[Choice of a rational method and optimization of terminal colostomy]

The author analyses the results of various methods of terminal colostomy, among which are the "column" technique, with stitching of the edges of the peritoneum to the skin and leaving the excess of the brought out intestine in 258 patients, the formation of a flat stoma by the ordinary method in 179 patients, and with retroperitoneal passing of the intestine in 752 patients in radical surgical treatment of rectal carcinoma and other diseases of the large intestine. The operations were conducted in the period from 1973 to 1987. The frequency of early paracolostomy complications (suppuration, retraction, etc.) in these groups of patients was, respectively, 31%, 22.9%, and 17.6%; that of late-term complications, 70.6%, 50.3%, and 20.3%. The article shows the results of study of the causes of these complications, which formed the basis for improving the methods and techniques of the operation the principal differences of which consisted in: (1) colostomy, except for the final formation of the opening at the level of the skin, was conducted before mobilization of the rectum; (2) retroperitoneal passing of the intestine was accomplished through the upper angle of a lyre-shaped incision of the pelvic peritoneum to the left of the sigmoid colon; (3) the use of a "closed" method of flat stoma formation by cutting the intestinal wall at the level of the skin down to the mucosa and attaching it to the skin by the musculoserous coat with interrupted catgut sutures, and only after that is the excessive mucosa cut off and the intestinal lumen opened.(ABSTRACT TRUNCATED AT 250 WORDS)