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Annals of the Royal College of Surgeons... Nov 2021This study aims to assess the rate of stoma reversal in patients who have undergone stoma formation with permanent intent for functional bowel disorder. We also assessed...
INTRODUCTION
This study aims to assess the rate of stoma reversal in patients who have undergone stoma formation with permanent intent for functional bowel disorder. We also assessed the incidence of malignancy in defunctioned bowel.
METHODS
This is a retrospective study of the outcomes of patients undergoing planned permanent stoma formation for functional bowel disorder over a 10-year period at a single tertiary centre.
RESULTS
Of 92 patients included in the study, 11 (12%) requested and underwent stoma reversal following stoma formation for functional bowel disorder. Of 84 patients with defunctioned bowel left in situ, two (2%) developed bowel malignancy during our study period.
CONCLUSIONS
Stoma formation may be necessary for patients with incontinence and constipation when conservative treatments fail. Some patients have very firm views about the need for a stoma, but a significant proportion of patients do not cope with a stoma and request reversal, therefore patient selection and pre-procedure counselling are important. The risk of developing malignant disease in the defunctioned colon is potentially significant, and consideration should be given to appropriate surveillance in this group of patients. Evidence for stoma formation in functional gastrointestinal disorders is lacking; this study reports outcomes in a large cohort of patients over a long period, and highlights areas where further research and practice guidelines are needed. If large numbers of patients are undergoing stoma reversal posing significant mortality and morbidity risks, this suggests that patient selection and preoperative counselling need refinement.
Topics: Adult; Aged; Aged, 80 and over; Colostomy; Female; Gastrointestinal Diseases; Humans; Ileostomy; Male; Middle Aged; Patient Preference; Retrospective Studies; Surgical Stomas; Young Adult
PubMed: 34414788
DOI: 10.1308/rcsann.2021.0087 -
International Journal of Environmental... Feb 2023Stoma surgery may reduce the quality of life, including sex life. A literature review was undertaken to explore what factors impact on the sexual health and sexuality of... (Review)
Review
INTRODUCTION
Stoma surgery may reduce the quality of life, including sex life. A literature review was undertaken to explore what factors impact on the sexual health and sexuality of people with a stoma.
METHODOLOGY
A review of the literature was undertaken using the online databases Cochrane, PsychInfo, Embase and Pubmed. The search was limited to articles on colostomates and ileostomates in the English language that were peer-reviewed and written in the past 5 years.
RESULTS
Intestinal stoma surgery affects many aspects of a patient's life, including body image, relationship with a partner and quality of sex life. The introduction of perioperative educational programmes for patients qualified for ostomy surgery and their relatives will provide the necessary support in the face of physical and mental difficulties that may be associated with the procedure.
Topics: Humans; Quality of Life; Ostomy; Surgical Stomas; Body Image; Sexuality
PubMed: 36768026
DOI: 10.3390/ijerph20032660 -
Surgery Apr 2023Hartmann's procedure is a treatment option for perforated acute diverticulitis, especially when organ dysfunction(s) are present. Its use has been criticized mostly out...
BACKGROUND
Hartmann's procedure is a treatment option for perforated acute diverticulitis, especially when organ dysfunction(s) are present. Its use has been criticized mostly out of fear of high permanent stoma rate. The aim of this study was to investigate the rate of stoma reversal, reasons behind nonreversal, and safety of reversal surgery.
METHODS
This was a single-center retrospective study of patients undergoing urgent Hartmann's procedure due to acute diverticulitis between the years 2006 and 2017 with follow-up until March 2021.
RESULTS
A total of 3,319 episodes of diverticulitis in 2,932 patients were screened. The Hartmann's procedure was performed on 218 patients, of whom 157 (72%) had peritonitis (48 (22%) with organ dysfunction). At 2-years, 76 (34.9%) patients had died with stoma, 42 (19.3%) were alive with stoma, and 100 (45.9%) had undergone stoma reversal. The survival of patients with and without reversal were 100% and 42.7% at 1-year, 96.0% and 35.0% at 2-years and 88.9% and 20.7% at 5-years, respectively. The risk factors for nonreversal were old age, a need for outside assistance, low HElsinki Staging for Acute Diverticulitis stage, and higher C-reactive protein level upon hospital admission. The most common reasons for nonreversal in surviving patients were patient not willing to have the operation 18 (41%) and dementia 10 (23%). Twelve (12%) patients had a major complication after reversal (Clavien-Dindo IIIb-IV) and 90-day mortality after reversal was 0%.
CONCLUSION
After the Hartmann's procedure for acute diverticulitis, one-third died, half underwent stoma reversal, and one-fifth did not undergo stoma reversal within 2 years. Patients who survive with stoma are either not willing to have reversal or have severe comorbidities excluding elective surgery. The Hartmann's procedure remains a viable option for high-risk patients with perforated acute diverticulitis.
Topics: Humans; Retrospective Studies; Multiple Organ Failure; Diverticulitis; Colostomy; Surgical Stomas
PubMed: 36517294
DOI: 10.1016/j.surg.2022.10.028 -
Danish Medical Journal Mar 2020Stoma-site incisional hernia is a common complication. Besides decreasing affected patients' quality of life, it may lead to emergency surgery due to incarceration. If...
INTRODUCTION
Stoma-site incisional hernia is a common complication. Besides decreasing affected patients' quality of life, it may lead to emergency surgery due to incarceration. If stoma sites lead to an incisional hernia analogous to other abdominal incisions, considerable underreporting may be present in the literature.
METHODS
This was a single-centre, retrospective cohort study comprising consecutive patients undergoing laparoscopic rectal resection for rectal carcinoma with temporary diverting stoma and subsequent stoma reversal. CTs were reviewed to identify stoma-site incisional hernia, and potential confounders for development of a hernia were assessed.
RESULTS
A total of 91 patients underwent stoma reversal and subsequent CT. In all, 72 of the 91 included patients had a transverse colostomy, among whom 19 (26%) developed a hernia. Among the remaining 19 patients treated with an ileostomy, four (21%) developed stoma-site incisional hernia. The mean time from stoma reversal to follow-up CT was 47.6 months (range: 28.5-66.7 months). No significant associations between stoma-site hernia and the included potential risk factors were observed.
CONCLUSIONS
25% developed reversal-site incisional hernia. We were unable to find any predictors for development of stoma reversal-site hernia. If hernias occur as frequently as this study shows, investigation of potential ways to decrease their occurrence is warranted.
FUNDING
none.
TRIAL REGISTRATION
The study was approved by the Danish Data Protection Agency (R. no. 2012-58-0004).
Topics: Aged; Colostomy; Female; Humans; Ileostomy; Incidence; Incisional Hernia; Laparoscopy; Laparotomy; Male; Middle Aged; Quality of Life; Rectal Neoplasms; Retrospective Studies; Risk Factors; Surgical Stomas; Tomography, X-Ray Computed
PubMed: 32138828
DOI: No ID Found -
British Journal of Nursing (Mark Allen... Apr 2022The Ostomy Life Study 2019 aimed to obtain a better understanding of the challenges faced by people with stoma.
AIM
The Ostomy Life Study 2019 aimed to obtain a better understanding of the challenges faced by people with stoma.
METHODS
Online survey with participants from 17 countries.
FINDINGS
Of the 54 614 individuals invited to take part, 5187 responded; 62% of the respondents avoided physical and social activities because of their stoma and 37% had never consulted their stoma care nurse to have the fit of their stoma product checked. In a subgroup receiving questions on leakage (=4209), output under the baseplate and leakage onto clothes were experienced within the previous month by 76% and 26% of respondents, respectively. Higher chance of leakage was associated with an irregular stoma shape and peristomal body profile; a stoma level at or below the skin surface; and the presence of creases, folds and other changes in the peristomal area.
CONCLUSION
Leakage and access to a stoma care nurse to provide the necessary care and guidance remain important concerns for individuals with a stoma.
Topics: Humans; Ostomy; Risk Factors; Surgical Stomas; Surveys and Questionnaires
PubMed: 35404660
DOI: 10.12968/bjon.2022.31.7.376 -
Scientific Reports Apr 2023The safety of early stoma closure after lower anterior resection (LAR) for rectal cancer remains controversial. In this study, patients scheduled to undergo LAR and...
The safety of early stoma closure after lower anterior resection (LAR) for rectal cancer remains controversial. In this study, patients scheduled to undergo LAR and stoma creation for rectal cancer were recruited. In absence of anastomotic leakage on radiological examination, closure of the diverting ileostomy was performed within 2 weeks. The primary endpoint was incidence of the colorectal anastomosis leakage after early stoma closure. Because of the slow accrual rate, the study was closed before recruitment reached the planned number of patients (n = 20). Among the 13 patients enrolled between April 2019 and March 2021, early stoma closure was performed in seven patients (53.8%). Non-clinical anastomotic leakage, leakage identified only on radiological examination, occurred in five cases, resulting in rescheduling of stoma closure. One patient did not undergo early stoma closure due to ileus. After stoma closure, colorectal anastomotic leakage manifested in one case; its incidence rate was 14.2%. Surgical site infection occurred in 42.8% of patients. This study revealed that asymptomatic anastomotic leakage occurred frequently. Considering the low rate of successful cases and the high rate of complications, early stoma closure within 2 weeks after LAR should not be performed routinely. Trial registration: (UMIN000036382 registered on 03/04/2019).
Topics: Humans; Anastomotic Leak; Anastomosis, Surgical; Ileostomy; Surgical Stomas; Rectal Neoplasms; Postoperative Complications; Retrospective Studies
PubMed: 37081037
DOI: 10.1038/s41598-023-33697-9 -
Clinics in Colon and Rectal Surgery Feb 2008The creation of intestinal stomas for diversion of enteric contents is an important component of the surgical management of several gastroenterologic disease processes....
The creation of intestinal stomas for diversion of enteric contents is an important component of the surgical management of several gastroenterologic disease processes. Despite the frequency with which these procedures are performed, complications of stoma creation remain common, despite extensive measures aimed at reducing them. Early postoperative complications (those seen less than one month postoperatively) can lead to significant cost, both financially and psychologically, and incur significant morbidity. Commonly seen early postoperative stomal complications include improper stoma site selection, vascular compromise, retraction, peristomal skin irritation, peristomal infection/abscess/fistula, acute parastomal herniation and bowel obstruction, and pure technical errors. The author reviews these early complications associated with stoma creation, discusses means of preventing them, and outlines the management strategy for such complications when they do occur.
PubMed: 20011393
DOI: 10.1055/s-2008-1055318 -
Respiratory Care Apr 2005An increasing number of technology-dependent patients are sent home for long-term home-management of stable chronic illness. With a patient who is going to undergo... (Review)
Review
An increasing number of technology-dependent patients are sent home for long-term home-management of stable chronic illness. With a patient who is going to undergo tracheotomy, patient-education (for the patient and his/her caregivers) should begin early (before the tracheostomy, if possible), should be individualized to the patient, and should include basic airway anatomy, medical justification for the tracheostomy, tube description and operation, signs and symptoms of respiratory and upper-airway distress, signs and symptoms of aspiration, suctioning technique, tracheostomy tube-cleaning and maintenance, stoma-site assessment and cleaning, cardiopulmonary resuscitation, emergency decannulation and reinsertion procedures, tube-change procedure, equipment-and-supply use and ordering procedures, and financial issues. There should be a scheduled follow-up plan with the attending physician. A combination of process-validation, through additional research, and expert consensus may be needed to standardize the long-term care of patients who undergo tracheostomy.
Topics: Device Removal; Humans; Humidity; Long-Term Care; Speech; Suction; Surgical Stomas; Tracheostomy
PubMed: 15807917
DOI: No ID Found -
Advances in Skin & Wound Care Nov 2017Protecting the skin against moisture-associated damage is an important component of comprehensive skin and wound care. Based on a review of literature, the authors... (Review)
Review
BACKGROUND
Protecting the skin against moisture-associated damage is an important component of comprehensive skin and wound care. Based on a review of literature, the authors propose key interventions to protect and prevent damage in the skin folds, perineum, and areas surrounding a wound or stoma.
OBJECTIVE
The aim of this scoping review is to identify and provide a narrative integration of the existing evidence related to the management and prevention of moisture-associated skin damage (MASD).
METHODS
Study authors searched several databases for a broad spectrum of published and unpublished studies in English, published between 2000 and July 2015. Selected study information was collated in several different formats; ultimately, key findings were aggregated into a thematic description of the evidence to help generate a set of summative statements or recommendations.
RESULTS
Based on inclusion criteria, 37 articles were considered appropriate for this review. Findings included functional definitions and prevalence rates of the 4 types of MASD, assessment scales for each, and 7 evidence-based strategies for the management of MASD.
CONCLUSIONS
Based on this scoping review of literature, the authors propose key interventions to protect and prevent MASD including the use of barrier ointments, liquid polymers, and cyanoacrylates to create a protective layer that simultaneously maintains hydration levels while blocking external moisture and irritants.
Topics: Body Fluids; Dermatitis, Irritant; Fecal Incontinence; Female; Humans; Male; Risk Assessment; Skin Care; Surgical Stomas; Treatment Outcome; Urinary Incontinence
PubMed: 29049257
DOI: 10.1097/01.ASW.0000525627.54569.da -
Quality of Life Research : An... Aug 2022Quality of life can be negatively impacted by the formation of a stoma and is influenced by a number of factors. Research to date treats people with a stoma as a...
PURPOSE
Quality of life can be negatively impacted by the formation of a stoma and is influenced by a number of factors. Research to date treats people with a stoma as a homogenous group based on their quality of life. We attempted to identify subgroups based upon self-reported quality of life and explored variables associated with group membership.
METHODS
The present study is a secondary analysis of a cross-sectional sample of 1419 people with a stoma. Participants completed validated questionnaires for quality of life, physical activity and clinical and demographic characteristics. Latent profile analysis was used to identify the optimal number of subgroups (profiles) and multinomial regression modelling was conducted to identify variables associated with profile membership.
RESULTS
The analysis revealed 4 distinct profiles of people with a stoma: 'consistently good quality of life' [N = 891 (62.8%)], 'some quality of life concerns' [N = 184 (13.0%)], 'low quality of life' [N = 181 (12.8%)] and 'financial concerns' [N = 163 (11.5%)]. Modelling revealed that people with a recent stoma (formed < 2 years previously), who have a hernia and are less physically active were more likely to belong to the 'low quality of life' profile. Furthermore, those aged 16-55 were more likely to have financial concerns.
CONCLUSION
This study was the first to identify latent profiles within this population and assess whether certain variables are associated with membership. Future research should build upon this to identify additional variables associated with these profiles, which can help to provide the basis for targeting and tailoring future interventions to specific subgroups of people with a stoma.
Topics: Cross-Sectional Studies; Exercise; Humans; Quality of Life; Surgical Stomas; Surveys and Questionnaires
PubMed: 35217962
DOI: 10.1007/s11136-022-03102-5