Complications after double-barreled wet colostomy compared to separate urinary and fecal diversion during pelvic exenteration: time to change back?

Gynecol Oncol. 2013 Jan;128(1):60-64. doi: 10.1016/j.ygyno.2012.08.004. Epub 2012 Aug 11.


Objective: To assess complications associated with double-barreled wet colostomy (DBWC) in the first six months after pelvic exenteration as compared to separate urinary and fecal diversion (SUD).

Methods: A single institution retrospective chart review was conducted of all patients who underwent a pelvic exenteration between 2000 and 2011. Patients were included if the procedure involved at least a urinary diversion and a perineal phase. Patient demographics and complications in the first 6months after surgery were recorded.

Results: Thirty-three patients met inclusion criteria (12 DBWC and 21 SUD). The majority of patients had recurrent cervical cancer (58%) followed by vaginal, vulva, and endometrial cancer. All patients had previously received radiation. 10/12 patients with a DBWC and 67% of SUD had pelvic reconstruction. Median length of stay (LOS) was shorter for DBWC (14.5 vs. 20days, p=.01). Median operating times were shorter for DBWC (610 vs. 702minutes, p=.04). No urinary conduit or anastomotic bowel leaks occurred in the DBWC group compared to 5 (24%) and 2 (9.5%), respectively, in the SUD group (p=.06 for any leak). 58% of the DBWC and 62% of the SUD group required re-operation, and there were no 30-day peri-operative deaths.

Conclusions: DBWC can be performed safely at the time of pelvic exenteration. We found reduced operating times, shorter LOS, and a trend toward fewer urinary conduit and/or bowel anastomotic leaks in DBWC exenteration patients. DBWC may be favorable over more technically challenging SUD in this heavily radiated population that generally has a limited overall survival.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Colostomy / adverse effects*
  • Colostomy / methods
  • Female
  • Genital Neoplasms, Female / surgery*
  • Humans
  • Middle Aged
  • Operative Time
  • Pelvic Exenteration / adverse effects*
  • Retrospective Studies
  • Urinary Diversion / adverse effects*
  • Uterine Cervical Neoplasms / surgery