Phadke M V, Stocks L H, Phadke Y G
WakeMed Affiliated with UNCCH, Raleigh, NC, USA.
Surg Endosc. 2007 Sep;21(9):1658-61. doi: 10.1007/s00464-007-9194-z. Epub 2007 Apr 3.
Brooke ileostomy and colostomy are associated with infection in the stomal and/or main wounds, leading to complications. The source of infection is feces from the open lumen. The objective of the present study was to find a way to prevent infection and subsequent complications. It was started in 1986 by serendipity after discovery that if wound contamination from intestinal contents is stopped in the immediate postoperative period, by a complete small/large intestinal obstruction, infection and complications are prevented. This study was based on the principle of delayed-primary wound closure.
Following its initial discovery for a Brooke ileostomy, the procedure was used for both ileostomy and colostomy. The stapled stoma was fixed to the opening in rectus sheath. It was covered with an appliance that has a transparent pouch, allowing daily inspection. During the period of postoperative ileus, there is angiogenesis on the serosal surface, making it refractory to infection. The stoma tends to bulge with the appearance of peristalsis. Stoma was then opened with electrocautery in a bedside procedure. The mucosal cuff protrudes, everts, advances with peristalsis, and "grafts" itself on angiogenesis on the surface of a single layer of serosa. The advancing margin of the mucosal cuff fuses with the circumference of the opening in dermis. The maturation of the stoma is natural and automatic. Absence of sutures reduced the tissue trauma and foreign body reaction, resulting in better wound healing. This new procedure was named "delayed-primary self-maturation" (DPSM).
Thirty seven colostomies and nine ileostomies were performed using DPSM. Infection in the stomal and/or main wound and subsequent complications were prevented.
Delayed-primary self-maturation is technically easier and more scientific than a conventional ileostomy or colostomy and is recommended for all types of stomas.
布鲁克回肠造口术和结肠造口术与造口和/或主要伤口的感染相关，会导致并发症。感染源是开放肠腔中的粪便。本研究的目的是找到一种预防感染及后续并发症的方法。该研究始于1986年，是偶然发现的结果，即如果在术后即刻通过完全性小肠/大肠梗阻来阻止肠内容物污染伤口，就能预防感染和并发症。本研究基于延迟一期伤口闭合的原则。
自最初发现用于布鲁克回肠造口术后，该方法被用于回肠造口术和结肠造口术。用吻合器将造口固定于腹直肌鞘的开口处。用带有透明袋的装置覆盖，以便每日检查。在术后肠梗阻期间，浆膜表面有血管生成，使其不易感染。随着蠕动的出现，造口往往会隆起。然后在床边操作中用电灼打开造口。黏膜袖口突出、外翻，随着蠕动前进，并在单层浆膜表面的血管生成处“移植”自身。黏膜袖口的前进边缘与真皮开口的周边融合。造口的成熟是自然且自动的。不使用缝线减少了组织创伤和异物反应，从而实现更好的伤口愈合。这种新方法被命名为“延迟一期自我成熟”（DPSM）。
使用DPSM进行了37例结肠造口术和9例回肠造口术。预防了造口和/或主要伤口的感染及后续并发症。
延迟一期自我成熟在技术上比传统的回肠造口术或结肠造口术更简单、更科学，推荐用于所有类型的造口。
