A Study on stomas in emergency laparotomies

Sethu Kannan, R (2016) A Study on stomas in emergency laparotomies. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Stoma is a surgically made intestinal opening on anterior abdominal wall. Its common forms include colostomy and ileostomy. Shock, marked blood loss, significant faecal contamination, associated injuries, time till presentation and multiplicity of injury are widely accepted factors favouring stoma formation than primary repair which leads to significant mortality and morbidity owing to friable tissue that cannot hold a suture. A trouble free stoma is a boon. A troublesome can bring about social, domestic and psychological upsets. The use of mechanical sutures, the dedication and skill of nursing staff and stoma therapies and improvement in colostomy appliances have helped to improve the quality of life of patients with a stoma. In the present study, an attempt was made to identify common indications and complications associated with intestinal stoma in a tertiary care set-up. This insight will help us decrease the problems associated with this commonly performed general surgical procedure. AIMS & OBJECTIVES: 1. To study the various etiologies for stomas in emergency laparotomies. 2. To find the commonest procedure performed and its relation with the cause. 3. To assess the post operative morbidity and mortality and its relation to cause and type of stoma done. MATERIALS & METHODS: Its a prospective and retrospective observational study. Method of sampling was non-random, purposive. Those patients who had underwent emergency stomas were included in this study. Informed written consent was taken from the patients or their guardian willing to participate in the study. Detailed history was taken from the study group to establish 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 peroperative 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 analysed RESULTS & DISCUSSION: In emergency setting, midline laparotomy to relieve the patient of his symptoms is the first goal. The common procedures performed included primary closure of perforation incase 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 non viable 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. The prevalence of morbidity in these patients were similar to any group of patients undergoing emergency laparotomy. The age predilection of morbidity towards elderly people is mainly due to significant proportion of malignant closed loop obstructions in this age group. Presence of a systemic disease, poor general habitus, inadequate optimization all have known to increase the tendency to develop post operative morbidity and mortality. Overall, prognosis is good in patients provided with early intervention, intensive post operative management while ensuring proper psychological support CONCLUSION: Abdomen injuries due to blunt and penetrating trauma and acute bowel pathologies leading to peritonitis such as bowel perforations are the leading causes needing stoma. • More the lag period from the onset of symptoms/trauma to theatre, more is the incidence of stoma as anastomotic leakage is more common in this group. • Post operative patient education and counseling is of utmost importance as there is no hope for prior sensitization in emergency settings • Adequate hydration, electrolyte correction, nutrition management and psychological support teams play a crucial role in bringing significant number of patients for reversal.

Item Type: Thesis (Masters)
Uncontrolled Keywords: stomas ; emergency laparotomies.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 27 Sep 2017 01:56
Last Modified: 27 Sep 2017 01:56
URI: http://repository-tnmgrmu.ac.in/id/eprint/3375

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