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Steen CJ, Wei MYK, Vadakkenchery Varghese E, Asghari-Jafarabadi M, Sansom W, Balakrishnan V, An V, Chandra R. Quality of life amongst patients with diverting umbilical stomas in rectal surgery: a single centre prospective randomized controlled pilot study. ANZ J Surg 2024; 94:187-192. [PMID: 37749845 DOI: 10.1111/ans.18709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/08/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The umbilical stoma (umbistoma) has been proposed as a viable alternative site for a temporary defunctioning stoma. Suggested advantages of the umbistoma include decreased number of surgical incisions required, improved cosmesis and ease of reversal surgery. This study aimed to assess the patient experience of umbilical loop ileostomies in rectal surgery, with the primary outcome being patient reported quality of life (QoL). METHODS A total of 20 patients undergoing laparoscopic rectal cancer surgery were randomly allocated to have a defunctioning ileostomy at a conventional site (right iliac fossa) or at the umbilicus. Patient-reported QoL was assessed at 6 weeks using the Stoma-QoL questionnaire. Secondary outcomes were number of stomas reversed, length of time awaiting stoma reversal surgery, duration of operative time for stoma reversal, length of hospital stay following stoma reversal and rate of parastomal or post reversal incisional hernias. RESULTS Patients who had an umbilical stoma scored significantly lower on the Stoma-QoL questionnaire compared to the conventional group, particularly on questions regarding feelings of tiredness, body insecurity and anxiety. No significant differences were observed between the two groups in relation to secondary outcomes. CONCLUSION There may be potential disadvantages to the umbilical stoma with negative impacts on body image and subsequent increased social anxiety. Patient selection and adequate counselling will be important when considering an umbilical stoma. Further larger scale prospective studies are required to further validate the feasibility and longer-term safety of umbilical stomas in both clinical outcomes as well as patient QoL.
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Affiliation(s)
- Christopher J Steen
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Cabrini Research, Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Matthew Y K Wei
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | | | - Mohammad Asghari-Jafarabadi
- Cabrini Research, Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Wendy Sansom
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Vikram Balakrishnan
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Vinna An
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Raaj Chandra
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Jemec G, Herschend NO, Hansen HD, Findley A, Williams A, Sully K, Karlsmark T, Størling Z. Psychometric validation of the Ostomy Skin Tool 2.0. PeerJ 2023; 11:e16685. [PMID: 38130931 PMCID: PMC10734405 DOI: 10.7717/peerj.16685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
Background Peristomal skin complications (PSCs) pose a major challenge for people living with an ostomy. To avoid severe PSCs, it is important that people with an ostomy check their peristomal skin condition on a regular basis and seek professional help when needed. Aim To validate a new ostomy skin tool (OST 2.0) that will make regular assessment of the peristomal skin easier. Methods Seventy subjects participating in a clinical trial were eligible for the analysis and data used for the validation. Item-level correlation with anchors, inter-item correlations, convergent validity of domains, test-retest reliability, anchor- and distribution-based methods for assessment of meaningful change were all part of the psychometric validation of the tool. Results A final tool was established including six patient reported outcome items and automatic assessment of the discolored peristomal area. Follow-up with cognitive debriefing interviews assured that the concepts were considered relevant for people with an ostomy. Conclusion The OST 2.0 demonstrated evidence supporting its reliability and validity as an outcome measure to capture both visible and non-visible peristomal skin complications.
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Affiliation(s)
- Gregor Jemec
- Department of Dermatology, Roskilde Hospital, Roskilde, Denmark
| | | | | | - Amy Findley
- Patient-Centered Outcomes, Adelphi Values, Bollington, United Kingdom
| | - Abi Williams
- Patient-Centered Outcomes, Adelphi Values, Bollington, United Kingdom
| | - Kate Sully
- Patient-Centered Outcomes, Adelphi Values, Bollington, United Kingdom
| | - Tonny Karlsmark
- Copenhagen Wound Healing Centre, Department of Dermatology, Bispebjerg Hospital, København, Denmark
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Liu C, Zhang J, Li L, Zhang L, Shang L, Ma Y. Comparison of specimen extraction site and another site for protective loop ileostomy in laparoscopic low anterior rectal resection: a retrospective comparative study. Langenbecks Arch Surg 2023; 408:151. [PMID: 37055576 PMCID: PMC10102083 DOI: 10.1007/s00423-023-02886-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/04/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Protective loop ileostomy is commonly performed in laparoscopic low anterior rectal resection to prevent the serious complications of anastomotic fistula. It is usually created at the right lower quadrant of the abdomen and another wound is required for stoma. The study aimed to evaluate the outcomes of ileostomy at the specimen extraction site (SES) and another site (AS) beside the auxiliary incision. METHODS A retrospective analysis was conducted on 101 eligible patients with pathologically diagnosed adenocarcinoma of the rectum from January 2020 to December 2021 in the study center. According to whether the ileostomy was at the specimen extraction site, patients were divided into SES group (40 patients) and AS group (61 patients). Clinicopathological characteristics, the intraoperative details, and postoperative outcomes of the two groups were measured. RESULTS Univariate analysis showed that the operative time was significantly shorter and the blood loss was significantly less in the SES group than in the AS group during laparoscopic low anterior rectal resection, the time to first flatus was significantly shorter, and the pain was significantly less in the SES group than in the AS group during ileostomy closure. The postoperative complications were similar in both groups. Multivariable analysis showed that ileostomy at the specimen extraction site was a significant factor influencing the operative time and blood loss of rectal resection, and influencing the pain and the time to first flatus during ileostomy closure. CONCLUSION Compared to ileostomy at AS, protective loop ileostomy at SES was time-saving and less bleeding during laparoscopic low anterior rectal resection, and more quick to first flatus and less pain during stoma closure, and did not lead to more postoperative complications. The median incision of the lower abdomen and the left lower abdominal incision were both good sites for ileostomy.
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Affiliation(s)
- Chao Liu
- Department of Laser Cosmetic Clinic, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Jizhun Zhang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Leping Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Li Zhang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Liang Shang
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China
| | - Yan Ma
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
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Zheng B, Wang Q, Wei M, Yue Y, Li X. Which site is better for prophylactic ileostomy after laparoscopic rectal cancer surgery? By the specimen extraction site or new site: A systematic review and meta-analysis. Front Oncol 2023; 13:1116502. [PMID: 36874091 PMCID: PMC9975498 DOI: 10.3389/fonc.2023.1116502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023] Open
Abstract
Background There is controversy about the outcomes of prophylactic ileostomy via the specimen extraction site (SES) after laparoscopic rectal cancer surgery (LRCS). We, therefore, performed a meta-analysis to determine the efficacy and safety of stoma through the SES versus new site (NS). Methods All relevant studies from 1997 to 2022 were searched in the PubMed, EMBASE, Cochrane Library, CNKI, VIP databases. This meta-analysis was performed using RevMan software 5.3 for statistical analysis. Results 7 studies with 1736 patients were included. The present meta-analysis noted that prophylactic ileostomy via SES was associated with a higher risk of overall stoma-related complications, especially parastomal hernia (OR, 2.39, 95% CI 1.43-4.00; p=0.0008). No statistical difference was found in terms of wound infection, ileus, stoma edema, stoma prolapse, stoma necrosis, stoma infection, stoma bleeding, stoma stenosis, skin inflammation around the stoma, stoma retraction and postoperative pain score on postoperative day 1 and 3 between SES group and NS group. However, prophylactic ileostomy via SES was associated with lesser blood loss (MD = -0.38, 95% CI: -0.62 - -0.13; p=0.003), shorter operation time(MD = -0.43, 95% CI: -0.54 - -0.32 min; p<0.00001), shorter post-operative hospital stay (MD = -0.26, 95% CI: -0.43 - -0.08; p=0.004), shorter time to first flatus(MD = -0.23, 95% CI: -0.39 - -0.08; p=0.003) and lower postoperative pain score on postoperative day 2. Conclusion Prophylactic ileostomy via SES after LRCS reduces new incision, decreases operative time, promotes postoperative recovery, and improves cosmetic outcomes, but may increase the incidence of parastomal hernias. The vast majority of parastomal hernias can be repaired by closing the ileostomy, therefore SES remain an option for temporary ileostomy after LRCS.
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Affiliation(s)
- Bobo Zheng
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Quan Wang
- Ambulatory Surgery Center of Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yumin Yue
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Xiaojun Li
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, China
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Coletta D, De Padua C, Iannone I, Puzzovio A, Greco PA, Patriti A, La Torre F. Defunctioning Ileostomy to Prevent the Anastomotic Leakage in Colorectal Surgery. The State of the Art of the Different Available Types. Front Surg 2022; 9:866191. [PMID: 35495739 PMCID: PMC9043457 DOI: 10.3389/fsurg.2022.866191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/08/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Diego Coletta
- Department of Surgical Sciences, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
- *Correspondence: Diego Coletta ; orcid.org/0000-0002-9116-0733
| | - Cristina De Padua
- Department of General Surgery, Emergency Department, Emergency and Trauma Surgery Unit, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Immacolata Iannone
- Department of General Surgery, Emergency Department, Emergency and Trauma Surgery Unit, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonella Puzzovio
- Department of General Surgery, Emergency Department, Emergency and Trauma Surgery Unit, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Alberto Patriti
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Filippo La Torre
- Department of Surgical Sciences, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
- Department of General Surgery, Emergency Department, Emergency and Trauma Surgery Unit, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
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Vigna C, Arndt K, Dressler J, Loehner D, Messaris E. Single Center Experience with Umbilical Stomas Following Colorectal Surgery. J Laparoendosc Adv Surg Tech A 2022; 32:432-437. [PMID: 35119309 DOI: 10.1089/lap.2021.0809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The umbilicus is commonly used as an access site to perform minimally invasive colorectal surgery. Umbilical stomas are becoming an attractive option as an alternative site for temporary stomas since they reduce the need for additional abdominal incisions. Methods: We retrospectively evaluated patients who underwent umbilical stoma creation after colorectal resection for diagnosis of rectal cancer, diverticulitis, or ulcerative colitis between January 2020 and July 2021. Surgical technique, clinical and perioperative outcomes, complications, and cosmetic end results were described. Results: A total of 11 patients underwent umbilical stoma creation. There were no major surgical complications. Peristomal skin irritation was secondary to difficulties with the management of the pouching system. One patient presented with ostomy prolapse. Three patients experienced incisional hernia after stoma reversal. There were no wound infections. Conclusion: Umbilical stomas appear to be a safe alternative to conventional stomas and provide superior cosmetic outcomes.
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Affiliation(s)
- Carolina Vigna
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kevin Arndt
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jeremy Dressler
- Division of Colorectal Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Donna Loehner
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Ku DH, Kim HS, Shin JY. Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery. Ann Coloproctol 2020; 36:304-310. [PMID: 32054255 PMCID: PMC7714381 DOI: 10.3393/ac.2019.10.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose Limited data exist on the use of low midline and transverse incisions for specimen extraction or stoma sites in laparoscopic rectal cancer surgery (LRCS). We compared the short-term and medium-term outcomes of these incisions and assessed whether wound complications in specimen extraction sites (SES) are increased by specimen extraction through the stoma site (SESS) in LRCS. Methods From March 2010 to December 2017, 189 patients who underwent LRCS and specimen extraction through low abdominal incisions were divided into 2 groups: midline (n = 102) and transverse (n = 87), and perioperative outcomes were compared. Results The midline group showed a higher frequency of temporary stoma formation (P = 0.001) and splenic flexure mobilization (P < 0.001) than the transverse group. The overall incisional hernia and wound infection rates in the SES were 21.6% and 25.5%, respectively, in the midline group and 26.4% and 17.2%, respectively, in the transverse group (P = 0.494 and P = 0.232, respectively). In patients who underwent SESS, the incisional hernia and wound infection rates of SES after stoma closure were 39.1% and 43.5%, respectively, in the midline group, and 35.5% and 22.6%, respectively, in the transverse group (P = 0.840 and P = 0.035, respectively). Conclusion In terms of incisional hernia and wound infection at the SES, a low midline incision may be used as a low transverse incision in patients without temporary stoma in LRCS. However, considering the high wound complication rates after stoma closure in patients with SESS in this study, SESS should be performed with caution in LRCS.
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Affiliation(s)
- Do Hoe Ku
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyeon Seung Kim
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Yong Shin
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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Wang P, Liang JW, Zhou HT, Wang Z, Zhou ZX. Surgical specimen extraction via a prophylactic ileostomy procedure: A minimally invasive technique for laparoscopic rectal cancer surgery. World J Gastroenterol 2018; 24:104-111. [PMID: 29358887 PMCID: PMC5757115 DOI: 10.3748/wjg.v24.i1.104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To retrospectively evaluate the safety and feasibility of surgical specimen extraction via a prophylactic ileostomy procedure in patient with rectal cancer.
METHODS We systematically reviewed 331 consecutive patients who underwent laparoscopic anterior resection for rectal cancer and prophylactic ileostomy in our institution from June 2010 to October 2016, including 155 patients who underwent specimen extraction via a prophylactic ileostomy procedure (experimental group), and 176 patients who underwent specimen extraction via a small lower abdominal incision (control group). Clinical data were collected from both groups and statistically analyzed.
RESULTS The two groups were matched in clinical characteristics and pathological outcomes. However, mean operative time was significantly shorter in the experimental group compared to the control group (161.3 ± 21.5 min vs 168.8 ± 20.5 min; P = 0.001). Mean estimated blood loss was significantly less in the experimental group (77.4 ± 30.7 mL vs 85.9 ± 35.5 mL; P = 0.020). The pain reported by patients during the first two days after surgery was significantly less in the experimental group than in the control group. No wound infections occurred in the experimental group, but 4.0% of the controls developed wound infections (P = 0.016). The estimated 5-year disease-free survival and overall survival rate were similar between the two groups.
CONCLUSION Surgical specimen extraction via a prophylactic ileostomy procedure represents a secure and feasible approach to laparoscopic rectal cancer surgery, and embodies the principle of minimally invasive surgery.
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Affiliation(s)
- Peng Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jian-Wei Liang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hai-Tao Zhou
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zheng Wang
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhi-Xiang Zhou
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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