Assessment of a support garment in parastomal bulging from a patient perspective: a qualitative study

Nursing Interventions for the Management of a Stoma Complicated by a Parastomal Hernia or Bulge: A Scoping Review

BACKGROUND

Parastomal hernia or bulging is a long-recognised complication in relation to a stoma. Around half of patients develop a parastomal bulge and up to 75% experience symptoms. Only a minority is offered surgical treatment; thus, most patients manage the bulge on their own or by interventions provided by stoma care nurses.

AIMS AND OBJECTIVES

To identify and present the available information on nursing interventions for the management of symptoms caused by the parastomal bulge.

METHODS

This scoping review followed the framework by the Joanna Briggs Institute, conducting searches in 11 databases and through stoma organisations. Literature on nursing management of parastomal bulges was included. Two authors independently screened and selected the studies, with data-charting performed by one author and verified by another. The PAGER framework depicted the state of the evidence and the PRISMA-ScR checklist guided the process.

RESULTS

Of 8361 screened publications, 44 were included. Management of the parastomal bulge and related symptoms were described in eight nursing interventions: appliances, support garments, irrigation and regulation of stool, strangulation, disguise and intimacy, physical activity, support and education, record keeping, follow-up and referral. Most evidence was based on expert opinion with only ⅓ of papers using study designs, such as cross-sectional, qualitative, review, before and after study, Delphi and RCT.

CONCLUSION

This scoping review highlights the complexity of providing nursing interventions for parastomal bulging. It shows that one intervention can manage multiple symptoms and potentially several symptoms simultaneously, whereas several interventions may be needed to address a single symptom. Therefore, decisions on interventions must be based on the underlying cause of the problem. Due to the limited number of studies on the effects of nursing interventions, more rigorous research is needed in the future.

RELEVANCE TO CLINICAL PRACTICE

The results can be used as an inspirational guide for clinical practice.

Return to Physical Activity in Individuals with Surgical Stomas: A Scoping Review

In surgically treated individuals with surgical stomas, the return to physical activity is an indicator of quality of life that reflects their well-being. With the aim of synthesizing the available evidence regarding the return to physical activity in individuals with surgical stomas, a scoping review was developed following the methodological approach of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews criteria. Searches were conducted in Medline (PubMed), Scopus, Web of Science, Cinahl, and Lilacs, as well as the meta-search engines TripDatabase and Epistemonikos, using MeSH terms. Included studies were written in Spanish, English, Portuguese, and German, without any limitation on the year of publication. A total of n = 15 studies was included (n = 2 qualitative; n = 2 case reports; n = 1 case series; n = 1 cohort; n = 8 cross-sectional; and n = 1 randomized clinical trial), which showed variability in the quality of the designs. The qualitative studies explored themes such as motivation, beliefs about physical activity, and other lifestyle factors. The case reports described physiological, psychological, and functional implications of returning to physical activity for specific individuals after ostomy surgery. Quantitative studies evaluated the effects of different types of physical activity on quality of life and tolerance to physical activity in these individuals, employing various measurement instruments. In conclusion, the evidence on returning to sports and physical activity after stoma surgery is limited and varied. While studies highlight the importance of social support and self-confidence, they generally lack rigor and primarily focus on adults and oncology patients. There is a need for more research to establish clear guidelines on physical activity type, frequency, and intensity to ensure safe and beneficial outcomes for individuals with stomas.

Proof of concept of an experimental prototype for the prevention of parastomal hernia

PURPOSE

The aim of this study was to analyse the complications and problems associated with the use of an experimental prototype designed for the prevention of parastomal hernia (PSH), one of the most frequent complications in ostomates.

METHODS

A single-centre, non-comparative, proof-of-concept interventional pilot study of an experimental prototype designed to be used in conjunction with an abdominal compression binder to prevent PSH was conducted. The "Ostomy Fixation Device for Hernia Prevention" (patent P201531826) is a semi-rigid ostomy protector, to be used in conjunction with a compression binder. It is designed to adapt to the dimensions of standard ostomy bags from different brands and serves to transmit, in a localised manner, the support coming from the compression binder in the peristomal area without putting pressure on the collection bag. The main outcome measures were efficacy, safety, and patient-users' opinion/perception.

RESULTS

Ten patients were studied for 12 months. Mean age was 61 years (± 11.59), 70% (7) were male, 80% (8) ostomised for colorectal cancer, 90% (9) underwent planned surgery and 80% (8) had a colostomy.

EFFICACY

the incidence of HPE was 10% (1).

SAFETY

no participant experienced pain, discomfort, itching, stinging, leakage, pouch detachment, allergy to components, or injury to the stoma or peristomal skin due to rubbing or pressure. 90% (n = 9) were considered "very satisfied" or "satisfied" with the device.

CONCLUSIONS

An innovative device designed in collaboration between healthcare professionals and end-users has been shown to be safe and effective in reducing PSH in the group of ostomates studied.

Assessment of the quality of online patient information resources for patients considering parastomal hernia treatment

AIM

The aim was to examine the quality of online patient information resources for patients considering parastomal hernia treatment.

METHODS

A Google search was conducted using lay search terms for patient facing sources on parastomal hernia. The quality of the content was assessed using the validated DISCERN instrument. Readability of written content was established using the Flesch-Kincaid score. Sources were also assessed against the essential content and process standards from the National Institute for Health and Care Excellence (NICE) framework for shared decision making support tools. Content analysis was also undertaken to explore what the sources covered and to identify any commonalities across the content.

RESULTS

Fourteen sources were identified and assessed using the identified tools. The mean Flesch-Kincaid reading ease score was 43.61, suggesting that the information was difficult to read. The overall quality of the identified sources was low based on the pooled analysis of the DISCERN and Flesch-Kincaid scores, and when assessed against the criteria in the NICE standards framework for shared decision making tools. Content analysis identified eight categories encompassing 59 codes, which highlighted considerable variation between sources.

CONCLUSIONS

The current information available to patients considering parastomal hernia treatment is of low quality and often does not contain enough information on treatment options for patients to be able to make an informed decision about the best treatment for them. There is a need for high-quality information, ideally co-produced with patients, to provide patients with the necessary information to allow them to make informed decisions about their treatment options when faced with a symptomatic parastomal hernia.

Outcomes of parastomal hernia repair after national centralization

BACKGROUND

In 2010, it was decided to centralize parastomal hernia repairs to five specialized hernia centres in Denmark to improve outcomes. The aim of this nationwide cohort study was to evaluate whether centralization of parastomal hernia repairs has had an impact on outcomes. Specifically, readmission, reoperation for complication, and operation for recurrence were analysed before and after centralization.

METHODS

By merging clinical and administrative outcome data from the Danish Hernia Database with those from the Danish National Patient Registry, all patients undergoing parastomal hernia repair in Denmark from 1 January 2007 to 31 December 2018 were included. Centralization was defined as having at least 70 per cent of procedures were performed at one of the five national centres. Readmission, reoperation, and recurrence rates for emergency and elective repairs were evaluated before and after centralization.

RESULTS

In total, 1062 patients were included. Median follow-up was 992 days. Overall, the centralization process took 7 years. For elective repairs, the readmission, reoperation, mortality, and recurrence rates were comparable before and after centralization, but more patients overall and more patients with co-morbidity were offered surgery after centralization. For emergency repairs, there was a significant reduction in rates of reoperation (from 44.9 per cent (48 of 107) to 23 per cent (14 of 62); P = 0.004) and mortality (from 10.3 per cent (11 of 107) to 2 per cent (1 of 62); P = 0.034) after centralization.

CONCLUSION

Centralization led to more elective operations and better outcomes when emergency repair was needed. Centralization of parastomal hernia repair led to more patients receiving elective repair and significantly improved outcomes after emergency repair.