Renol, Mathew Koshy (2007) Morbidity analysis of modalities of faecal diversion following operations for Colo-Rectal Cancer. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: The role of faecal diversion in colorectal surgery is hotly debated with many a studies, done many a ways to finally have no clear-cut consensus. There seems to be a consensus however, to differ based on experiences and prejudices. The western literature has a clear line drawn between surgeons who prefer either one of these modalities. To add to the complexity of the situation, there is also another group of surgeons who question the very role of a diversion stoma. In this interesting mayhem, it is important for us to have our own conclusions based on our experiences in the light of our cultural, social and dietary differences amongst the many others. This study is to look at the morbidity pattern amongst our ostomates and to corroborate it to their quality of life. We hope that this can influence our clinical practice. AIM OF THE STUDY: To compare the morbidity associated with loop ileostomies and loop colostomies in adult patients who have undergone curative surgery for colorectal cancers. OBJECTIVES: 1. To compare the morbidity associated with loop ileostomies and loop colostomies in adult patients who have undergone curative surgery for colorectal cancers. 2. To compare the effect of loop ileostomy and loop colostomy on the nutritional status of adult patients who have undergone curative surgery for colorectal cancers. 3. To compare the efficacy of decompression of the distal bowel loop with loop ileostomy and loop colostomy in adult patients who have undergone curative surgery for colorectal cancers. 4. To compare the quality of life index of adult patients, with loop ileostomy and loop colostomy, who have undergone curative surgery for colorectal cancers. DESIGN: 1. Retrospective study comparing the morbidity of adult patients who have undergone curative surgery for colorectal cancers. 2. Prospective randomized study comparing morbidity, quality of life, efficacy of decompression and effect on nutritional status of adult patients who have undergone curative surgery for colorectal cancers. SUBJECTS: INCLUSION CRITERIA: Adult patients with colorectal cancer who are planned for elective resectional surgery with curative intent, who have a defunctioning stoma created simultaneously during the primary surgery. EXCLUSION CRITERIA: Patients satisfying the inclusion criteria but did not have a stoma created. METHODOLOGY: The study was done in two limbs. The initial retrospective study was to look at the morbidity patterns and to identify the relevant parameters important for comparison of the stoma groups. A. RETROSPECTIVE LIMB: 1. Collection of data from the Inpatient records. 2. Include patient based on criteria. 3. Record the stoma related morbidities in either group. B. PROSPECTIVE LIMB: 1. Include patient based on criteria after informed consent. 2. Randomise the patient to either group. 3. Review routine investigations. 4. Counselling by Enterostomal therapist and siting of stoma 5. Anthropometric measures taken-B.M.I. 6. Nutritional assessment-Hb., S.Albumin. 7. Pre-op Bowel preparation and prophylactic Abs. 8. The operation with stoma creation as indicated. 9. Post-op stoma function and morbidity monitor. 10. B.M.I. at discharge. 11. Out patient review to monitor stoma related morbidity. 12. Review for stoma closure at 3 months-B.M.I., Hb. S.Alb. 13. Rectal and anal pressure recordings. 14. Q.O.L.I. assessment. 15. Post – Closure morbidity assessment. CONCLUSIONS: 1. The incidence of morbidity amongst the ileostomies was 77% and 43% amongst the colostomies. However, this difference was not statistically significant. 2. The type of stoma did not have any effect on the nutritional status of the patients. 3. The efficacy of decompression of the distal loop, by manometric studies could not be done. 4. The quality of life in patients with loop ileostomy and loop colostomy are comparable, with both of them having a good quality of life.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Morbidity analysis ; modalities ; faecal diversion ; operations ; Colo-Rectal Cancer. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 04 May 2018 02:20 |
| Last Modified: | 04 May 2018 02:20 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7418 |
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