Page 13 - Tina van Loon
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General introduction


              Introduction

              The  first  successful  deliberate  colostomy  operation  was  performed  over  two
                              1
              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
                                                                                 th
              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
                              5
              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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