Complications after double-barreled wet colostomy compared to separate urinary and fecal diversion during pelvic exenteration: Time to change back?

• Published in: Gynecologic oncology Vol. 128; no. 1; pp. 60 - 64
• Main Authors: Backes, Floor J, Tierney, Brent J, Eisenhauer, Eric L, Bahnson, Robert R, Cohn, David E, Fowler, Jeffrey M
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2013
• Subjects: Adult; Aged; Colostomy - adverse effects; Colostomy - methods; DBWC; Double-barreled wet colostomy; Female; Genital Neoplasms, Female - surgery; Hematology, Oncology and Palliative Medicine; Humans; Ileal conduit; Middle Aged; Obstetrics and Gynecology; Operative Time; Pelvic exenteration; Pelvic Exenteration - adverse effects; Reconstruction; Retrospective Studies; Urinary and fecal diversion; Urinary Diversion - adverse effects; Uterine Cervical Neoplasms - surgery; Reconstruction; Pelvic exenteration; Urinary and fecal diversion; Ileal conduit; Double-barreled wet colostomy; DBWC
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2012.08.004

Abstract 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 6 months 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. 20 days, p = .01). Median operating times were shorter for DBWC (610 vs. 702 minutes, 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.