Abstract
From February 1989 to February 1992, 23 pseudocontinent perineal colostomies (PC), performed after abdominoperineal excision for rectal carcinoma, were evaluated. Perineal colostomy was performed using a free autotransplant of smooth muscle, according to Schmidt, associated with colonic irrigation. This procedure was proposed to the younger and more alert patients without advanced rectal carcinoma. These 23 cases represented 35% of the rectal extirpations performed during the same period. Four patients did not accept a PC and preferred, after being fully informed about both types of colostomies, to have a classical iliac colostomy which they thought to be safer. The advantages of this procedure were mainly psychological, as the body scheme and corporeal image were not disturbed. Continence was evaluated in only 21 cases, because two patients had non-specific complications (necrosis of the colonic extremity, and colonic perforation due to enema material). Ten patients were incontinent to flatus, but did not have to wear a sanitary towel, while 11 patients had occasional, minor soiling, requiring the use of a sanitary towel. None of the patients had major incontinence requiring a secondary iliac colostomy. When asked what they thought of results, none said that they were dissatisfied. The degree of satisfaction was subjective and was not correlated with the quality of functional results as seven patients declared themselves satisfied although they had minor soiling, and conversely, two patients were not completely satisfied, even though they had no soiling. Six months after operation, the muscular transplanted ring had disappeared in half of the patients, but this did not seem to have any repercussion of the quality of functional results. We believe that adequate colonic irrigations are essential to obtain good functional results. The method does not compromise carcinological excision and offers the possibility of examining the perineum. Our results are encouraging and have led us to continue this evaluation. Further questions to be answered include: what are the contraindications to PC? Can PC be proposed to all patients, or only to those who refuse an iliac colostomy? Can the surgical technique be improved?
| Original language | French |
|---|---|
| Pages (from-to) | 181-186 |
| Number of pages | 6 |
| Journal | Gastroenterologie Clinique et Biologique |
| Volume | 17 |
| Issue number | 3 |
| Publication status | Published - 1993 |
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Keywords
- anal incontinence
- perineal colostomy
- rectal cancer
- surgery
ASJC Scopus subject areas
- Gastroenterology
Cite this
COLOSTOMIES PERINEALES PSEUDO-CONTINENTES APRES AMPUTATION RECTALE POUR CANCER. / Elias, D.; Lasser, P.; Leroux, A.; Rougier, P.; Comandella, M. G.; Deraco, M.
In: Gastroenterologie Clinique et Biologique, Vol. 17, No. 3, 1993, p. 181-186.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - COLOSTOMIES PERINEALES PSEUDO-CONTINENTES APRES AMPUTATION RECTALE POUR CANCER
AU - Elias, D.
AU - Lasser, P.
AU - Leroux, A.
AU - Rougier, P.
AU - Comandella, M. G.
AU - Deraco, M.
PY - 1993
Y1 - 1993
N2 - From February 1989 to February 1992, 23 pseudocontinent perineal colostomies (PC), performed after abdominoperineal excision for rectal carcinoma, were evaluated. Perineal colostomy was performed using a free autotransplant of smooth muscle, according to Schmidt, associated with colonic irrigation. This procedure was proposed to the younger and more alert patients without advanced rectal carcinoma. These 23 cases represented 35% of the rectal extirpations performed during the same period. Four patients did not accept a PC and preferred, after being fully informed about both types of colostomies, to have a classical iliac colostomy which they thought to be safer. The advantages of this procedure were mainly psychological, as the body scheme and corporeal image were not disturbed. Continence was evaluated in only 21 cases, because two patients had non-specific complications (necrosis of the colonic extremity, and colonic perforation due to enema material). Ten patients were incontinent to flatus, but did not have to wear a sanitary towel, while 11 patients had occasional, minor soiling, requiring the use of a sanitary towel. None of the patients had major incontinence requiring a secondary iliac colostomy. When asked what they thought of results, none said that they were dissatisfied. The degree of satisfaction was subjective and was not correlated with the quality of functional results as seven patients declared themselves satisfied although they had minor soiling, and conversely, two patients were not completely satisfied, even though they had no soiling. Six months after operation, the muscular transplanted ring had disappeared in half of the patients, but this did not seem to have any repercussion of the quality of functional results. We believe that adequate colonic irrigations are essential to obtain good functional results. The method does not compromise carcinological excision and offers the possibility of examining the perineum. Our results are encouraging and have led us to continue this evaluation. Further questions to be answered include: what are the contraindications to PC? Can PC be proposed to all patients, or only to those who refuse an iliac colostomy? Can the surgical technique be improved?
AB - From February 1989 to February 1992, 23 pseudocontinent perineal colostomies (PC), performed after abdominoperineal excision for rectal carcinoma, were evaluated. Perineal colostomy was performed using a free autotransplant of smooth muscle, according to Schmidt, associated with colonic irrigation. This procedure was proposed to the younger and more alert patients without advanced rectal carcinoma. These 23 cases represented 35% of the rectal extirpations performed during the same period. Four patients did not accept a PC and preferred, after being fully informed about both types of colostomies, to have a classical iliac colostomy which they thought to be safer. The advantages of this procedure were mainly psychological, as the body scheme and corporeal image were not disturbed. Continence was evaluated in only 21 cases, because two patients had non-specific complications (necrosis of the colonic extremity, and colonic perforation due to enema material). Ten patients were incontinent to flatus, but did not have to wear a sanitary towel, while 11 patients had occasional, minor soiling, requiring the use of a sanitary towel. None of the patients had major incontinence requiring a secondary iliac colostomy. When asked what they thought of results, none said that they were dissatisfied. The degree of satisfaction was subjective and was not correlated with the quality of functional results as seven patients declared themselves satisfied although they had minor soiling, and conversely, two patients were not completely satisfied, even though they had no soiling. Six months after operation, the muscular transplanted ring had disappeared in half of the patients, but this did not seem to have any repercussion of the quality of functional results. We believe that adequate colonic irrigations are essential to obtain good functional results. The method does not compromise carcinological excision and offers the possibility of examining the perineum. Our results are encouraging and have led us to continue this evaluation. Further questions to be answered include: what are the contraindications to PC? Can PC be proposed to all patients, or only to those who refuse an iliac colostomy? Can the surgical technique be improved?
KW - anal incontinence
KW - perineal colostomy
KW - rectal cancer
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=0027405194&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0027405194&partnerID=8YFLogxK
M3 - Articolo
C2 - 8330692
AN - SCOPUS:0027405194
VL - 17
SP - 181
EP - 186
JO - Clinics and Research in Hepatology and Gastroenterology
JF - Clinics and Research in Hepatology and Gastroenterology
SN - 2210-7401
IS - 3
ER -