A Reading on Colostomy
A Reading Presented to
The faculty of Nursing Department
Monica Aguirre, RN
In Partial fulfilment of the
Requirements in NCM-217
By:
Karl Angelo Montano, Stn
BSN 3B
January 25, 2021
“Temporary closure of colostomy with suture before
colostomy takedown improves the postoperative
outcomes”
Bibliography
Wan-Hsiang, H., Ko-Chao, L., Tsai, K., & Hong-Hwa, C. (2018). Temporary
closure of colostomy with suture before colostomy takedown improves
the postoperative outcomes. International Journal of Colorectal
Disease, 33(1), 47-52. doi:http://dx.doi.org/10.1007/s00384-017-2934-
1
Summary
Issues regarding postoperative outcomes of colostomy takedown have
been widely discussed in the literature, wound infection especially. Temporary
closure of colostomy with suture before takedown was adopted in our study,
which provided excellent traction to aid mobilization of stomy and avoided
stool spillage to downgrade the wound classification to Bclean contamination.
Results In univariate analyses, significantly shorter operative time and lower
postoperative wound infection rate were noted in the group receiving silk
suture. Mobilization, excision of ostomy edge with skin, anastomosis with
absorbable suture, repair of the rectus sheath, and primary closure of wound
skin were same in both groups. Outcome measurements Operative time and
wound infection rate were primary endpoints.
Wound infection was identified by the review of progress notes, e.g.,
clinical findings of localized cellulitis, need for antibiotic treatment, and/or
opening of the wound. Statistical analyses Fisher's exact test was used to
determine the association between groups and categorical variables. Multiple
regression analysis and multivariate logistic regression were used
todemonstrate the associations with operative time and wound infection,
respectively. Operative time and wound infection rate were compared for the
two groups. Multiple regression analyses results and patients' clinical
characteristics were also shown inDiscussion Temporary closure of a
colostomy with silk suture shortened the operative time and lowered the
wound infection rate. In some retrospective studies, the median operative time
ranged from 72.6 to 116 min. In two randomized trials, the average operative
time was 127.2 and 116.4 min, respectively, for loop ileostomy and colostomy.
It would be unfair to conclude that a takedown procedure was better based on
shorter operative time alone, as there are many other confounding factors.
The difficulty to hold the all Allis and unequal distribution of traction
force caused the edge damage of the colostomy, wound contamination and
the prolonged operative time. The wound infection rate in ostomy takedown is
believed to be associated with the techniques of wound closure. Purse-string
closure was associated with fewer wound infections than primary closure in
randomized controlled trials. Our study showed that hospital stay was
predominantly prolonged for patients with wound infection, which was
consistent with the finding in prior reports. Any procedure designed to reduce
wound infection rates should be applied to avoid lengthened hospital stay and
the expenses derived. Second, the results for wound healing times were not
shown because the exact days were not available, but the wound healing time
of most patients was less than 2 weeks. Finally, the limitation in long-term
follow-up made us unable to investigate the incidence and risk factors of
incision hernia in temporary ostomy wound.
Reaction
The article is about improving postoperative outcome in colostomy.
A colostomy is a surgical procedure that brings one end of the large intestine
out through the abdominal wall. During this procedure, one end of the colon is
diverted through an incision in the abdominal wall to create a stoma. A stoma
is the opening in the skin where a pouch for collecting feces is attached. the
reasons for having a colostomy are Infection of the abdomen, such as
perforated diverticulitis or an abscess, Injury to the colon or rectum, for
example, a gunshot wound and Partial or complete blockage of the large
bowel intestinal obstruction.
I was amazed by the article that I have read because they were
successful in decreasing the infection and they were able to shorten the
surgery time. I hope there will be more researches about this to lessen more
the infection rate and there will be less complications. This procedure can also
lessen the anxiety of patients because they will not anymore worry about
infection and they will not anymore spend more money for extra antibiotics if
there will be infection again. I hope someday I will be able to assist in a
surgical operation involving colostomy as it will make my nursing journey
more exciting.
