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International Wound Journal Feb 2019This literature review was conducted to summarise empirical evidence relating to psychosocial health following ostomy surgery during hospitalisation and after discharge.... (Review)
Review
This literature review was conducted to summarise empirical evidence relating to psychosocial health following ostomy surgery during hospitalisation and after discharge. Both qualitative and quantitative studies were searched from 2000 to 2017 using PubMed, CINAHL, Ebrary, Elsevier, Science Direct, and Scopus. Twenty-seven articles were included that examined the patient's psychosocial health following colostomy or ileostomy surgery. Among the 27 included studies, 11 adopted qualitative research methods and 16 used quantitative designs. Most of the studies were conducted to determine psychosocial problems and emotions of the individuals, their adaptation to the stoma, and their quality of life. Most of the psychosocial problems identified in these studies were poor body image perception and self-respect, depression, sexual problems, and lower psychosocial adaptation. This literature review has illustrated the patient's psychosocial health following stoma surgery. Further studies exploring the effect of psychosocial interventions could be planned.
Topics: Adaptation, Psychological; Adult; Aged; Aged, 80 and over; Colostomy; Female; Humans; Ileostomy; Male; Middle Aged; Quality of Life; Self Concept; Stress, Psychological; Surgical Stomas; Surveys and Questionnaires
PubMed: 30392194
DOI: 10.1111/iwj.13018 -
Deutsches Arzteblatt International Mar 2018About 100 000 ostomy carriers are estimated to live in Germany today. The creation of an ostomy represents a major life event that can be associated with impaired...
BACKGROUND
About 100 000 ostomy carriers are estimated to live in Germany today. The creation of an ostomy represents a major life event that can be associated with impaired quality of life. Optimal ostomy creation and proper ostomy care are crucially important determinants of the success of treatment and of the patients' quality of life.
METHODS
This article is based on pertinent publications retrieved by a selective search in PubMed, GoogleScholar, and Scopus, and on the authors' experience.
RESULTS
Intestinal stomata can be created using either the small or the large bowel. More than 75% of all stomata are placed as part of the treatment of colorectal cancer. The incidence of stoma-related complications is reported to be 10-70%. Skin irritation, erosion, and ulceration are the most common early complications, with a combined incidence of 25-34%, while stoma prolapse is the most common late complication, with an incidence of 8-75%. Most early complications can be managed conservatively, while most late complications require surgical revision. In 19% of cases, an ostomy that was initially planned to be temporary becomes permanent. Inappropriate stoma location and inadequate ostomy care are the most common causes of early complications. Both surgical and patient-related factors influence late complications.
CONCLUSION
Every step from the planning of a stoma to its postoperative care should be discussed with the patient in detail. Preoperative marking is essential for an optimal stoma site. Optimal patient management with the involvement of an ostomy nurse increases ostomy acceptance, reduces ostomy-related complications, and improves the quality of life of ostomy carriers.
Topics: Adult; Aged; Female; Germany; Humans; Intestinal Neoplasms; Male; Middle Aged; Ostomy; Quality of Life; Risk Factors; Self-Management; Surgical Stomas
PubMed: 29607805
DOI: 10.3238/arztebl.2018.0182 -
Annals of the Royal College of Surgeons... Apr 2018Background Hartmann's procedure is a commonly performed operation for complicated left colon diverticulitis or malignancy. The timing for reversal of Hartmann's is not... (Observational Study)
Observational Study
Background Hartmann's procedure is a commonly performed operation for complicated left colon diverticulitis or malignancy. The timing for reversal of Hartmann's is not well defined as it is technically challenging and carries a high complication rate. Methods This study is a retrospective audit of all patients who underwent Hartmann's procedure between 2008 and 2014. Reversal of Hartmann's rate, timing, American Society of Anesthesiologists grade, length of stay and complications (Clavien-Dindo) including 30-day mortality were recorded. Results Hartmann's procedure (n = 228) indications were complicated diverticular disease 44% (n = 100), malignancy 32% (n = 74) and other causes 24%, (n = 56). Reversal of Hartmann's rate was 47% (n = 108). Median age of patients was 58 years (range 21-84 years), American Society of Anesthesiologists grade 2 (range 1-4), length of stay was eight days (range 2-42 days). Median time to reversal of Hartmann's was 11 months (range 4-96 months). The overall complication rate from reversal of Hartmann's was 21%; 3.7% had a major complication of IIIa or above including three anastomotic leaks and one deep wound dehiscence. Failure of reversal and permanent stoma was less than 1% (n = 2). Thirty-day mortality following Hartmann's procedure was 7% (n = 15). Where Hartmann's procedure wass not reversed, for 30% (n = 31) this was the patient's choice and 70% (n = 74) were either high risk or unfit. Conclusions Hartmann's procedure is reversed less frequently than thought and consented for. Only 46% of Hartmann's procedures were stoma free at the end of the audit period. The anastomotic complication rate of 1% is also low for reversal of Hartmann's procedure in this study.
Topics: Adult; Aged; Aged, 80 and over; Anastomosis, Surgical; Colectomy; Colon, Sigmoid; Colostomy; Diverticulitis, Colonic; Female; Humans; Male; Medical Audit; Middle Aged; Operative Time; Postoperative Complications; Rectum; Reoperation; Retrospective Studies; Surgical Stomas; Treatment Outcome; Young Adult
PubMed: 29484943
DOI: 10.1308/rcsann.2018.0006 -
Ethiopian Journal of Health Sciences Sep 2021Background and Objective: Quality of life of patients can be affected a treatment. A good quality of life is essential to achieve a goal in treating patients. This study...
BACKGROUND
Background and Objective: Quality of life of patients can be affected a treatment. A good quality of life is essential to achieve a goal in treating patients. This study aims to assess stoma related quality of life.
METHODS
A cross-sectional study was done at St. Paul's Hospital millennium Medical College from February 1 to July 31, 2019. A structured questionnaire was used to interview patients and review charts of patients to retrieve information on sociodemographic variables, type, and indications of the stoma. Data was collected using structured questionnaire adopted from the City of Hope and Beckman Research Institute after modifications to make it in line with the Ethiopian context.
RESULTS
The mean score for the overall quality of life for stomata was 7.42 ± 0.53. Around 70% of patients have adjusted their dietary style due to stoma. More than half of them reported feelings of depression following stoma surgery. Only 34% of patients resumed sexual activity and only 11% were satisfied with it. None of them were enrolled in stoma association or support group. Factors such as type of ostomy (temporary/permanent), adjustment in dietary style due to stoma, depression, change in diet for not passing gas in public, and change in clothing style had significant effects on overall quality of life and its subscales ( < 0.05).
CONCLUSIONS
This study demonstrated that living with stoma has a greater impact on the overall aspect of quality of life.
Topics: Colostomy; Cross-Sectional Studies; Humans; Personal Satisfaction; Quality of Life; Surgical Stomas; Surveys and Questionnaires
PubMed: 35221616
DOI: 10.4314/ejhs.v31i5.11 -
International Journal of Surgery... Dec 2016Stoma formation delays discharge after colorectal surgery. Stoma education is widely recommended, but little data are available regarding whether educational... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Stoma formation delays discharge after colorectal surgery. Stoma education is widely recommended, but little data are available regarding whether educational interventions are effective. The aim of this prospective study was to investigate whether an enhanced recovery after surgery (ERAS) programme with dedicated ERAS and stoma nurse specialists focusing on counselling and stoma education can reduce the length of hospital stay, re-admission, and stoma-related complications and improve health-related quality of life (HRQoL) compared to current stoma education in a traditional standard care pathway.
METHODS
In a single-center study 122 adult patients eligible for laparoscopic or open colorectal resection who received a planned stoma were treated in either the ERAS program with extended stoma education (n = 61) or standard care with current stoma education (n = 61). The primary endpoint was total postoperative hospital stay. Secondary endpoints were postoperative hospital stay, major or minor morbidity, early stoma-related complications, health-related quality of life, re-admission rate, and mortality. HRQoL was measured by the generic 15D instrument.
RESULTS
Total hospital stay was significantly shorter in the ERAS group with education than the standard care group (median [range], 6 days [2-21 days] vs. 9 days [5-45 days]; p < 0.001). Regarding overall major and minor morbidity, re-admission rate, HRQoL, stoma-related complications and 30-day mortality, the two treatment groups exhibited similar outcomes.
CONCLUSION
Patients receiving a planned stoma can be included in an ERAS program. Pre-operative and postoperative stoma education in an enhanced recovery programme is associated with a significantly shorter hospital stay without any difference in re-admission rate or early stoma-related complications.
Topics: Adult; Aged; Aged, 80 and over; Colorectal Surgery; Colostomy; Critical Pathways; Female; Humans; Ileostomy; Length of Stay; Male; Middle Aged; Patient Education as Topic; Patient Readmission; Perioperative Care; Postoperative Complications; Prospective Studies; Quality of Life; Recovery of Function; Surgical Stomas; Treatment Outcome; Young Adult
PubMed: 27780772
DOI: 10.1016/j.ijsu.2016.10.031 -
Annals of the Royal College of Surgeons... Sep 2018Introduction Several stoma related complications can occur following ileostomy or colostomy formation. The reported incidence of these conditions varies widely in the... (Review)
Review
Introduction Several stoma related complications can occur following ileostomy or colostomy formation. The reported incidence of these conditions varies widely in the literature. A systematic review of randomised controlled trials reporting the incidence of stoma related complications in adults was performed to provide the most comprehensive summary of existing data. Methods PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and the Cochrane Library were searched for trials assessing the incidence of complications in adults undergoing conventional stoma formation. Data were extracted by two independent reviewers and entered into SPSS for statistical analysis. The Cochrane Collaboration tool for assessing risk of bias was used to critically appraise each study. Cochran's Q statistic and the I statistic were used to measure the level of heterogeneity between studies. Results Overall, 18 trials were included, involving 1,009 patients. The incidence of stoma related complications ranged from 2.9% to 81.1%. Peristomal skin complications and parastomal hernia were the most common complications. End colostomy had the highest incidence of morbidity, followed by loop colostomy and loop ileostomy. There were no trials involving patients with end ileostomy. There was a high level of detection bias and heterogeneity between studies. Conclusions This systematic review has summarised the best available evidence concerning the incidence of stoma related morbidity. The high level of heterogeneity between studies has limited the accuracy with which the true incidence of each stoma related complication can be reported. Large, multicentre trials investigating homogenous participant populations are therefore required.
Topics: Adult; Aged; Aged, 80 and over; Colostomy; Female; Humans; Ileostomy; Incidence; Male; Middle Aged; Morbidity; Postoperative Complications; Randomized Controlled Trials as Topic; Surgical Stomas
PubMed: 30112948
DOI: 10.1308/rcsann.2018.0126 -
Nutrition Journal May 2015An issue of recent research interest is excessive stoma output and its relation to electrolyte abnormalities. Some studies have identified this as a precursor of...
INTRODUCTION
An issue of recent research interest is excessive stoma output and its relation to electrolyte abnormalities. Some studies have identified this as a precursor of dehydration and renal dysfunction. A prospective study was performed of the complications associated with high-output stomas, to identify their causes, consequences and management.
MATERIALS AND METHODS
This study was carried out by a multidisciplinary team of surgeons, gastroenterologists, nutritionists and hospital pharmacists. High-output stoma (HOS) was defined as output ≥1500 ml for two consecutive days. The subjects included in the study population, 43 patients with a new permanent or temporary stoma, were classified according to the time of HOS onset as early HOS (<3 weeks after initial surgery) or late HOS (≥3 weeks after surgery). Circumstances permitting, a specific protocol for response to HOS was applied. Each patient was followed up until the fourth month after surgery.
RESULTS
Early HOS was observed in 7 (16%) of the sample population of 43 hospital patients, and late HOS, in 6 of the 37 (16%) non-early HOS population. By type of stoma, nearly all HOS cases affected ileostomy, rather than colostomy, patients. The patients with early HOS remained in hospital for 18 days post surgery, significantly longer than those with no HOS (12 days). The protocol was applied to the majority of EHOS patients and achieved 100% effectiveness. 50% of readmissions were due to altered electrolyte balance. Hypomagnesaemia was observed in 33% of the late HOS patients.
CONCLUSION
The protocol developed at our hospital for the detection and management of HOS effectively addresses possible long-term complications arising from poor nutritional status and chronic electrolyte alteration.
Topics: Aged; Colorectal Neoplasms; Colostomy; Female; Humans; Ileostomy; Magnesium Deficiency; Male; Malnutrition; Middle Aged; Nutritional Status; Postoperative Complications; Prospective Studies; Surgical Stomas
PubMed: 25956387
DOI: 10.1186/s12937-015-0034-z -
Polski Przeglad Chirurgiczny Feb 2018The main reason of the emergence of enteric stoma is colorectal cancer. Enteric stoma is a serious health, as well as life problem. In Poland, there are about 6,000...
INTRODUCTION
The main reason of the emergence of enteric stoma is colorectal cancer. Enteric stoma is a serious health, as well as life problem. In Poland, there are about 6,000 stoma surgeries yearly. It changes the functioning of patients, restricts their daily activity and influences their quality of life significantly. Therefore, in the modern treatment process, all spheres of human life and its surroundings are considered. The evaluation of the quality of life and the level of acceptance of the disease enables us to identify the regions in which patients require attention and help, as well as places to which health promotion among patients with a stoma should be directed. The aim of the study was the evaluation of the acceptance of the disease and the quality of life in patients with colostomy.
MATERIAL AND METHODS
The study conducted between February 2015 and February 2016 included101 patients with enteric stoma of the Provincial Specialist Hospital in Wrocław at Kamieńskiego St. in the departments of General Surgery with the Subdivision of Traumatology and Orthopedic Surgery, Subdivision of Metabolic Surgery, Subdivision of Endocrine Surgery and Oncological Surgery . Two anonymous questionnaires, i.e., health-related quality of life (HRQoL) and acceptance of illness scale (AIS), were used. 60% (61 people) were women, and 40% (40 people) were men. The mean age was 48; the youngest respondent was 20 years old, and the oldest was 79 years old. 17% of the respondents had primary education, 25% - vocational, 33% - secondary and 26% - university-level.
RESULTS
The most common reason for the emergence of a stoma among the respondents was colon cancer (44%), followed by: mechanical bowel onstruction (26%), intestinal damage following injuries (25%), inflammatory bowel disease (6%). The quality of life of patients with colostomy was evaluated in view of their health condition, postoperative recovery, everyday limitations, and self-evaluation. The majority of participants pointed to the deterioration of their quality of life. A higher level of acceptance of the disease was revealed in men as 75% of men, and 61% of women acceptted their health status. The education level also influences the acceptance of the disease, as 41% participants with higher education, and only 6% participants with primary education did not accept their health status. We revealed some social factors influencing the quality of life and the acceptance of the disease, i.e., gender, age, education, job, and place of living.
CONCLUSIONS
Gender and education have an impact on the level of the acceptance of the disease, but they do not influence the quality of life. The acceptance of the disease is connected with the quality of life in patients with a stoma. The higher the level of acceptance of the disease, the better the quality of life. Research indicates the need to deepen patients' education regarding their functioning in society.
Topics: Adaptation, Psychological; Adult; Aged; Colostomy; Female; Humans; Life Style; Male; Middle Aged; Patient Satisfaction; Poland; Postoperative Period; Quality of Life; Surgical Stomas; Surveys and Questionnaires; Young Adult
PubMed: 29513247
DOI: 10.5604/01.3001.0011.5954 -
JAMA Surgery Mar 2020Bridge to elective surgery using self-expandable metal stent (SEMS) placement is a debated alternative to emergency resection for patients with left-sided obstructive... (Comparative Study)
Comparative Study
IMPORTANCE
Bridge to elective surgery using self-expandable metal stent (SEMS) placement is a debated alternative to emergency resection for patients with left-sided obstructive colon cancer because of oncologic concerns. A decompressing stoma (DS) might be a valid alternative, but relevant studies are scarce.
OBJECTIVE
To compare DS with SEMS as a bridge to surgery for nonlocally advanced left-sided obstructive colon cancer using propensity score matching.
DESIGN, SETTING, AND PARTICIPANTS
This national, population-based cohort study was performed at 75 of 77 hospitals in the Netherlands. A total of 4216 patients with left-sided obstructive colon cancer treated from January 1, 2009, to December 31, 2016, were identified from the Dutch Colorectal Audit and 3153 patients were studied. Additional procedural and intermediate-term outcome data were retrospectively collected from individual patient files, resulting in a median follow-up of 32 months (interquartile range, 15-57 months). Data were analyzed from April 7 to October 28, 2019.
EXPOSURES
Decompressing stoma vs SEMS as a bridge to surgery.
MAIN OUTCOMES AND MEASURES
Primary anastomosis rate, postresection presence of a stoma, complications, additional interventions, permanent stoma, locoregional recurrence, disease-free survival, and overall survival. Propensity score matching was performed according to age, sex, body mass index, American Society of Anesthesiologists score, prior abdominal surgery, tumor location, pN stage, cM stage, length of stenosis, and year of resection.
RESULTS
A total of 3153 of the eligible 4216 patients were included in the study (mean [SD] age, 69.7 [11.8] years; 1741 [55.2%] male); after exclusions, 443 patients underwent bridge to surgery (240 undergoing DS and 203 undergoing SEMS). Propensity score matching led to 2 groups of 121 patients each. Patients undergoing DS had more primary anastomoses (104 of 121 [86.0%] vs 90 of 120 [75.0%], P = .02), more postresection stomas (81 of 121 [66.9%] vs 34 of 117 [29.1%], P < .001), fewer major complications (7 of 121 [5.8%] vs 18 of 118 [15.3%], P = .02), and more subsequent interventions, including stoma reversal (65 of 113 [57.5%] vs 33 of 117 [28.2%], P < .001). After DS and SEMS, the 3-year locoregional recurrence rates were 11.7% for DS and 18.8% for SEMS (hazard ratio [HR], 0.62; 95% CI, 0.30-1.28; P = .20), the 3-year disease-free survival rates were 64.0% for DS and 56.9% for SEMS (HR, 0.90; 95% CI, 0.61-1.33; P = .60), and the 3-year overall survival rates were 78.0% for DS and 71.8% for SEMS (HR, 0.77; 95% CI, 0.48-1.22; P = .26).
CONCLUSIONS AND RELEVANCE
The findings suggest that DS as bridge to resection of left-sided obstructive colon cancer is associated with advantages and disadvantages compared with SEMS, with similar intermediate-term oncologic outcomes. The existing equipoise indicates the need for a randomized clinical trial that compares the 2 bridging techniques.
Topics: Aged; Aged, 80 and over; Colonic Diseases; Colonic Neoplasms; Female; Humans; Intestinal Obstruction; Male; Middle Aged; Preoperative Period; Propensity Score; Retrospective Studies; Self Expandable Metallic Stents; Surgical Stomas; Survival Rate
PubMed: 31913422
DOI: 10.1001/jamasurg.2019.5466