Complications after double-barreled wet colostomy compared to separate urinary and fecal diversion during pelvic exenteration: time to change back?
OBJECTIVE
To assess complications associated with double-barreled wet colostomy (DBWC) in the first six months after pelvic exenteration as compared to separate urinary and fecal diversion (SUD).


METHODS
A single institution retrospective chart review was conducted of all patients who underwent a pelvic exenteration between 2000 and 2011. Patients were included if the procedure involved at least a urinary diversion and a perineal phase. Patient demographics and complications in the first 6months after surgery were recorded.


RESULTS
Thirty-three patients met inclusion criteria (12 DBWC and 21 SUD). The majority of patients had recurrent cervical cancer (58%) followed by vaginal, vulva, and endometrial cancer. All patients had previously received radiation. 10/12 patients with a DBWC and 67% of SUD had pelvic reconstruction. Median length of stay (LOS) was shorter for DBWC (14.5 vs. 20days, p=.01). Median operating times were shorter for DBWC (610 vs. 702minutes, p=.04). No urinary conduit or anastomotic bowel leaks occurred in the DBWC group compared to 5 (24%) and 2 (9.5%), respectively, in the SUD group (p=.06 for any leak). 58% of the DBWC and 62% of the SUD group required re-operation, and there were no 30-day peri-operative deaths.


CONCLUSIONS
DBWC can be performed safely at the time of pelvic exenteration. We found reduced operating times, shorter LOS, and a trend toward fewer urinary conduit and/or bowel anastomotic leaks in DBWC exenteration patients. DBWC may be favorable over more technically challenging SUD in this heavily radiated population that generally has a limited overall survival.
Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH, USA.
Floor J
FJ
Backes
Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH, USA.
Brent J
BJ
Tierney
Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH, USA.
Eric L
EL
Eisenhauer
Division of Urology, Ohio State University College of Medicine, Columbus, OH, USA.
Robert R
RR
Bahnson
Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH, USA.
David E
DE
Cohn
Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH, USA. Electronic address: Jeffrey.fowler@osumc.edu.
Jeffrey M
JM
Fowler
D000328:Adult; D000368:Aged; D003125:Colostomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D061646:Operative Time; D010385:Pelvic Exenteration / Q000009:adverse effects*; D012189:Retrospective Studies; D014547:Urinary Diversion / Q000009:adverse effects*; D002583:Uterine Cervical Neoplasms / Q000601:surgery