Perineal colostomy with appendicostomy as an alternative for an abdominal colostomy: Symptoms, functional status, quality of life, and perceived health

PURPOSE: Abdominoperineal rectum resection with perineal colostomy and appendicostomy for antegrade continence enema has been developed as an alternative for abdominal colostomy or total anal reconstruction in patients with low rectal cancer. This present study was designed to compare symptoms, functional status, quality of life, and perceived health after perineal colostomy and appendicostomy with that after abdominal colostomy. METHODS: Twenty-seven patients, 14 with abdominal colostomy and 13 with perineal colostomy and appendicostomy, were included. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires C30 and CR38 were used to investigate functional status and symptoms. Quality of life was measured by using a Linear Analog Scale and the Satisfaction with Life Scale. Self-perceived health was assessed by using a Linear Analog Scale. RESULTS: Patients with perineal colostomy and appendicostomy were younger and more frequently female. They experienced better physical functioning (93.3 vs. 73.3 P=0.048), a slightly better role functioning (100 vs. 83.3 not significant), body image (77.8 vs. 66.7 not significant), and sexual functioning (33.3 vs. 0; not significant) than patients with abdominal colostomy. Stoma-related problems were substantial in patients with abdominal colostomy (38.1) and very limited in patients with an appendicostomy (8.7). Fecal loss did not occur one hour or more after antegrade continence enema in 11 patients with perineal colostomy and was limited in the others. Quality of life and self-perceived health were comparably good in both groups. CONCLUSIONS: Perineal colostomy with appendicostomy for antegrade continence enema is a valid and acceptable alternative for a permanent abdominal colostomy in selected patients, with a comparable functional and quality of life outcome. © 2007 The American Society of Colon and Rectal Surgeons.