A study on stomas in emergency laparotomies

ABSTRACT

Background: Stoma is a surgically made intestinal opening on the anterior abdominal wall. Its common forms include colostomy and ileostomy. Shock, marked blood loss, significant fecal contamination, associated injuries, time till presentation and multiplicity of injury are widely accepted factors favoring stoma formation than primary repair which leads to significant mortality and morbidity owing to friable tissue that cannot hold a suture. Aims and objectives: To study the various etiologies for stomas in emergency laparotomies, to assess the postoperative morbidity and mortality and its relation to cause and type of stoma done. Materials and methods: This observational study was done in Madras medical college and Rajiv Gandhi Government Hospital from 2013-2016. Method of sampling was non-random, purposive. Those patients who had undergone emergency stomas were included in this study. Informed written consent was taken from the patients or their guardian willing to participate in the study. A detailed history was taken from the study group to establish a proper diagnosis. Thorough physical examination was done in each case. Data collection sheets were filled in by the investigator himself. The operation procedure and related preoperative factors were observed directly and recorded in the data collection sheet instantly. After completing the collection of data it was compiled in a systematic way and analyzed. Results: The common procedures performed included primary closure of a perforation in case of small isolated perforations with not much contamination. Resection followed by either anastomosis or stomas was done in most of the patients with malignant obstruction or nonviable or ischemic bowel. Even in those patients who had anastomosis, a covering stoma was placed as the healing process in these patients may be impaired.