TOTAL FEKAL DÝVERSÝYONDA LOOP KOLOSTOMÝNÝN ETKÝNLÝÐÝ

Bu çalýþmada, 1992-1997 yýllarý arasýnda Ege Üniversitesi Týp Fakültesi Genel Cerrahi Kliniði, Kolorektal Cerrahi Bölümünde acil ya da elektiv olarak opere edilerek loop kolostomi uygulanan 56 olgu, loop kolostominin total fekal diversiyonu saðlama yönündeki etkinliðinin deðerlendirilmesi amacýyla prospektif olarak incelendi. Kadýn - erkek oranýnýn 14/42 olarak belirlenen olgularýn yaþ ortalamasý 56.8 idi. 49 hastaya transvers loop kolostomi uygulanýrken, 7 hastaya sigmoid loop kolostomi uygulandý. Etiyolojik faktörler olarak olgularýn 22'inde rektovajinal fistül, birinde anorektal kanser, 16'ýnda travma, 4'ünde benign rektal darlýk, 9'unda Fournier gangreni, 2'inde rektovajinal fistül, birinde anorektal kanser, birinde kistoenterik fistül ve bir olguda da divertikülite baðlý abse söz konusu idi. Olgular, postoperatif 7. gün ve 12. ay arasýndaki zamanda oral baryum içirilmek suretiyle radyolojik olarak tetkik edildi. Baryum alýmýndan 24 saat sonra çekilen filmlerde kolonun distaline geçip geçmediði araþtýrýldý. Dört olguda baryumun distaline geçiþi gözlendi. Sonuç olarak, loop kolostominin fekal diversiyonda etkin olduðu ve daimi diversiyon amacýyla kullanýlabileceði kanýsýndayýz.

THE EFFICACY OF LOOP COLOSTOMY IN MAINTAINING TOTAL FECAL DIVERSION

In the study, 56 patients to whom emergency or elective loop colostomies were performed at the Colorectal Surgical Unit of General Surgery Department of Ege University Medical School Hospital between February 1992 and May 1998, were studied prospectively to evaluate the efficacy of loop colostomy in maintaining total fecal diversion. The female/male ratio of the patients was 14/42 with mean age of 56.8. While transverse loop colostomy was performed in 49 patients, seven patients underwent sigmoid loop colostomy. The etiologic factors included colorectal cancer in 22 patients, colonic trauma in 16, benign rectal stricture in four, Fournier's gangrene in nine, rectovaginal fistula in two, anorectal cancer in one patient, cystoenteric fistula in one patient and diverticulitis with abscess in one patient. The patients were evaluated radiologically after barium meal was given orally between the seventh day and twelfth month postoperatively. The passage of barium into the distal limb of the colon was detected in the last x-rays of the 56 patients 24 hours passed from the time of barium intake. However, only f our patients showed passage of barium into the distal colon in the x-ray. As a result, we consider that loop colostomy is efficacious in diverting fecal stream and can be used for permanent diversion.