Nolitha Makapi Tisetso Morare1, Meshack Nkosinaye Motha2, Maeyane Stephens Moeng2,3. 1. University of Witwatersrand, Parktown, Johannesburg, 2193, South Africa. nmorare@gmail.com. 2. University of Witwatersrand, Parktown, Johannesburg, 2193, South Africa. 3. Academic Head of Trauma, Charlotte Maxeke Johannesburg Academic Hospital, Parktown, Johannesburg, 2193, South Africa.
Abstract
BACKGROUND: Stoma is occasionally fashioned during trauma surgery. A loopogram is routinely conducted in the surgical planning for stoma reversal. This is associated with medical and cost implications. A study was undertaken to evaluate the influence of loopograms on the management of trauma patients at a Johannesburg hospital. METHODS: A retrospective analysis of records in the stoma database (January 2013 to December 2018) was conducted. The patient demographics, method of injury, stoma-type, loopogram findings and post-operative courses were analysed. RESULTS: 112 records were obtained. 9 (8%) patients were excluded for pending investigations or surgery. 13 (11.6%) patients were excluded for incomplete data. The remaining 90 (80.3%) patients, with a mean age of 32.9 had non-contributory loopograms and underwent a reversal procedure. 43 (47.8%) had a loop colostomy while 47 (52.2%) had undergone a Hartmann's procedure. Mechanism of injury was stab wounds (81.4%L; 61.7%H); gunshot wounds (13.9%L; 29.7%H) and blunt trauma (L5% and 9%H). The post-operative complication rate was 30% for the loop group (2.3% ≥ Clavien-Dindo 3) and 25.5% for the Hartmann's group (4% ≥ Clavien-Dindo 3). The average timing to reversal was 38 weeks (range 12-60) in the Hartmann's group and 22 weeks (range 12-32) the loop colostomy group. CONCLUSION: Significant findings are infrequent on loopogram for trauma patients. When these findings are detected, the effect on management is questionable. They are not without complications and have cost and time implications. Loopograms are helpful in selective cases rather than as a routine investigation, particularly in resource-limited settings.
BACKGROUND: Stoma is occasionally fashioned during trauma surgery. A loopogram is routinely conducted in the surgical planning for stoma reversal. This is associated with medical and cost implications. A study was undertaken to evaluate the influence of loopograms on the management of traumapatients at a Johannesburg hospital. METHODS: A retrospective analysis of records in the stoma database (January 2013 to December 2018) was conducted. The patient demographics, method of injury, stoma-type, loopogram findings and post-operative courses were analysed. RESULTS: 112 records were obtained. 9 (8%) patients were excluded for pending investigations or surgery. 13 (11.6%) patients were excluded for incomplete data. The remaining 90 (80.3%) patients, with a mean age of 32.9 had non-contributory loopograms and underwent a reversal procedure. 43 (47.8%) had a loop colostomy while 47 (52.2%) had undergone a Hartmann's procedure. Mechanism of injury was stab wounds (81.4%L; 61.7%H); gunshot wounds (13.9%L; 29.7%H) and blunt trauma (L5% and 9%H). The post-operative complication rate was 30% for the loop group (2.3% ≥ Clavien-Dindo 3) and 25.5% for the Hartmann's group (4% ≥ Clavien-Dindo 3). The average timing to reversal was 38 weeks (range 12-60) in the Hartmann's group and 22 weeks (range 12-32) the loop colostomy group. CONCLUSION: Significant findings are infrequent on loopogram for traumapatients. When these findings are detected, the effect on management is questionable. They are not without complications and have cost and time implications. Loopograms are helpful in selective cases rather than as a routine investigation, particularly in resource-limited settings.
Authors: Nikiforos Ballian; Barbara Zarebczan; Alejandro Munoz; Bruce Harms; Charles P Heise; Eugene F Foley; Gregory D Kennedy Journal: J Gastrointest Surg Date: 2009-09-02 Impact factor: 3.452