A COMPREHENSIVE STUDY ON INTESTINAL STOMAS

Abstract

BACKGROUND: Intestinal stomas are commonly constructed in an emergency as well as elective setting for a variety of indications. Historically associated with a high morbidity, evolution of skills on the part of the surgeon has lead to better understanding of the indications, technique of construction and management of a stoma. This study aims to evaluate the above-mentioned parameters and hence improve the outcome of patients undergoing a stoma. AIM AND OBJECTIVE: 1. To study the various indications of intestinal stomas. 2. To study the techniques of intestinal stomas. 3. To study the complications of intestinal stomas and their management.
4. To study the overall compliance of patients in whom a stoma was constructed PATIENTS AND METHODS: 50 patients admitted in M K C G Medical college and Hospital Berhampur and later operated and managed with a stoma were closely followed up from the date of admission to the date of discharge and the various parameters were studied.
RESULTS: A total of 50 patients were included in the study who underwent stoma formation at this hospital from November 2022 to October 2023. A total of 17 patients, for whom the stoma was constructed, had hollow viscous perforation. Although the site of the perforation varied, the intraoperative findings warranted a stoma in these patients. Loop ileostomy was the most commonly performed surgery (n=16) amongst patients who presented with hollow viscous perforation as the perforation was most commonly located in the ileum or the base of appendix. Only one patient (n=1) underwent a transverse loop colostomy for a perforation in the sigmoid colon. Malignant bowel obstruction was the second most common cause (n=8). Patients with malignant bowel obstruction needed a stoma either for decompression or diversion (n=4 each). All patients with decompression were done a transverse loop
colostomy whereas patients requiring diversion were done a loop ileostomy, end ileostomy or an end colostomy according to the level and severity of obstruction. Benign cause of intestinal obstruction was the third most common etiological factor associated with construction of a stoma. However, it is worth noting that benign diseases accounted for 78% (n=39) of all causes of stoma placement.

CONCLUSION: Construction and management of stoma was associated with a few complications. Most patients however tolerated the procedure well and the overall compliance was satisfactory. Loop ileostomy was the commonly constructed stoma and the one associated with most complications. Transverse 6 loop colostomy was associated with no complications and was extremely well tolerated.