Outcomes of Double-Barrelled Wet Colostomy (DBWC) for urinary and faecal diversion- Single centre experience
Author(s):
Mr Lawrence H Kim
,
Mr Lawrence H Kim
Affiliations:
Ms Bhagya Parkash
,
Ms Bhagya Parkash
Affiliations:
Mr Alan Thompson
,
Mr Alan Thompson
Affiliations:
Mr Pardeep Kumar
Mr Pardeep Kumar
Affiliations:
BAUS ePoster online library. Kim L. 06/27/17; 177369; P4-3
Dr. Lawrence Kim
Dr. Lawrence Kim
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Abstract
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Introduction
Total pelvic exenteration requires both urinary and stool diversion, usually achieved via bilateral stomas. The double-barrelled wet colostomy (DBWC) is a single stoma which diverts both the stool and urinary flow but keeps them separate. It also enables mobilisation of rectus abdominis as a myocutaneous flap to fill the perineum and avoids the need for a bowel anastomosis to form a separate ileal conduit.
Aims
To evaluate perioperative outcomes, early and late complications of DBWC formation

Methods
Patient data was collated prospectively. The following parameters were measured: baseline characteristics (Age, BMI, ASA, sex, extent and type of carcinoma, history of radiotherapy, neo-adjuvant chemotherapy, plastics reconstruction; perioperative outcomes (operative time, length of stay- ITU and total, transfusion, complications); renal function, biochemical changes; and long term complications

Results
41 patients underwent DBWC (27 male, 14 female – median age 62 years). Median BMI was 27.1 kg/m2. All patients received neo-adjuvant radiotherapy. 30 patients required a rectus abdominis flap. Early post-operative complications were common (Clavien-Dindo I – 4 patients, II – 15 patients, IIIa – 4 patients).
6 patients developed hydronephrosis at 12 weeks resulting in a modification in operative technique for subsequent patients. 2 patients have required revision to bilateral stomas.

Conclusion
The DBWC is a good option in selected patients. The ureteric anastomosis in these previously irradiated patients requires careful monitoring. A single stoma facilitates the use of rectus flap to fill the large perineal defect. Comparative study with bilateral stoma would be needed to facilitate better patient selection.




Introduction
Total pelvic exenteration requires both urinary and stool diversion, usually achieved via bilateral stomas. The double-barrelled wet colostomy (DBWC) is a single stoma which diverts both the stool and urinary flow but keeps them separate. It also enables mobilisation of rectus abdominis as a myocutaneous flap to fill the perineum and avoids the need for a bowel anastomosis to form a separate ileal conduit.
Aims
To evaluate perioperative outcomes, early and late complications of DBWC formation

Methods
Patient data was collated prospectively. The following parameters were measured: baseline characteristics (Age, BMI, ASA, sex, extent and type of carcinoma, history of radiotherapy, neo-adjuvant chemotherapy, plastics reconstruction; perioperative outcomes (operative time, length of stay- ITU and total, transfusion, complications); renal function, biochemical changes; and long term complications

Results
41 patients underwent DBWC (27 male, 14 female – median age 62 years). Median BMI was 27.1 kg/m2. All patients received neo-adjuvant radiotherapy. 30 patients required a rectus abdominis flap. Early post-operative complications were common (Clavien-Dindo I – 4 patients, II – 15 patients, IIIa – 4 patients).
6 patients developed hydronephrosis at 12 weeks resulting in a modification in operative technique for subsequent patients. 2 patients have required revision to bilateral stomas.

Conclusion
The DBWC is a good option in selected patients. The ureteric anastomosis in these previously irradiated patients requires careful monitoring. A single stoma facilitates the use of rectus flap to fill the large perineal defect. Comparative study with bilateral stoma would be needed to facilitate better patient selection.




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