In my department pseudocontinent perineal colostomy after abdominperineal colostomy is a commonly used procedure that showed it's efficacy. But as far as i saw and read its not that commonly used. It's why i wanted to hear your experience and if you do not used why?
The answer of the question is so complex. It depends of so many factors like: who performance status, general condition, age, religion etc.
Several studies suggest that elderly patient have worst QoL after sphincter preserving surgery compare to young patients. Body image is a part of quality of life but not more important then other scales such as functional, emotional, global quality of life, sexual etc. The problem is how body image affect each person or whole society. In some religions like Islam abdominal colostomy which normally affecting only body image can lead to severe decreasing in global quality of life, depressing, role, emotional and sexual functioning.
In my opinion perineal colostomy will lead to some kind of incontinence in almost every patient with need of using pads. There are many doubts about affecting global quality of life, role and sexual functioning, perineal colostomy complications and last but not least in case of local recurrence in patient with perineal colostomy it will be not easy to be managed.
Some papers suggest that abdominoperineal resection with permanent abdominal colostomy have better quality of life compare to sphincter preserving surgery especially in lower rectal cancer due to low anterior resection syndrome.
From my experience, only half of patients have acceptable QoL after LAR, so the other half defenitly require permanent colostomy
Although the preoperative functional evaluation of the pelvic floor is advisable in this particular kind of patients with rectal cancer, few groups perform it. If you are planning a sphincter saving procedure, always try to do all the tests, because no matter the age, gender, racial group etc., patients with poor function will do worst than those with normal values. Patients with very low lesions that are involving the sphincter mechanism, and require an formal oncologic procedure we do not never try to compromise good oncological results over cosmetic or social results. Please do not get confused, ther are patients for SS procedures and patients for APR procedures, to try to mix both groups just to show "How good I am" is doomed to compromise patients lives. As Dimitar has already said, this is a "several peacks hat" and for this reason in our department we always perform preoperative functional evaluation in all our patients for SSP but not in those for an APR. Try to design a Continent or "pseudo continent" perineal colostomy procedures are for ourselves NOT for the patients.
I totally agree with the above discussion,IN low rectal carcinomas the protocol is to subject them for chemo rad preop ,but during resection invariably in most our stapling is over the tumour involved area,secondly as mentioned above with very low or ultra low resections pt"s quality of life is not as good as we expect due to frequency both day and night and also leak for which pad is necessary.Both LAR and APR are to be chosen with due considerations.Interestingly practice is changing due to availability of new Tools even tumours involving the sphincters are being considered for ss rections.we need to see the long term results in this group.
can you give us a hint about your institute experience of this procedure? I think it is more a heroic surgery which benifit to the patient is less than its magnitude or feared risks?????
- Badges
- Science topic
- Similar topics
- Social Psychology
- Attitude