Morare Nolitha Makapi Tisetso, Motha Meshack Nkosinaye, Moeng Maeyane Stephens
University of Witwatersrand, Parktown, Johannesburg, 2193, South Africa.
Academic Head of Trauma, Charlotte Maxeke Johannesburg Academic Hospital, Parktown, Johannesburg, 2193, South Africa.
World J Surg. 2021 Jul;45(7):2009-2014. doi: 10.1007/s00268-021-06064-w. Epub 2021 Mar 15.
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.
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.
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.
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.
在创伤手术中偶尔会造口。在造口还纳的手术规划中通常会进行肠袢造影。这会带来医疗和成本方面的影响。开展了一项研究以评估肠袢造影对约翰内斯堡一家医院创伤患者管理的影响。
对造口数据库（2013年1月至2018年12月）中的记录进行回顾性分析。分析了患者人口统计学资料、损伤方式、造口类型、肠袢造影结果及术后病程。
获取了112份记录。9例（8%）患者因待进行检查或手术而被排除。13例（11.6%）患者因数据不完整而被排除。其余90例（80.3%）患者，平均年龄32.9岁，肠袢造影无诊断价值并接受了还纳手术。43例（47.8%）行袢式结肠造口术，47例（52.2%）接受了哈特曼手术。损伤机制为刺伤（低位81.4%；高位61.7%）、枪伤（低位13.9%；高位29.7%）和钝性创伤（低位5%；高位9%）。袢式造口组术后并发症发生率为30%（≥Clavien-Dindo 3级为2.3%），哈特曼组为25.5%（≥Clavien-Dindo 3级为4%）。哈特曼组平均还纳时间为38周（范围12 - 60周），袢式结肠造口组为22周（范围12 - 32周）。
创伤患者肠袢造影的显著发现并不常见。当检测到这些发现时，对管理的影响值得怀疑。它们并非没有并发症，且有成本和时间方面的影响。肠袢造影在某些特定病例中有用，而不是作为常规检查，尤其是在资源有限的环境中。
