INTRODUCTION


3/34

Colostomy

an incision (cut) into the colon (large intestine) tocreate an artificial opening or "stoma" to theexterior of the abdomen. This opening serves as a

substitute anus through which the intestines caneliminate waste products until the colon can healor other corrective surgery can be done

(Texas Pediatric Surgical Assc)

Colostomy is an operation frequently performedin pediatric surgery.


4/34


5/34

Indication

Colostomy

Hirschprung Disease

Anorectal Malformation


6/34


7/34

Important role:

Preoperative

Intraoperative postoperative

Achieving Low morbidity rate


8/34

METHOD


9/34

Retrospektif

Data from:

649 patient

Medical record

1982-2010

Perioperatif protocol


10/34

Perioperative Protocol

1. Admission on the day before surgery

2. Clear liquids by mouth

3. Repeated proximal stoma irrigations with

saline solution, 24 h prior to the operation

4. Administration of IV antibiotics during

anesthesia induction and continued for 48 h

5. Meticulous surgical technique


11/34

Meticulous surgical technique

Packing of the proximalstoma

Plastic drape to immobilizethe surgical field

Multiple silk sutures inmucocutaneous junction

Careful hemostasis,emphasis in avoiding

contamination, Cleaning the edge of the

stomas to allowanastomosis


12/34

Meticulous surgical technique (2)

A two-layer, end-to-

end anastomosis

with separatedlong-term 6-0

absorbable sutures


13/34

Meticulous surgical technique (3)

Generous irrigation ofthe peritoneal cavityand subsequent layers

with saline solution Closure in layers to

avoid dead space

Avoidance of

hematomas Wound coverage with

collodium


14/34


15/34


16/34

RESULT


17/34


18/34

Type of Colostomy

stoma 480

Loop 137

Hartman 32


19/34

1,5% (10 pts) had complication

Complication

Intestinal obstruction 6

Incisional hernia 4

-No anastomosis dehiscence

-No wound infection

-No episode of bleeding

-No anastomosis stricture

No mortality


20/34

DISCUSSION


21/34

COLOSTOMY

A routine procedure, frequently performed

Elective procedure

Assumed easy, reproducible, minimal morbidity May still be source of complications, incl

death

Author share routines & surgical technique

they use during colostomy closure procedure


22/34

SURGERY PREPARATION

Irrigation of proximal stoma

Clear fluids by mouth

Contribution not clear

Prophylactic antibiotic

Erythromycin by mouth : frequent vomiting Ampicillin, gentamicin, clindamycin

Ampicillin, gentamicin, flagyl

Cephalosporin, flagyl


23/34

OPERATIVE ROUTINES

PACKING OF STOMA

Prepare skin with Betadine & Alcohol

Pack proximal stoma with gauze + Betadine

Operative field immobilized with plastic drape

Very important in reduction of contamination


24/34

COAGULATE & CUT

Use coagulation to coagulate!

Use cutting current to cut!*excessive burning may leave damaged tissue

bacterial proliferation

Hemostasis


25/34

BOWEL ANASTOMOSIS

One-layer anastomosis

Two-layer anastomosis

Several articles: both are as good

Authors observation: leakage or dehiscenceoccurred in one-layer anastomosis

Profuse irrigation of peritoneal cavity is alsoimportant


26/34

ABDOMINAL WALL CLOSURE

Single-layer with running suture Fashionable, quick, and easy

Produce more pain, cosmetically undesirable, moreprone to evisceration

Single-layer with interrupted stitches Used in secondary operation in wound dehiscence

Safer closure (lower tension of skin edges), bettercosmetic scar

Each layer closed separately


27/34

(ABDOMINAL WALL CLOSURE)

Incisional hernia

lack of wound layer closure The need to pay attention to all steps & details of

operation

NGT is unnecessary in clean operation


28/34

SIZE DISCREPANCY

Greater discrepancy demands more technical

procedure End-to-end anastomosis or

End-to-side anastomosis (if dicrepancy >4:1)

The bigger size discrepancy, the longer waiting

time with the colostomy open


29/34


30/34


31/34


32/34

CONCLUSION


33/34

Based on Authors opinion and experience

Colostomy closure can be performed with

minimal mortality & morbidity Providing meticulous technique


34/34

THANK YOU

jr colostomy closure

Documents