>Year 2009, Issue 3
Baqueiro CA, Terrazas EF, Mancera C, Galindo NA
Laparoscopic closure of colostomy
Cir Gen 2009; 31 (3)
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Objective: To compare the laparoscopic and conventional open techniques to close a Hartmanns colostomy.
Setting: Hospital Espaņol de México (third level health care hospital).
Design: Transversal comparative study.
Statistical analysis: Students t and chi-square tests.
Patients and methods: We analyzed the clinical records of patients with a colostomy and Hartmann, who were subjected to closure of the colostomy with intestinal transit restitution, from January 2003 to December 2008, either with open surgery (C-CA) or with laparoscopy (C-CL). Assessed variables were: morbidity, mortality, method of the anastomosis, nutritional status (albumin), surgical time, time of colostomy before its closure, age, and gender.
Results: There were 33 patients, 17 men and 16 women, average age of 58 ± 17 years (range 34 to 84), 20 with C-CA and 13 with C-CL. There were five fistulae in the whole group, four in the C-CA group, and one in the C-CL (p = NS). The number of fistulae was significantly higher in the 13 manual anastomosis (p ‹ 0.05). Patients with fistula had higher serum albumin levels. No significant difference existed in the surgical time between the two techniques; but in-hospital stay was significantly lower in the C-CL Group, in which two conversions had to be made.
Discussion: The larger number of patients with fistula in the C-CA group was because a larger number of manual anastomoses were performed in this group, and in this study there were significantly more fistulae in the manual anastomoses. The C-CL Group showed a significantly shorter in-hospital stay, although both groups were started on oral ingestion at the same time. The percentage of fistulae in the whole group is higher than that reported in the literature; although the percentage in the C-CL group is comparable to that of the literature (0 to 2.2%).
Conclusions: Closure of a colostomy by laparoscopy is particularly indicated in patients with a colostomy and Hartmann made through laparoscopy, as this has a low morbidity and nil mortality, diminishing post-operative hospital stay, even when starting oral ingestion in the recommended time for cicatrization of the anastomosis.
||Hartmannīs, colostomy, laparoscopic, diverticulitis, fistulae.
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>Year 2009, Issue 3