Colostomy complications — a surgical failure or a population problem

Abstract

Abstraer: Stoma related complications vary from population to population. This study was undertaken in order to compare the complications associated with the most frequently constructed stomata at King Faisal Specialist Hospital (loop transverse, loop sigmoid and end colostomy) and those previously reported by one of the authors from a different population in New Zealand. Diverting stomata were of the dependant loop type. All operations were performed by or under the supervision of the same surgeon. One hundred and forty-one colonic stomata were fashioned in 137 patients (72 men, 65 women). There were 74 end stomata, 60 loop transverse and 7 loop sigmoid colostomies. One hundred and twenty-seven stomata were fashioned electively and 14 were constructed as emergencies. One patient died post operatively from overwhelming sepsis following colonic perforation. Follow-up varied from l to 72 months and most complications occurred within the first 6 months. The overalt stoma complication rate was 22.7%. The complication tate was highest in patients in whom a Ioop transverse colostomy was performed. Stoma related complications were fewer in males than females (18.9% vs. 26.9%) and higher in patients having an emergency rather than ah elective stomata (35.7% vs. 21.3%) although these differences did not reach statistical significante. Patients with stomata and early (Dukes Stage A and B) cancer had fewer stoma related complications (15.7%) than more advanced patients (25%). These diŸ were not statistically significant either. The overall stoma related complication rate in the New Zealand study was 11.1% and this was significantly diffcrent from the rate recorded in the present study (p < 0.01). Ir is suggested that increased intra-abdominal pressure consequent upon straining in conjunction with frequent bending (rukoo) and kneeling (sujood) during prayer may be associated with ah increased risk of stoma prolapse and may be responsible for the differences in stoma prolapse rates identified between Saudi Arabia and New Zealand. Patients should thus be advised not bend of kneel for prayer immediately following colostomy surgery.