Post-Surgery Complications: Managing Colostomy Closure Wound Issues

The surgical wound from the closure of the stoma has opened after the sutures were removed, resulting in continuous leakage of fecal matter?

Hello, Dr.
Ke.
My father is 68 years old and had a temporary colostomy placed in the right upper abdomen after undergoing surgery for rectal cancer.
Recently, three days after the closure of the colostomy, the wound opened up, causing fecal leakage.
The doctor has provided two options: one is to be hospitalized for a month, fasting and receiving total parenteral nutrition through a catheter placed in the neck, allowing the wound to heal on its own; the other is to undergo direct surgery, which may require re-establishing the colostomy.
I would like to ask Dr.
Ke which option is more advisable for elderly patients.
Additionally, if we choose to fast and administer total parenteral nutrition, what is the likelihood of wound healing? Are there any potential side effects? If the wound does not heal, will another surgery still be necessary? What is the reason for re-establishing the colostomy after surgery? (My father has been able to pass stool directly through the anus since the closure.) I am unsure whether this will result in a temporary or permanent colostomy after reconnection.
Thank you, Dr.
Ke, from a very anxious and worried daughter.

Kang Xiaobao, 40~49 year old female. Ask Date: 2022/09/28

Dr. Ke Fangxu reply Surgery

The issue your father is facing is a leak at the site of the stoma closure.
There are two viable options.
The first is to temporarily withhold food and wait for the leak to heal on its own.
The benefits of this approach are that it avoids the need for another surgery.
However, there are three drawbacks: first, it may take a longer time; second, if the healing is poor or if an infection cannot be controlled, surgery may still be necessary; and third, prolonged total parenteral nutrition (TPN) could potentially harm liver function.
The second option involves surgical intervention, which has the advantage of a relatively shorter recovery time.
However, it comes with two disadvantages: first, your father would have to undergo another surgery, which carries its own risks; and second, there is a possibility that another stoma closure surgery may be required, although I believe the likelihood of this is low.
If your father's overall health is good, and considering the current standards of medical care, 68 years old is not considered advanced age.
Personally, I would recommend surgical treatment as the outcomes are more predictable.
If your father’s physical condition is poor and the surgical risks are higher, then temporarily withholding food may be a lower-risk option, but it also has its drawbacks that need to be considered.
I hope you, your father, and all family members can have a thorough discussion with the physician to make a decision that everyone can accept.
Finally, I wish your father a speedy recovery.

Reply Date: 2022/09/28

More Info

Post-surgery complications, particularly after colostomy closure, can be a source of significant concern for both patients and their families. In your father's case, the wound opening and subsequent leakage of stool is understandably distressing. Let's break down the situation and the options presented by the physician.

Firstly, it is not uncommon for surgical wounds, especially in older adults, to experience complications such as dehiscence (wound reopening). Factors such as age, nutritional status, underlying health conditions, and the nature of the surgery can all contribute to wound healing difficulties. In your father's case, the fact that he is 68 years old may play a role in the healing process, as older adults often have slower healing rates and may be more susceptible to complications.

The two options provided by the physician are:
1. Conservative Management with Total Parenteral Nutrition (TPN): This approach involves hospitalization, fasting, and administering all necessary nutrients intravenously. The goal here is to allow the wound to heal without the stress of bowel movements, which could exacerbate the situation. The success of this method largely depends on the wound's condition and the patient's overall health. While TPN can support healing by providing essential nutrients, it also comes with risks, such as infections related to the intravenous line, metabolic imbalances, and potential liver complications from prolonged use.

2. Surgical Intervention: The second option is to perform surgery to repair the wound. This could involve re-establishing the colostomy if the closure is deemed unsuccessful. The need for a new colostomy could arise if the tissue is not viable or if the wound does not heal adequately. The decision to proceed with surgery would depend on the surgeon's assessment of the wound's condition and the likelihood of successful closure.

Regarding the likelihood of healing with TPN, it can be effective, especially if the wound is not severely infected and the patient is otherwise stable. However, if the wound does not show signs of improvement after a certain period, surgical intervention may still be necessary.
As for the potential for side effects from TPN, while it is generally safe when monitored properly, there are risks involved. These can include infections, electrolyte imbalances, and complications related to long-term intravenous access.
If the wound does not heal and surgery is required, the reason for re-establishing a colostomy could be due to inadequate healing of the rectal stump or complications that arise from the closure attempt. The decision on whether the colostomy would be temporary or permanent would depend on the surgical findings and the patient's ability to maintain bowel function post-surgery.

In conclusion, both options have their merits and risks. It is crucial to have a thorough discussion with the surgical team about the potential outcomes, risks, and benefits of each approach. Additionally, considering your father's overall health and preferences is essential in making the best decision for his care. It is understandable to feel anxious during this time, and seeking support from healthcare professionals can help alleviate some of that stress.

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