1. University of Szeged (Hungary) Faculty of Medicine. Surgery Clinic. Departement B.

2. Umbilical End Colostomy The Solution of Peristomal Hernia Baradnay Gy. Csíkos M.

3. „ I tell you that wich you yourselves do know, show you sweet C aesar’s wounds, poor poor dumb mounths, and bid them speak for me!” „ Mondom, ami tudva van. Itt felfödö m kedves C easar sebeit, ez árva néma szájakat, s hagyom helyettem szólani.” W.Shekaspea r e: Julis Ceasar III.felv. Ford.:Vörösmarty M.

4. Complications of Colostomies: Anus sigmoideus (traditional) Stricture 1-13% Prolapse 30% Parastomal Hernias One out of every 4 Stomies ends in a Complication!! Reoperation Rate betwen Success Rate of late Reoperation is between (Andivot T. Ann.Chir. 1996) 11-48% 13-33 % 63-74 %

8. Umbilical End Colostomy Material Number of Cases 317 1984 01 01-2007 06 30 (24 Years) Female Male 116(60.5 years) 201 (65years) The Umbilical Colostomies were created in Connection with Abdomono-Perineal Resestion and Hartmann Operation

9. Umbilical End Colostomy No. 317 Complications requiers Reoperation Early Late Retraction 3 (0.9%) --------- Prolapses ----------- 4( 1.2%) Strictures ----------- 15(5%) Parastomal Hernias--- 4(1.2%) …………………………………………………………………… 3(0.9%) 23(7.4%) Total 26(8.1%) Ileus 0 0 Mortality (in Connection of Colostomy) 0

10. Umbilical End Colostomy Technique:  Midline skin incision with semi-circular incision 5 cm distance around the umbilicus  Removal of umbilicus with a circular incision  Cross-shaped incision of de fascia  Stapled and mobilized oral sigmoid stump pulled through the stoma opening, and stiched with interrupted sutures in two layers to the fascia and skin.

19. „The use of the umbilical site is not a unique concept, some surgeons prefer to create the colostomy in the umbilicus initially. Raza and colleagues evaluated 101 patients in whom they performed an umbilical colostomy….. only four patients required reoperation. There where no peristomal hernias and no prolapses in their experience.” Corman.M.L.:Colon and Rectal Surgery. Lippincott 1984.645 p. Raza, SD., Portin BA. etc.: Dis.Colon Rect. 20.223-230. 1977

20. Umbilical End Colostomy Conclusions An Umbilical Colostomy does not hinder the patients from dressing. It provides an exellent function for irrigation The number and ratio of acute and late complication is ideal A pre-formed opening in abdominal wall is used to create the colostomy The patients were satisfied with the Umbilical Colostomy: None of them asked for its transfer Hajdúszoboszló, 2008 Oct. 16

22. Thank you for your attention !