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EP1326 Double-barreled wet colostomy after total pelvic exenteration (video)

Introduction/Background Double-barreled wet colostomy (DBWC) is an alternative method to classical reservoirs using two stomas for patients who underwent total pelvic exenteration for advanced pelvic malignancies. It was firstly described and performed by MF Carter in the late eighties. Methodology The procedure starts with the mobilization of the left colon beyond the splenic flexure. A sufficient length of the colon is necessary to perform a well everted loop colostomy at a previously marked site. Afterwards, a double-barreled colostomy is created in which the distal part of the colon is sectioned and sutured at about 15 cm to the stoma. Both ureters are mobilized towards the colostomy and the healthier ends of them are re-implanted separately along the anti-mesenteric tenia of the distal segment. Subsequently, a pig tail ureteral stent is placed bilaterally which runs from a curl in the renal pelvic to the skin through the stoma. It must be removed 4–6 weeks after surgery. After the intervention, the urine reservoir, which has been created distal to the stoma, empties out freely without fecal contact. Results Surgically the double-barreled wet colostomy has many advantages when compared with other incontinent cutaneous diversion: is technically easier, requires only one stoma, avoids the use of small bowel and thus reduces surgical time and length of stay in hospital. Furthermore, its avoids the use of over-irradiated small bowel for urinary diversion in patients who underwent previous radio-chemotherapy. The use of small bowel in this patients may predispose to leaks. Several studies have demonstrated there is no statistically significant difference in the rate of postoperative complications. Furthermore, with an adequate stoma care, peristomal dermatitis and other local skin complications can be avoided or easily controlled. Conclusion Finally, one of the most important advantages is the improvement in the quality of life and self-perception of these women. Disclosure Nothing to disclose