None listed
Conditions
Brief summary
Historically, cecostomy has been advocated to protect a left sided anastomosis, used as a treatment for large bowel obstruction, cecal perforation. Hypothesis: For temporary fecal diversion after left hemicolectomy due to obstructing cancer or sigmoid volvulus , tube cecostomy may help to reduce the rate of anastomotic leakage and also to avoid the second operation for stoma closure. Methods: Over eleven years between January 1998 and November 2009, all patients fulfilling the inclusion criteria with large bowel obstruction due to cancer or sigmoid volvulus only, were randomly divided into two groups: A and B. Group A: 44 patients undergoing tube cecostomy as diverting stomas after left hemicolectomy due to obstructing cancer. Tube cecostomy was performed as described by Clark and Hubay in 1972 . Group B: 44 patients undergoing loop colostomy as diverting stomas after left hemicolectomy due to obstructing cancer. Conclusion: Tube cecostomy is of therapeutic value in select situations. Proper patient selection, careful tube placement, and vigilant postoperative tube care should provide adequate function with minimal morbidity.
Interventions
Group A: 44 patients undergoing tube cecostomy for fecal diversion after left hemicolectomy due to obstructing cancer. Tube cecostomy was performed as described by Clark and Hubay in 1972.Two concentric purse-string sutures are placed over the anterior portion of the cecum leaving 3 cm. distance between them . A serosal incision is made central to the sutures and a suction trochar passed into the cecum to deflate it. Following this, the mucosa of the cecum is grasped with fine hemostats and ele
Group A: 44 patients undergoing tube cecostomy for fecal diversion after left hemicolectomy due to obstructing cancer. Tube cecostomy was performed as described by Clark and Hubay in 1972.Two concentric purse-string sutures are placed over the anterior portion of the cecum leaving 3 cm. distance between them . A serosal incision is made central to the sutures and a suction trochar passed into the cecum to deflate it. Following this, the mucosa of the cecum is grasped with fine hemostats and elevated. A number 28 Foley catheter with a 30 cc. balloon is passed through the mucosal opening and a ligature is tied snugly around the everted mucosal edge to insure hemostasis. Then, 4 seromuscular stitches are applied to fix the cecum to the parietal peritoneum. The cecal tube is connected to the collecting tube. The cecal tubes were removed within 8 weeks. Group B: 44 patients undergoing loop colostomy by exeriorization of the transverse colon in the form of loop as diverting stoma for fecal diversion after left hemicolectomy. The colostomies were closed within 8 weeks.
Sponsors
Aly Saber
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
22 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
Inclusion criteria: The following inclusion criteria were defined: (1) gross large bowel obstruction on plain films of the abdomen with compatible history and physical findings; (2) barium enema showing complete colorectal obstruction; (3) surgical finding of complete large bowel obstruction
Exclusion criteria
Patients with perforation in addition to obstruction, and those with uncertain diagnosis or insufficient clinical data were also excluded from the study
Outcome results
None listed