Analysis Of Two Different Sigmoid Colostomy And Preventiont Of Its Stomal Complications

Objective:To evaluate objectively and accurately the differences in efficacy in intraoperative,postoperative complications, and defecation function one year after surgery between theintraperitoneal sigmoid colostomy and the extraperitoneal sigmoid colostomy, wecompared the patients receiving Abdominoperineal resection because of Anal and lowerrectal malignant tumor at the First Affiliated Hospital of Soochow University andLianyungang Hospital of Traditional Chinese Medicine affiliated to Nanjing University ofChinese Medicine During the period of2004-2013, especially who receivedextraperitoneal sigmoid colostomy with or without abdominal functional training. Maybewe could find a way to reduce postoperative complications and enhance bowel function soas to reduce the patient’s pain and inconvenience and improve the quality of life.Methods:1. We collected perioperative data of the patients, who had been undergoneAbdominoperineal resection because of Anal and lower rectal malignant tumor, from themedical records. And we kept records of the general conditions (such as the patient’s name,gender, age, address, diagnosis, operation date) and the perioperative case (such asoperation of colostomy method, operation time, operative blood loss, the postoperative firstexhaust and defecation time, postoperative hospitalization time, with or withoutpostoperative complications and reoperation).2. The data of160cases were collected by querying the patient hospital records,telephoning and visitingpatients in their homes during one follow-up year. Of these160patients, the intraperitoneal sigmoid colostomy group was56, the extraperitoneal sigmoidcolostomy group was72, theextraperitoneal sigmoid colostomy with abdominal functionaltraining group was32. Patients and staff were blinded follow-up, and all data after loggingwas coveredand categorized. 3. The perioperative case, the postoperative complications, and the defecationfunction one year after surgery were compared between the intraperitoneal sigmoidcolostomy group and the extraperitoneal sigmoid colostomy group(transabdominal rectusextraperitoneal colostomy and lateral rectus colostomy), especially between theextraperitoneal sigmoid colostomy group and the extraperitoneal sigmoid colostomy withabdominal functional training group. Chi-square test and T test were used by SPSS17.0software to evaluate the statistical significance of count data and Measurementdata.Differences with a P value of less than0.05was considered statistically significant,and difference with a P value of less than0.01was considered highly statisticallysignificant.Results:1. General information:160patients were set into three groups. Of these160patients,the intraperitoneal sigmoid colostomy group was56, the extraperitoneal sigmoidcolostomy group was72, the extraperitoneal sigmoid colostomy with abdominal functionaltraining group was32. T test showed there was no statistically significant difference in thethree groups (patient age: P＞0.05). It is feasible to compare between the intraperitonealsigmoid colostomy group and the extraperitoneal sigmoid colostomy group, especiallybetween the extraperitoneal sigmoid colostomy group and the extraperitoneal sigmoidcolostomy with abdominal functional training group.2. Perioperative case: There have no difference in terms of stoma location, blood loss,operative time, and postoperative hospitalization time among the three groups. In terms ofthe postoperative first exhaust and defecation time, the intraperitoneal sigmoid colostomygroup and the extraperitoneal sigmoid colostomy group were less than the extraperitonealsigmoid colostomy with abdominal functional training group.3. Postoperative complications: first, Pearson X2test showed there was statisticallysignificant difference in the total complications rate and the incidence of stomacomplications between the intraperitoneal sigmoid colostomy group and theextraperitoneal sigmoid colostomy(respectively P＜0.01, P＜0.05). The results showclearly that the total complications rate in the intraperitoneal sigmoid colostomy group wassignificantly higher than that of the extraperitoneal colostomy group, and the incidence ofstoma complications in the intraperitoneal sigmoid colostomy group was higher than it.Pearson X2test showed there was no statistically significant difference in the general complications between two groups (P＞0.05).Second, Pearson X2test showed there was statistically significant difference in thetotal complications rate and the incidence of stoma complications between theextraperitoneal sigmoid colostomy group and the extraperitoneal sigmoid colostomy withabdominal functional training group(respectively P＜0.05, P＜0.05). The results showclearly that the both the complications rates in the extraperitoneal sigmoid colostomygroup were higher than that of the extraperitoneal sigmoid colostomy with abdominalfunctional training group. Pearson X2test showed there was no statistically significantdifference in the general complications between two groups (P＞0.05).Thirdly, Pearson X2test showed that there was statistically significant difference inthe incidence of stoma complications between the transabdominal rectus extraperitonealcolostomy group and the lateral rectus colostomy (P＜0.05), especially the incidence ofparastomal hernia was more salient(P＜0.01). The results show clearly that the incidenceof stoma complications of the lateral rectus colostomy group was significantly higher thanthat of transabdominal rectus colostomy group. Pearson X2test showed there was nostatistically significant difference in the general complications between two groups (P＞0.05).4. Ostomy function evaluation:1）The results of the signal time before defecation were as follows: The signal time ofthe intraperitoneal sigmoid colostomy group occurred mainly less than10seconds, andnone occurred more than30seconds; The signal time of the extraperitoneal colostomygroup occurred mainly in10-19seconds and20-30seconds, especially6cases occurredmore than30seconds; The signal time of the extraperitoneal sigmoid colostomy withabdominal functional training group occurred mainly in20-30seconds and more than30seconds. The results show clearly that the signal time before defecation of theextraperitoneal sigmoid colostomy group was longer than that of the intraperitonealsigmoid colostomy group, and the signal time before defecation because of the abdominalfunctional training occurred significantly ahead of time.2)The time of the emergence of defecation signal from autonomous control todefecation was as follows: The time of the intraperitoneal sigmoid colostomy groupoccurred mainly less than1minute, and none occurred more than2minutes; The time of the extraperitoneal colostomy group occurred mainly in1-2minutes, especially7casesoccurred more than2minutes; The proportion of the extraperitoneal sigmoid colostomywith abdominal functional training group which defecate time was less than1minute wasless than that of the extraperitoneal sigmoid colostomy group, and the proportion of theextraperitoneal sigmoid colostomy with abdominal functional training group whichdefecate time was more than2minutes was more than that of the extraperitoneal sigmoidcolostomy group. The results show clearly that autonomous control of defecation functionof the extraperitoneal sigmoid colostomy group, especial the extraperitoneal sigmoidcolostomy with abdominal functional training group, have improved significantly.Conclusions:Patients who have been performed Extraperitoneal sigmoid colostomy compared withintraperitoneal sigmoid colostomy have better ability of autonomous control of defecationfunction and less stoma complications. In terms of stoma complications, especially inreducing parastomal hernia, the patients who have been performed transabdominal rectusextraperitoneal colostomy have more advantage. Abdominal function exercise afteroperation can further reduce the complications and improve the colostomy stoma.