JR Colostomy Closure
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Transcript of JR Colostomy Closure
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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
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INTRODUCTION
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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.
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Indication
Colostomy
Hirschprung Disease
Anorectal Malformation
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Important role:
Preoperative
Intraoperative postoperative
Achieving Low morbidity rate
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METHOD
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Retrospektif
Data from:
649 patient
Medical record
1982-2010
Perioperatif protocol
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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
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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
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Meticulous surgical technique (2)
A two-layer, end-to-
end anastomosis
with separatedlong-term 6-0
absorbable sutures
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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
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RESULT
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Type of Colostomy
stoma 480
Loop 137
Hartman 32
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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
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DISCUSSION
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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
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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
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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
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COAGULATE & CUT
Use coagulation to coagulate!
Use cutting current to cut!*excessive burning may leave damaged tissue
bacterial proliferation
Hemostasis
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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
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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
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(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
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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
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CONCLUSION
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Based on Authors opinion and experience
Colostomy closure can be performed with
minimal mortality & morbidity Providing meticulous technique
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THANK YOU