What Is a Loop Ostomy?

Double-column colostomy, also known as double-column colostomy; colon double-lumen colostomy; loop double barrel colostomy, is a pediatric surgical operation.

Double colonic ostomy

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Double-column colostomy, also known as double-column colostomy; colon double-lumen colostomy; loop double barrel colostomy, is a pediatric surgical operation.

Pediatric Surgery / Colonostomy / Colostomy

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Colostomy can be divided into temporary and permanent. Among them, a double-lumen stoma is used for temporary stoma, and a single-lumen stoma is used for permanent stoma.

The stoma location is mostly in the transverse colon or sigmoid colon. In rare cases, the stoma is selected in the cecum.

Double loop colostomy is suitable for:

1. When the rectal and anal atresia is high, in order to ensure the success of radical surgery, sigmoid colostomy or transverse colostomy is often performed before surgery.

2. Immature infants or children with anal deformities that are deformed with other systems at the same time, should make a colostomy first, and then perform rectal anal plasty after the condition improves.

3. Congenital anus, the sick child is in critical condition with severe malnutrition or aspiration pneumonia.

4. Insufficient equipment and technical conditions, when there is not enough grasp to perform anal-free radical surgery, in order to save the lives of sick children, colostomy can be performed first, and later transferred to a specialist hospital for treatment.

5. Some scholars advocate that colostomy should be selected for congenital megacolon. It is safer to perform radical surgery after 3 months. Or when congenital megacolon with enteritis and high malnutrition can not tolerate radical surgery; congenital megacolon patients who have difficulty cleaning and washing the colon before surgery should also perform colostomy.

A colostomy for the congenital megacolon is usually chosen at the proximal end of the dilated intestine. Do not make a stoma in the dilated intestinal section near the spasm section, because sometimes the ganglion cells in the intestinal tube are also missing or degenerate, making the stoma fail. When there is no ganglion cells in the whole colon, the stoma should be selected at the end of the ileum. Before the stoma, a frozen section should be performed to confirm that the ganglion cells can be performed when normal.

6. Colonic atresia in neonates, those who are critically ill and unable to undergo bowel resection and anastomosis, should first perform a double-lumen colostomy in order to quickly remove the obstruction and improve the general situation.

7. Colon injury or perforation or rectal anus injury, while repairing the injury, in order to ensure the healing of the repair site, a colostomy should be performed.

There are many bacteria in the colon, which can easily cause infection of the abdominal cavity or incision after surgery. Therefore, in addition to emergency stoma, intestinal cleansing should be prepared.

1. Do barium enema, rectal manometry, rectal mucosal biopsy, and cholinesterase measurement before operation to clearly diagnose and understand the scope of the lesion.

2. Do routine hematuria, liver and kidney function and electrocardiogram before operation.

3. Preparation of intestinal tract before surgery. Colonic lavage is performed daily with saline in 3 weeks before surgery, in order to remove feces in the colon, relieve bloating, restore intestinal patency, reduce symptoms of poisoning, improve nutrition, and treat enteritis. The condition of the sick child is gradually improved, and at the same time, the enema effectively relieves the functional colonic obstruction, and gradually restores the partially expanded intestine to normal, which is convenient for the decision of the scope of resection during the operation. Attention should be paid to colonic lavage: isotonic saline must be used, because hypotonic fluid is prone to water poisoning, hypertonic fluid is prone to salt poisoning. The most important thing is to accurately measure the amount of in and out of the enema to prevent the infused saline from staying in the intestine. The total amount of each enema should not exceed 100ml / kg body weight. The enema should choose a soft but slightly thicker anal canal to facilitate the discharge of feces from the anal canal. The enema should understand the extent and direction of the diseased bowel, and the tube should be placed gently. Each time the enema should pass through the anal canal to the dilated section. Do not overfill the amount of fluid each time. Gently massage the abdomen after injecting a certain amount of saline, and squeeze the expansion section downward, so that the intestinal gas, feces and the infused liquid are discharged from the anal canal. The purpose of cleaning the dilated section should be achieved after the daily enema. In the winter enema should pay attention to keep warm to prevent cold and upper respiratory tract infection. For patients with short spasticity, you can inject "123 solution" (ie, 33% magnesium sulfate 30ml, glycerol 60ml, and normal saline 90ml) before cleaning and washing the intestines with normal saline. Infants can be injected in half to stimulate bowel movements and then cleanse and intestines with saline.

4. If there is water and electrolyte disturbance, it should be corrected in time. Anemia can be transfused in small quantities.

5. Give low-residue, easy-to-digest, high-protein, high-vitamin foods during the enema, if necessary, give high intestinal nutrition, actively improve malnutrition, and improve the body resistance of sick children.

6. Give intestinal sterilant 3 days before surgery to reduce intestinal bacteria and reduce infection rate after surgery.

7. Preoperative blood distribution.

8. Place a gastric tube before surgery, and place a urinary catheter after disinfection in the operating area.

General anesthesia and continuous epidural anesthesia can be selected. Basic and local anesthesia can also be done when the condition is critical.

1. After laparotomy, the colon to be prepared for stoma is lifted out of the abdominal cavity, and a non-vascular area is selected in the corresponding mesentery for incision, and then gradually expanded to allow a glass rod to pass through.

2. Pass the glass rod through the mesentery hole, and then suture the peritoneal, fascial and skin intermittently at the distal and proximal colonic serosal layers. In order to prevent intestinal hernia nearby.

3. Suture the incision, wrap around the bowel with iodovolt gauze, and promote adhesion between the bowel and the skin as soon as possible. The bowel was covered with vaseline gauze.

4. Take out the glass rod 48h after operation, and cut it along the direction of the colon band with an electric knife. Intestinal mucosal eversion completes the colostomy. This type of ostomy is connected with the posterior wall of the colon between the distal and proximal ends.

1. Intraabdominal and incision infection

Because colostomy is a bacterial operation, sometimes it is performed urgently without intestinal preparation, so there is more chance of contaminating the abdominal cavity and incision. Therefore, if possible, prepare the intestinal tract before surgery as much as possible. In the case of intestinal preparation, the abdominal cavity and incision should be properly protected from contamination during surgery. The intestinal canal can be sterilized with new cleanser or iodophor. Antibiotics should be applied to prevent infection after surgery.

2. Stomatal bowel prolapse

Frequently, the layers of the abdominal wall between the stoma are sutured too loosely, which causes the diameter of the stoma and intestine to be too large, which may cause prolapse with intestinal peristalsis. The preventive method is to close the stoma bowel and abdominal wall sutures tightly, not too loose, to the limit of leaving a little finger.

3. Narrow stoma

It is caused by too tight the abdominal wall of the suture. When the stoma is too tight, the intestinal tube at the postoperative stoma can have severe edema, which can even cause circulation disorders. Long-term obstruction of the outlet, difficulty in defecation, can even expand the proximal colon of the stoma and form fecal stones. As soon as the above conditions are found, treatment should be expanded early.

4. Stoma retraction

The length of the intestinal canal should be enough. If it is not free enough, there will be tension in the intestinal canal, which will cause retraction after surgery. The feces discharged from the retracted stoma will directly impregnate the abdominal wall and cause erosion of the abdominal wall, making the care of false anus difficult.