Manual Colostomy Reversals Following Wide Colorectal Resections at Poorly Equipped Surgical Facilities

Background: The decision for colostomy reversal is usually not easy and often reflects patient’s desire, fully analyzed and agreed by the surgeon. The unavailability of mechanical suturing devices considerably increases this challenge. This study was aimed at sharing our experience with manual colostomy reversals (MCR) techniques after wide colorectal resections (WCRR) as well as documenting related early outcomes and complications.
Methods: This retrospective study was carried out between 1^st January 2007 and 31^st December 2009, at the Lusaka University Teaching Hospital and The Lubumbashi University Clinics. Data were collected from operating lists, clinical records of in-patients and out-patient clinic records. Only fully documented cases with consistent targeted parameters including demography, indication for the colostomy, colostomy type, reversal technique, complications, hospital stay and discharge were considered for statistically analyze.
Results: A total of 124 colostomies were performed during the study period; 98 were temporary. Thirty six of these 98 resections were wide and of which the MCR was achieved as follows: simple colon mobilization (56%); additional symphysiotomy (28%), trans-sacral approach (11%) and the use of an ileo-colo-rectal transplant (6%). There was no significant difference in sex and age distribution. Causes of WCRR were: sigmoid colon volvulus (58%); colorectal cancer: (17%); perforated sigmoid diverticulitis (11%), amoebic perforations (18%) and rectal cancer (6%). All 36 patients (100%) got discharged after successful management of the following complications: a faecal fistula in two patients, a surgical abdominal site infection in 3 patients and pelvic pain and discomfort..
Conclusion: The MCR after WCRR is feasible in selected and well prepared patients with a perfect technique. Constraints for cancer resections and patient’ per operative safety shall be observed. The acquisition of colorectal stapling devices should remain the ideal.