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The colostomy is usually closed about two to three months after the main repair, provided the operation was successful. This operation requires an admission in the hospital of approximately five to six days.
The patient remains in the hospital for two to three days with nothing by mouth, and usually a tube is left from the nose into the stomach for a couple of days postoperatively.
Preoperative preparation may occur in the hospital or home setting. Irrigations are now necessary for the functional stoma and are performed in the same manner as those for the nonfunctioning stoma before the posterior sagittal anorectoplasty (PSARP). The child receives a clear liquid diet on the day before surgery. Antibiotics are administered preoperatively.
The operation entails taking down both stomas and performing a bowel anastomosis to re-establish the colon continuity.
Postoperatively, the child may experience more pain than after the pull-through procedure if a laparotomy was not required as part of the pull-through procedure.
The patient will then start passing stool through the new rectum about two to three days after surgery.
The number of bowel movements during the days following the colostomy closure is usually very high when compared with a normal child; therefore, some children suffer from severe diaper rash.
The surgeon and his nurse should be able to help the parents with the management of this diaper rash. After a few days and often a few weeks, the number of bowel movements start decreasing and children become constipated. The degree of constipation may vary from minimal to very severe.
Parents must be aware of the expected constipation and follow the doctor’s instructions to give an adequate diet or sometimes even a laxative-type medication to guarantee that the rectum empties every day.
After the colostomy is closed, the main recommendation to parents is to avoid constipation in their children, since constipation can create bad secondary effects.
Other than this, from the time the colostomy is closed until the child is 2 or 2½ years old, it is usually not necessary to attend the hospital because these children do not need special care.
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