Page 13 - Tina van Loon

General introduction

Introduction

The first successful deliberate colostomy operation was performed over two
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hundred years ago. It was created in 1793, in a newborn with an imperforate anus,
1‐3
who ultimately lived to the age of 45. Colostomy operations carried high
mortality rates at that time, mostly due to fatal peritonitis. Diverting colostomies
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were used increasingly often and became more common throughout the 20
century. At first, loop colostomies were primarily used to for fecal diversion in case
of bowel obstruction when nonoperative remedies were deemed useless. It would
take another almost 100 years before a “single barreled” stoma was described in
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1882.

Several surgeons have caused the increase in the use and popularity of a stoma.
Miles was a true pioneer in rectal cancer surgery in his technique which is now
known as abdominoperineal resection and secured the place for a colostomy ‐ also
known as ‘abdominal anus’ ‐ as a cornerstone in the surgical treatment of rectal
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cancer. Hartmann popularized the use of an end colostomy after a resection of
sigmoid and proximal rectum with oversewing of the distal rectum stump for
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sigmoid carcinoma. Re‐anastomosis would be the delayed, second procedure. It is
not known, if he himself used his eponymous procedure for complicated
3
diverticulitis. Even though over two centuries have passed since the first
colostomy creation, indications and surgical techniques have remained relatively
constant. Obstruction due to cancer or other causes, complicated diverticulitis,
diversion of a newly formed anastomosis, radiation proctitis, and faecal
incontinence are still the most frequent indications for a colostomy.

The development of the ileostomy took quite a bit longer and was first introduced
in 1879 for the treatment of obstructing right colon cancer. These early ‘flush’
ileostomies were constructed as skin‐level stomas and led to significant
complications such as skin complications, retraction and stenosis. It was dr. Bryan
Brooke who described the “Brooke ileostomy” in 1952 which dramatically changed
and advanced stoma surgery. His “more simple device to evaginate the ileal end at

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