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Merritt C, Maldonado P. Management of the Difficult Stoma. Surg Clin North Am 2024; 104:579-593. [PMID: 38677822 DOI: 10.1016/j.suc.2023.11.008] [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] [Indexed: 04/29/2024]
Abstract
Fecal ostomy creation is a commonly performed procedure with many indications. Better outcomes occur when preoperative patient education and stoma site marking are provided. Despite a seemingly simple operation, ostomy creation is often difficult and complications are common. Certain risk factors, particularly obesity, are strongly associated with stoma-related complications. The ability to optimize the ostomy and stoma in the operating room and to troubleshoot frequently encountered post-operative stoma-related issues are critical skills for surgeons and ostomy nurses alike.
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Affiliation(s)
- Clay Merritt
- Department of Colon and Rectal Surgery, Alexander T. Augusta Military Medical Center, 9300 DeWitt Loop, Sunrise Pavilion, 2nd Floor, General Surgery Reception Desk, Fort Belvoir, VA 22060, USA.
| | - Paola Maldonado
- Wound Care Clinic, Alexander T. Augusta Military Medical Center, 9300 DeWitt Loop, Sunrise Pavilion, 2nd Floor, General Surgery Reception Desk, Fort Belvoir, VA 22060, USA
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Guler S, Eyuboglu G, Baykara ZG, Hin AO, Akdemir H, Akar E, Leventoglu S, Yuksel O. The Effect of Stoma Site Marking on Stomal Complications: A Long-term Retrospective Study. Adv Skin Wound Care 2024; 37:254-259. [PMID: 38648238 DOI: 10.1097/asw.0000000000000134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To identify the effect of stoma site marking on stoma-related complications. METHODS The study sample included 639 individuals with stomas who were followed up in a stomatherapy unit in Turkey between January 1, 2017, and June 20, 2021. Researchers collected patient data from nursing records. Data were evaluated using number, percentage, χ2, and logistic regression tests. RESULTS Of the individuals with stomas, 60.6% (n = 387) were men, and 72.6% (n = 464) had a cancer diagnosis. Their mean age was 60.16 (SD, 14.81) years. The stoma site was marked preoperatively in of 67.1% of patients (n = 429), and 17.1% (n = 109) developed stoma-related complications. The complication rate was higher in individuals with unmarked stoma sites (25.7%; P = .000), emergency surgeries (25.0%; P = .006), colostomies (23.9%; P = .042), and permanent stomas (28.3%; P = .002). The three most common complications were peristomal skin problems (56.9%), mucocutaneous separation (13.8%), and edema (9.2%). CONCLUSIONS The incidence of stoma-related complications in the postoperative period was higher in individuals with unmarked stoma sites. The authors recommend that stoma and wound care nurses mark the stoma site in individuals for whom stoma creation is planned.
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Affiliation(s)
- Sevil Guler
- Sevil Guler, PhD, RN, is Professor, Faculty of Nursing, Department of Surgical Nursing, Gazi University, Ankara, Turkey. Gulcan Eyuboglu, PhD, RN, is Research Assistant, Erbaa Faculty of Health Science, Department of Nursing, Fundamentals of Nursing, Gaziosmanpasa University, Tokat, Turkey. Also at Gazi University, Faculty of Nursing, Department of Fundamentals of Nursing, Zehra Gocmen Baykara, PhD, RN, is Professor. At Gazi University Health Research and Application Center Hospital, Stomatherapy Unit, Aysel Oren Hin, RN; Hülya Akdemir, RN; and Emine Akar, RN, are Stoma and Wound Care Nurses. Also at Gazi University, Sezai Leventoglu, MD, and Osman Yuksel, MD, are Professors, Faculty of Medicine, Department of General Surgery. The authors have disclosed no financial relationships related to this article. Submitted January 5, 2023; accepted in revised form March 14, 2023
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Siemund I, Dahlin J, Mowitz M, Hamnerius N, Svedman C. Allergic contact dermatitis due to 1,6-hexanediol diacrylate in ostomy patients. Contact Dermatitis 2024; 90:501-506. [PMID: 38332444 DOI: 10.1111/cod.14516] [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: 09/20/2023] [Revised: 12/13/2023] [Accepted: 01/26/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Many people live with ostomies after life-saving surgery. Ostomy patients often suffer from peristomal dermatitis. Allergic contact dermatitis (ACD) has been reported, mostly due to contact allergy (CA) to topical agents. OBJECTIVES We present three patients with therapy resistant peristomal dermatitis, suggesting ACD caused by different stoma products. METHODS Patch testing was performed with baseline series, additional series, and selected allergens. They were also tested with their own ostomy products as is and separate extracts of the products. Extracts were analysed using Gas Chromatography-Mass Spectrometry (GC-MS). RESULTS In all three patients we diagnosed CA to 1,6-hexanediol diacrylate (HDDA), +++ in case (C) 1 and 3, ++ in C 2. HDDA was detected in C 2's ostomy pouch adhesive and in C 1's and 3's flange extenders used to improve the adhesion of the ostomy pouches. CONCLUSION Therapy resistant peristomal dermatitis should always be suspected of ACD and patch testing, especially with the patient's own products, should be performed.
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Affiliation(s)
- Ingrid Siemund
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jakob Dahlin
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Nils Hamnerius
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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MacDonald S, Wong LS, Ng HJ, Hastings C, Ross I, Quasim T, Moug S. Postoperative outcomes and identification of risk factors for complications after emergency intestinal stoma surgery - a multicentre retrospective study. Colorectal Dis 2024; 26:994-1003. [PMID: 38499914 DOI: 10.1111/codi.16947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/29/2023] [Accepted: 02/20/2024] [Indexed: 03/20/2024]
Abstract
AIM Approximately 4000 patients in the UK have an emergency intestinal stoma formed each year. Stoma-related complications (SRCs) are heterogeneous but have previously been subcategorized into early or late SRCs, with early SRCs generally occurring within 30 days postoperatively. Early SRCs include skin excoriation, stoma necrosis and high output, while late SRCs include parastomal hernia, retraction and prolapse. There is a paucity of research on specific risk factors within the emergency cohort for development of SRCs. This paper aims to describe the incidence of SRCs after emergency intestinal surgery and to identify potential risk factors for SRCs within this cohort. METHOD Consecutive patients undergoing emergency formation of an intestinal stoma (colostomy, ileostomy or jejunostomy) were identified prospectively from across three acute hospital sites over a 3-year period from the ELLSA (Emergency Laparotomy and Laparoscopic Scottish Audit) database. All patients were followed up for a minimum of 1 year. A multivariate logistic regression model was used to identify risk factors for early and late SRCs. RESULTS A total of 455 patients were included (median follow-up 19 months, median age 64 years, male:female 0.52, 56.7% ileostomies). Early SRCs were experienced by 54.1% of patients, while 51% experienced late SRCs. A total of 219 patients (48.1%) had their stoma sited preoperatively. Risk factors for early SRCs included end ileostomy formation [OR 3.51 (2.24-5.49), p < 0.001], while preoperative stoma siting was found to be protective [OR 0.53 (0.35-0.83), p = 0.005]. Patient obesity [OR 3.11 (1.92-5.03), p < 0.001] and reoperation for complications following elective surgery [OR 4.18 (2.01-8.69), p < 0.001] were risk factors for late SRCs. CONCLUSION Stoma-related complications after emergency surgery are common. Preoperative stoma siting is the only truly modifiable risk factor to reduce SRCs, and further research should be aimed at methods of improving the frequency and accuracy of this in the emergency setting.
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Affiliation(s)
- Scott MacDonald
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Li-Siang Wong
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Hwei Jene Ng
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Claire Hastings
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Immogen Ross
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Tara Quasim
- Department of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Susan Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
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Verma A, Kothari R, Mishra A, Agrawal P, Sharma D. Defunctioning ileostomy for typhoid ileal perforations: Out of the frying pan into the fire? Trop Doct 2024:494755241241830. [PMID: 38562099 DOI: 10.1177/00494755241241830] [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: 04/04/2024]
Abstract
Typhoid ileal perforation (TIP) is a common surgical emergency in low-middle income countries (LMICs). Its high surgical morbidity and mortality is due to its often late presentation or diagnosis, the patient's malnutrition, severe peritoneal contamination and unavailability of intensive care in most peripheral hospitals. This prompted the philosophy of minimizing the crisis by avoiding any repair or anastomosis, limiting the surgery in these physiologically compromised patients and performing only a temporary defunctioning ileostomy (DI) which could then be closed 10-12 weeks later.
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Affiliation(s)
- Amrendra Verma
- Assistant Professor, Department of Emergency Medicine, Government NSCB Medical College, Jabalpur, MP, India
| | - Reena Kothari
- Professor, Department of General Surgery, Government NSCB Medical College, Jabalpur, MP, India
| | - Arpan Mishra
- Associate Professor, Department of General Surgery, Government NSCB Medical College, Jabalpur, MP, India
| | - Pawan Agrawal
- Professor, Department of General Surgery, Government NSCB Medical College, Jabalpur, MP, India
| | - Dhananjaya Sharma
- Professor, Department of General Surgery, Government NSCB Medical College, Jabalpur, MP, India
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Ochoa B, McMahon L. Surgery for ulcerative colitis. Semin Pediatr Surg 2024; 33:151404. [PMID: 38615424 DOI: 10.1016/j.sempedsurg.2024.151404] [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] [Indexed: 04/16/2024]
Abstract
Ulcerative colitis (UC) has a more severe presentation and rapid progression in pediatric patients, resulting in a greater need for surgical intervention compared to adults. Though medical management of UC has advanced with new biologic therapies, surgery continues to play an important role when disease progresses in the form of worsened or persistent symptoms, hemodynamic instability, or sepsis. The goals of surgical management are to restore intestinal continuity with a functional pouch when possible. While the literature has been growing regarding studies of pediatric patients with UC, high level of evidence studies are limited and most recommendations are based on adult studies. Similar to adults, pediatric patients who have ileal pouches created require surveillance for recurrent disease and cancer surveillance. Unique issues for pediatric patients include monitoring of growth and appropriate transition to adult care after adolescence. This review includes indications for surgical management, overview of staged surgical approaches, and the technical details of the three-stage approach.
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Affiliation(s)
- Brielle Ochoa
- Division of Pediatric Surgery, Department of Surgery, Phoenix Children's, Phoenix, Arizona, USA
| | - Lisa McMahon
- Division of Pediatric Surgery, Department of Surgery, Phoenix Children's, Phoenix, Arizona, USA.
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Aubert M, Buscail E, Duchalais E, Cazelles A, Collard M, Charleux-Muller D, Jeune F, Nuzzo A, Pellegrin A, Theuil L, Toutain A, Trilling B, Siproudhis L, Meurette G, Lefevre JH, Maggiori L, Mege D. Management of adult intestinal stomas: The 2023 French guidelines. J Visc Surg 2024; 161:106-128. [PMID: 38448363 DOI: 10.1016/j.jviscsurg.2024.02.002] [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] [Indexed: 03/08/2024]
Abstract
AIM Digestive stoma are frequently performed. The last French guidelines have been published twenty years ago. Our aim was to update French clinical practice guidelines for the perioperative management of digestive stoma and stoma-related complications. METHODS A systematic literature review of French and English articles published between January 2000 and May 2022 was performed. Only digestive stoma for fecal evacuation in adults were considered. Stoma in children, urinary stoma, digestive stoma for enteral nutrition, and rare stoma (Koch, perineal) were not included. RESULTS Guidelines include the surgical landmarks to create digestive stoma (ideal location, mucocutaneous anastomosis, utility of support rods, use of prophylactic mesh), the perioperative clinical practice guidelines (patient education, preoperative ostomy site marking, postoperative equipment, prescriptions, and follow-up), the management of early stoma-related complications (difficulties for nursing, high output, stoma necrosis, retraction, abscess and peristomal skin complications), and the management of late stoma-related complications (stoma prolapse, parastomal hernia, stoma stenosis, late stoma retraction). A level of evidence was assigned to each statement. CONCLUSION These guidelines will be very useful in clinical practice, and allow to delete some outdated dogma.
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Affiliation(s)
- Mathilde Aubert
- Department of Digestive Surgery, hôpital Timone, Aix Marseille University, AP-HM, Marseille, France
| | - Etienne Buscail
- Digestive Surgery Department, hôpital Rangueil, Toulouse, France
| | | | - Antoine Cazelles
- Digestive Surgery Department, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - Maxime Collard
- Digestive Surgery Department, hôpital Saint-Antoine, AP-HP, Sorbonne université, 75012, Paris, France
| | | | - Florence Jeune
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | - Alexandre Nuzzo
- Digestive Surgery Department, hôpital Beaujon, AP-HP, Paris, France
| | | | | | - Amandine Toutain
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | | | | | | | - Jérémie H Lefevre
- Digestive Surgery Department, hôpital Saint-Antoine, AP-HP, Sorbonne université, 75012, Paris, France
| | - Léon Maggiori
- Digestive Surgery Department, hôpital Saint-Louis, AP-HP, Paris, France
| | - Diane Mege
- Department of Digestive Surgery, hôpital Timone, Aix Marseille University, AP-HM, Marseille, France.
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Lin H, Lin R, Yan M, Lin L, Sun X, Wu M, Dai X, Lin N. Associations between preparedness, perceived stress, depression, and quality of life in family caregivers of patients with a temporary enterostomy. Eur J Oncol Nurs 2024; 70:102557. [PMID: 38581900 DOI: 10.1016/j.ejon.2024.102557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/19/2024] [Accepted: 03/10/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE To investigate the preparedness, perceived stress, risk of depression, and quality of life of family caregivers of patients receiving a temporary enterostomy, to provide a reference for improving the long-term care and quality of life of patients receiving a temporary enterostomy. METHODS We enrolled 181 family caregivers of patients in a hospital in China from 2021 to 2023. Responses to the General Information Questionnaire, the Chinese Caregiver Preparedness Scale, the Chinese Perceived Stress Scale, the Chinese bilingual version of the Patient Health Questionnaire-2, and the 12-item Short Form Survey were collected online. RESULTS Pearson's correlation analysis revealed that family caregivers' risk of depression was negatively correlated with their preparedness, the physical component summary score, and the mental component summary score but was positively correlated with perceived stress. Multiple linear regression analysis identified factors influencing caregiver preparedness. CONCLUSIONS These findings help healthcare personnel to identify high-risk individuals among family caregivers of patients receiving a temporary enterostomy. This provides a basis for formulating well-planned, dynamic health education programs that meet patients' needs for disease-related knowledge and care.
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Affiliation(s)
- Huayan Lin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China; Department of Gastrointestinal Surgery, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Rongjin Lin
- Department of Nursing, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China; Department of Nursing, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Mengting Yan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China; Department of Gastrointestinal Surgery, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Liying Lin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China; Department of Gastrointestinal Surgery, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Xinyue Sun
- Department of Nursing, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China; Department of Nursing, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Mengting Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China; Department of Gastrointestinal Surgery, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaofeng Dai
- Department of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China; Department of Neurology, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Na Lin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China; Department of Gastrointestinal Surgery, National Regional Medical Center, Binhai Campus of The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China.
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Li SQ, Luo CL, Qiu H, Liu YX, Chen JM. Effect of Orem's self-care model on discharge readiness of patients undergoing enterostomy: A randomized controlled trial. Eur J Oncol Nurs 2024; 70:102549. [PMID: 38692158 DOI: 10.1016/j.ejon.2024.102549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/18/2024] [Accepted: 03/03/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of Orem's self-care model in preparing hospitals for the discharge of patients with colorectal cancer who undergo enterostomy. METHODS 92 patients with enterostomy were recruited between February 2022 and February 2023 from a general tertiary hospital. The participants were assigned to either the intervention group or the control group randomly. The intervention group received Orem's self-care program and a three-month follow-up, whereas the control group received only routine care and a three-month follow-up. Discharge readiness, self-care ability, and stoma-quality-of-life data were collected at hospital discharge (T1), 30 days (T2), and 90 days (T3) after discharge. RESULTS The intervention group had substantially higher discharge readiness (knowledge, p < 0.001; coping ability, p = 0.006; personal status, p = 0.001; expected support, p = 0.021; total score, p < 0.001), better self-care ability at T1 (self-care knowledge, p < 0.001; self-care skills, p = 0.010), better total quality of life (QoL) at T1, T2, and T3 (p < 0.001; p = 0.006; p = 0.014); better stoma management and daily routine at T1 (p = 0.004; p < 0.001); and better daily routine at T2 (p = 0.009) than the control group. CONCLUSIONS The designed discharge readiness program based on Orem's self-care could promote effective patient discharge readiness, self-care knowledge, self-care skills, and QoL. TRIAL REGISTRATION The trial number ChiCTR2200056302 registered on ClinicalTrials.gov.
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Affiliation(s)
- Si-Qing Li
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Cui-Lian Luo
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Hong Qiu
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Yu-Xia Liu
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Jian-Min Chen
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
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The PROPHER study: patient-reported outcomes after parastomal hernia treatment-a prospective international cohort study. Colorectal Dis 2024; 26:554-563. [PMID: 38296915 DOI: 10.1111/codi.16859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/01/2024] [Indexed: 02/02/2024]
Abstract
AIM A significant proportion of stoma patients develop a parastomal hernia (PSH), with reported rates varying widely from 5% to 50% due to heterogeneity in the definition and mode of diagnosis. PSHs are symptomatic in 75% of these patients, causing a significant impact on quality of life due to issues with appliance fitting, leakage, skin excoriation and pain. They can also lead to emergency presentations with strangulation and obstruction. Evidence is lacking on how to select patients for surgical intervention or conservative treatment. In those who do undergo surgery, the best operation for a particular patient or PSH is not always clear and many options exist. The aim of this study is to assess the impact of an individual patient's PSH treatment on their subsequent self-reported outcomes including treatment success and quality of life. METHODS This is a prospective international cohort study of PSH treatment, including both operative and non-operative interventions. A global network of clinicians and specialist nurses will recruit 1000-1500 patients and centralize detailed information, their individual background and their PSH treatment, as well as short-term outcomes up to 30 days. Patients will then provide their own outcomes data including quality of life and whether their treatment was successful, via a secure online system, at 3, 6 and 12 months. PROPHER will be run in two phases: an internal pilot phase of at least 10 hospitals from up to five countries, and a main phase of up to 200 hospitals from across the European Society of Coloproctology network. DISCUSSION This study will provide a wealth of contemporaneous information which will improve our ability to counsel patients and facilitate improved selection of appropriate and personalized interventions for those with a PSH.
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Qing X, Jiang J, Yuan C, Wang K. Mendelian randomization analysis identifies a genetic casual association between circulating C-reactive protein and intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2024; 33:107554. [PMID: 38176227 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107554] [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: 05/24/2023] [Revised: 12/21/2023] [Accepted: 12/30/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The causal effect of C-reactive protein (CRP) on intracerebral hemorrhage (ICH) remains controversial. We discussed the causal association of CRP with ICH based on two-sample Mendelian randomization. METHODS The data from two genome-wide association studies (GWAS) of European ancestry was extracted, including circulating CRP levels (204,402 individuals) and ICH (1,687 cases and 201,146 controls). The inverse variance weighted (IVW) method was primary tool to evaluate the causal relationship of circulating CRP levels on ICH risk. MR-Egger regression and MR-PRESSO global test were utilized to identify pleiotropy. Heterogeneity was discussed with Cochran's Q test. The leave-one-out analysis explored the reliability of the results. RESULTS 54 SNPs were identified as instrumental variables (IVs) for circulating CRP levels, and these IVs had no significant horizontal pleiotropy, heterogeneity, or bias. MR analysis demonstrated a causal relationship between elevated circulating CRP levels and decreased risk of ICH (ORIVW = 0.828, 95% CI 0.692-0.992, P = 0.040). CONCLUSION Elevated circulating CRP levels demonstrated a significant potentially protective causal relationship with risk of ICH.
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Affiliation(s)
- Xin Qing
- Clinical Laboratory, Boai Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan, PR China; West China Hospital, Sichuan University, Chengdu, PR China
| | - Junyi Jiang
- Clinical Laboratory, Boai Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan, PR China
| | - Chunlei Yuan
- Clinical Laboratory, Boai Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan, PR China
| | - Ke Wang
- Clinical Laboratory, Boai Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan, PR China.
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Zhang X, Li X, Cheng Z, Wang K, Dai Y, Wang Y. Modified Approach for Extraperitoneal Colostomy Creation in Laparoscopic Abdominoperineal Resection. Dis Colon Rectum 2024; 67:333-338. [PMID: 37962124 DOI: 10.1097/dcr.0000000000003049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND Parastomal hernia is a major long-term complication after abdominoperineal resection. Extraperitoneal colostomy has been proposed as an effective step for parastomal hernia prevention, but it has not been widely used as it is technically demanding and time-consuming. We proposed a modified approach for extraperitoneal colostomy creation by entering the extraperitoneal space through the arcuate line of the posterior rectus sheath. OBJECTIVE To evaluate the safety, difficulty, and efficacy of long-term parastomal hernia prevention of the modified approach for extraperitoneal colostomy creation compared with the conventional transperitoneal colostomy approach. DESIGN This was a retrospective evaluation of a surgical and video database. SETTINGS This was a single-institution retrospective study. PATIENTS Clinical data of 74 patients who underwent laparoscopic abdominoperineal resection surgery from January 2019 to January 2020 in the Department of General Surgery, Qilu Hospital of Shandong University, were retrospectively reviewed. MAIN OUTCOME MEASURES Baseline characteristics, time required for colostomy creation (from skin incision to colostomy maturation), perioperative complications, and long-term colostomy-related complications were compared. RESULTS Baseline characteristics did not differ between the 2 approaches. The BMI level ranged from 19.5 to 29.4 for patients undergoing extraperitoneal approach. Time required for colostomy creation median [interquartile range], (22 [21-25] minutes for extraperitoneal vs 23 [21-25] minutes for transperitoneal, p = 0.861) were comparable between the 2 approaches. The cumulative incidence of parastomal hernia was significantly greater with transperitoneal colostomy than extraperitoneal colostomy at 2 and 3 years postoperatively (16.2% vs 0%, p = 0.025, and 21.6% vs 0%, p = 0.005). The remaining perioperative complications and long-term colostomy-related complications did not differ between the 2 approaches. LIMITATIONS This study is limited by its retrospective design and small sample size. CONCLUSIONS The modified approach for extraperitoneal colostomy creation is safe, technically simple, and effective for long-term parastomal hernia prevention in patients with a BMI of 19.5 to 29.4.
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Affiliation(s)
- Xiang Zhang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Xin Li
- Department of General Surgery, Huantai Branch of Qilu Hospital of Shandong University, Zibo, Shandong, China
| | - Zhiqiang Cheng
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Kexin Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yong Dai
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yanlei Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Skovsen AP, Korgaard Jensen T, Gögenur I, Tolstrup MB. Small bowel anastomosis in emergency surgery. World J Surg 2024; 48:341-349. [PMID: 38686800 DOI: 10.1002/wjs.12059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/01/2023] [Indexed: 05/02/2024]
Abstract
BACKGROUND Emergency laparotomy is associated with a high morbidity and mortality rate. The decision on whether to perform an anastomosis or an enterostomy in emergency small bowel resection is guided by surgeon preference alone, and not evidence based. We examined the risks involved in small bowel resection and anastomosis in emergency surgery. METHODS A retrospective study from 2016 to 2019 in a university hospital in Denmark, including all emergency laparotomies, where small-bowel resections, ileocecal resections, right hemicolectomies and extended right hemicolectomies where performed. Demographics, operative data, anastomosis or enterostomy, as well as postoperative complications were recorded. Primary outcome was the rate of bowel anastomosis. Secondary outcomes were the anastomotic leak rate, mortality and complication rates. RESULTS During the 3.5-year period, 370 patients underwent emergency bowel resection. Of these 313 (84.6%) received an anastomosis and 57 (15.4%) an enterostomy. The 30-day mortality rate was 12.7% (10.2% in patients with anastomosis and 26.3% in patients with enterostomy). The overall anastomotic leak rate was 1.6%, for small-bowel to colon 3.0% and for small-bowel to small-bowel 0.6%. CONCLUSION A primary anastomosis is performed in more than eight out of 10 patients in emergency small bowel resections and is associated with a very low rate of anastomotic leak.
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Affiliation(s)
- Anders Peter Skovsen
- Surgical Department, Hillerød Hospital, University of Copenhagen, Hillerød, Denmark
| | | | - Ismail Gögenur
- Surgical Department, Zealand University Hospital, University of Copenhagen, Køge, Denmark
- Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark
| | - Mai-Britt Tolstrup
- Surgical Department, Hillerød Hospital, University of Copenhagen, Hillerød, Denmark
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Geropoulos G, Psarras K, Papaioannou M, Geropoulos V, Niti A, Nikolaidou C, Koimtzis G, Symeonidis N, Pavlidis ET, Koliakos G, Pavlidis TE, Galanis I. The Effectiveness of Adipose Tissue-Derived Mesenchymal Stem Cells Mixed with Platelet-Rich Plasma in the Healing of Inflammatory Bowel Anastomoses: A Pre-Clinical Study in Rats. J Pers Med 2024; 14:121. [PMID: 38276243 PMCID: PMC10817310 DOI: 10.3390/jpm14010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction: Multiple factors have been linked with increased risk of anastomotic leak in bowel surgery, including infections, inflammatory bowel disease, patient comorbidities and poor surgical technique. The aim of this study was to investigate the positive effect, if any, of adipose derived mesenchymal stem cells (MSCs) mixed with platelet-rich plasma (PRP) in the healing of bowel anastomoses, in an inflammatory environment after establishment of experimental colitis. Materials and Methods: Thirty-five male Wistar rats were divided into five groups of seven animals: normal controls, colitis controls, PRP, MSCs, and PRP+MSCs. All groups underwent laparotomy, one-cm segmental colectomy and anastomosis in situ. In the colitis group, colectomy was performed at the affected area. Colitis was previously established by transrectal administration of 2,4,6-trinitrobenzene sulfonic acid (TNBS) except for the normal controls. Post-mortem histopathological, tissue hydroxyproline and anastomotic bursting pressure (ABP) assessments were performed. The Mann-Whitney U test was used to assess statistical significance differences between groups. Results: No perioperative mortality was noted. Tissue hydroxyproline and ABP were significantly increased in the group of PRP+MSCs compared to colitis controls (p = 0.0151 and p = 0.0104, respectively). Inflammatory cell infiltration was lower and fibroblast activity higher in PRP+MSCs group, but not statistically significant (p > 0.05). Neoangiogenesis (p = 0.0073) and anastomotic area epithelialization (p = 0.0182) were significantly higher in PRP + MSCs group compared to colitis controls. Discussion: The synergistic effect of the PRP and MSCs is apparently responsible for the improved healing markers in bowel anastomoses even on inflammatory bowel. This gives hope for primary anastomoses and stoma saving in many emergency and/or elective circumstances, especially in immunocompromised or malnourished patients, even in cases with inflammation or peritonitis. Clinical studies should follow in order to support the clinical application of PRP+MSCs in gastrointestinal anastomoses.
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Affiliation(s)
- Georgios Geropoulos
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
| | - Kyriakos Psarras
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
| | - Maria Papaioannou
- Laboratory of Biological Chemistry, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Vasileios Geropoulos
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
| | - Argyri Niti
- Biohellenika Biotechnology Company, 55535 Thessaloniki, Greece; (A.N.)
| | - Christina Nikolaidou
- Department of Histopathology, Hippokration Hospital, 54642 Thessaloniki, Greece;
| | - Georgios Koimtzis
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
| | - Nikolaos Symeonidis
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
| | - Efstathios T. Pavlidis
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
| | - Georgios Koliakos
- Biohellenika Biotechnology Company, 55535 Thessaloniki, Greece; (A.N.)
| | - Theodoros E. Pavlidis
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
| | - Ioannis Galanis
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
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Abe K, Yamai D, Katsumi C, Oyamatsu M, Sato K. Incarcerated Small Bowel Herniation in a Stoma Mimicking Sigmoid End Colostomy Prolapse. Case Rep Gastroenterol 2024; 18:21-27. [PMID: 38249996 PMCID: PMC10798682 DOI: 10.1159/000535988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction A stoma prolapse is easy to diagnose by visual examination, and it rarely incarcerates. Therefore, manual reduction is usually performed as soon as the diagnosis is made. In this report, we describe a case of stoma prolapse that could not be reduced manually and ruptured because an incarcerated parastomal hernia occurred in the stoma, mimicking stoma prolapse. Case Presentation A 66-year-old woman underwent total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, omentectomy, resection of dissemination, and low anterior resection with formation of a sigmoid end colostomy for endometrial cancer with infiltration of the rectum. Fourteen months after the initial operation, she presented with stoma prolapse and multiple episodes of vomiting. The prolapsed stoma was 20 cm in length, appeared swollen and edematous, and was somewhat firm. Although it looked viable, some of the mucosa was darkish red, indicating congestion. Therefore, the diagnosis was sigmoid end colostomy prolapse with an ischemic component. An attempt at manual reduction resulted in rupture, so an emergency laparotomy was performed. Intraoperatively, we found that the ileum was incarcerated in the aperture created where the colostomy had been formed. When the incarcerated ileum was released, the stoma prolapse could be reduced easily. The end colostomy was refashioned in the left upper quadrant of the abdomen. Conclusion An incarcerated parastomal hernia can mimic stoma prolapse. If the findings differ from those of typical stoma prolapse, imaging should be performed to confirm whether another clinical entity is involved in the stoma prolapse.
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Affiliation(s)
- Kaoru Abe
- Division of Surgery, Sado General Hospital, Sado, Japan
| | - Daisuke Yamai
- Division of Surgery, Sado General Hospital, Sado, Japan
| | | | | | - Kenji Sato
- Division of Surgery, Sado General Hospital, Sado, Japan
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Wei‐ying Z, Hui‐ren Z, Hai‐ping Y, Li‐li M. The effect of telemedicine on stoma-related complications in adults with enterostomy: A systematic review and meta-analysis. Int Wound J 2024; 21:e14572. [PMID: 38272790 PMCID: PMC10789586 DOI: 10.1111/iwj.14572] [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: 10/29/2023] [Accepted: 12/04/2023] [Indexed: 01/27/2024] Open
Abstract
To assess the effect of telemedicine on stoma-related complications in adults with enterostomy, we conducted a meta-analysis to evaluate the effects of the telemedicine group compared to the usual group. Literature searches were performed in PubMed, Embase, Web of Science, The Cochrane Library, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), WanFang and VIP databases from their inception up to October 2023. Two authors independently screened and extracted data from the included and excluded literature according to predetermined criteria. Data collected were subjected to meta-analysis using Review Manager 5.3 software. The final analysis included a total of 22 articles, encompassing 2237 patients (telemedicine group: 1125 patients, usual group: 1112 patients). The meta-analysis results demonstrated that, compared to the usual group, the telemedicine group significantly reduced the overall occurrence of stoma-related complications, with an odds ratio (OR) of 0.22 (95% CI = 0.15-0.32, p < 0.00001). Furthermore, it resulted in a decrease in stoma complications (OR = 0.27, 95% CI = 0.15-0.47, p < 0.00001) and peristomal complications (OR = 0.25, 95% CI = 0.19-0.34, p < 0.00001). Therefore, the existing evidence suggests that the application of telemedicine can reduce the incidence of stoma and peristomal complications, making it a valuable clinical recommendation.
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Affiliation(s)
- Zhang Wei‐ying
- Shanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Zhuang Hui‐ren
- Shanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Yu Hai‐ping
- Shanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Ma Li‐li
- Shanghai East HospitalTongji University School of MedicineShanghaiChina
- East Hosptial Affiliated toTongji UniversityShanghaiChina
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Burghgraef TA, Geitenbeek RTJ, Broekman M, Hol JC, Hompes R, Consten ECJ. Permanent stoma rate and long-term stoma complications in laparoscopic, robot-assisted, and transanal total mesorectal excisions: a retrospective cohort study. Surg Endosc 2024; 38:105-115. [PMID: 37932600 PMCID: PMC10776460 DOI: 10.1007/s00464-023-10517-9] [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: 06/26/2023] [Accepted: 10/08/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The surgical resection of rectal carcinoma is associated with a high risk of permanent stoma rate. Primary anastomosis rate is suggested to be higher in robot-assisted and transanal total mesorectal excision, but permanent stoma rate is unknown. METHODS Patients undergoing total mesorectal excision for MRI-defined rectal cancer between 2015 and 2017 in 11 centers highly experienced in laparoscopic, robot-assisted or transanal total mesorectal excision were included in this retrospective study. Permanent stoma rate, stoma-related complications, readmissions, and reoperations were registered. A multivariable regression analysis was performed for permanent stoma rate, stoma-related complications, and stoma-related reoperations. RESULTS In total, 1198 patients were included. Permanent stoma rate after low anterior resection (with anastomosis or with an end colostomy) was 40.1% in patients undergoing laparoscopic surgery, 21.3% in patients undergoing robot-assisted surgery, and 25.6% in patients undergoing transanal surgery (P < 0.001). Permanent stoma rate after low anterior resection with an anastomosis was 17.3%, 11.8%, and 15.1%, respectively. The robot-assisted and transanal techniques were independently associated with a reduction in permanent stoma rate in patients who underwent a low anterior resection (with anastomosis or with an end colostomy) (OR 0.39 [95% CI 0.25, 0.59] and OR 0.35 [95% CI 0.22, 0.55]), while this was not seen in patients who underwent a restorative low anterior resection. 45.4% of the patients who had a stoma experienced stoma-related complications, 4.0% were at least once readmitted, and 8.9% underwent at least one reoperation. CONCLUSIONS The robot-assisted and transanal techniques are associated with a lower permanent stoma rate in patients who underwent a low anterior resection.
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Affiliation(s)
- T A Burghgraef
- Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
- Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - R T J Geitenbeek
- Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
- Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - M Broekman
- Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - J C Hol
- Department of Surgery, Amsterdam UMC, VUmc, Amsterdam, The Netherlands
| | - R Hompes
- Department of Surgery, Amsterdam UMC, AMC, Amsterdam, The Netherlands
| | - E C J Consten
- Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands
- Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Hill SS, Ottaviano KE, Palange DC, Chismark AD, Valerian BT, Canete JJ, Lee EC. Impact of Preoperative Factors in Patients With IBD on Postoperative Length of Stay: A National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Analysis. Dis Colon Rectum 2024; 67:97-106. [PMID: 37410942 DOI: 10.1097/dcr.0000000000002831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Patients with IBD are challenging to manage perioperatively because of disease complexity and multiple comorbidities. OBJECTIVE To identify whether preoperative factors and operation type were associated with extended postoperative length of stay after IBD-related surgery, defined by 75th percentile or greater (n = 926; 30.8%). DESIGN This was a cross-sectional study based on a retrospective multicenter database. SETTING The National Surgery Quality Improvement Program-Inflammatory Bowel Disease Collaborative captured data from 15 high-volume sites. PATIENTS A total of 3008 patients with IBD (1710 with Crohn's disease and 1291 with ulcerative colitis) with a median postoperative length of stay of 4 days (interquartile range, 3-7) from March 2017 to February 2020. MAIN OUTCOME MEASURES The primary outcome was extended postoperative length of stay. RESULTS On multivariable logistic regression, increased odds of extended postoperative length of stay were associated with multiple demographic and clinical factors (model p < 0.001, area under receiver operating characteristic curve = 0.85). Clinically significant contributors that increased postoperative length of stay were rectal surgery (vs colon; OR, 2.13; 95% CI, 1.52-2.98), new ileostomy (vs no ileostomy; OR, 1.50; 95% CI, 1.15-1.97), preoperative hospitalization (OR, 13.45; 95% CI, 10.15-17.84), non-home discharge (OR, 4.78; 95% CI, 2.27-10.08), hypoalbuminemia (OR, 1.66; 95% CI, 1.27-2.18), and bleeding disorder (OR, 2.42; 95% CI, 1.22-4.82). LIMITATIONS Retrospective review of only high-volume centers. CONCLUSIONS Patients with IBD who were preoperatively hospitalized, who had non-home discharge, and who underwent rectal surgery had the highest odds of extended postoperative length of stay. Associated patient characteristics included bleeding disorder, hypoalbuminemia, and ASA classes 3 to 5. Chronic corticosteroid, immunologic, small molecule, and biologic agent use were insignificant on multivariable analysis. See Video Abstract. IMPACTO DE LOS FACTORES PREOPERATORIOS EN PACIENTES CON ENFERMEDAD INFLAMATORIA INTESTINAL EN LA DURACIN DE LA ESTANCIA POSTOPERATORIA UN ANLISIS COLABORATIVO DEL PROGRAMA NACIONAL DE MEJORA DE LA CALIDAD QUIRRGICAENFERMEDAD INFLAMATORIA INTESTINAL ANTECEDENTES:Los pacientes con enfermedad inflamatoria intestinal son difíciles de manejar perioperatoriamente debido a la complejidad de la enfermedad y a múltiples comorbilidades.OBJETIVO:Este estudio tuvo como objetivo identificar si los factores preoperatorios y el tipo de operación se asociaron con una estadía postoperatoria prolongada después de una cirugía relacionada con enfermedad inflamatoria intestinal, definida por el percentil 75 o mayor (n = 926, 30.8%).DISEÑO:Este fue un estudio transversal basado en una base de datos multicéntrica retrospectiva.ESCENARIO:Datos capturados de quince sitios de alto volumen en El Programa Nacional de Mejoramiento de la Calidad de la Cirugía-Enfermedad Intestinal Inflamatoria en colaboración.PACIENTES:Un total de 3,008 pacientes con enfermedad inflamatoria intestinal (1,710 con enfermedad de Crohn y 1,291 con colitis ulcerosa) con una mediana de estancia postoperatoria de 4 días (RIC 3-7) desde marzo de 2017 hasta febrero de 2020.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue la extensión de la estancia postoperatoria.RESULTADOS:En la regresión logística multivariable, el aumento de las probabilidades de prolongar la estancia postoperatoria se asoció con múltiples factores demográficos y clínicos (modelo p<0.001, área bajo la curva ROC - 0.85). Los contribuyentes clínicamente significativos que aumentaron la duración de la estancia postoperatoria fueron la cirugía rectal (frente al colon) (OR 2.13, IC del 95 %: 1.52 a 2.98), una nueva ileostomía (frente a ninguna ileostomía) (OR 1.50, IC del 95 %: 1.15 a 1.97), hospitalización preoperatoria (OR 13.45, IC 95% 10.15-17.84), alta no domiciliaria (OR 4.78, IC 95% 2.27-10.08), hipoalbuminemia (OR 1.66, IC 95% 1.27-2.18) y trastorno hemorrágico (OR 2.42, IC 95% 1.22-4.82).LIMITACIONES:Revisión retrospectiva de solo centros de alto volumen.CONCLUSIONES:Los pacientes con enfermedad inflamatoria intestinal que fueron hospitalizados antes de la operación, que tuvieron alta no domiciliaria y que se sometieron a cirugía rectal tuvieron las mayores probabilidades de prolongar la estancia postoperatoria. Las características asociadas de los pacientes incluyeron trastorno hemorrágico, hipoalbuminemia y clases ASA 3-5. El uso crónico de corticosteroides, inmunológicos, agentes de moléculas pequeñas y de agentes biológicos no fue significativo en el análisis multivariable. (Traducción-Dr. Jorge Silva Velazco ).
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Affiliation(s)
- Susanna S Hill
- Department of Surgery, Section of Colon and Rectal Surgery, Albany Medical Center, Albany, New York
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Colwell JC, Pittman J, Rider P, Purtill H, Duckworth T. Evaluation of a Skin Barrier Ring With Assisted Flow: A Prospective Cohort Study. J Wound Ostomy Continence Nurs 2024; 51:46-50. [PMID: 38215297 DOI: 10.1097/won.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE The purpose of this study was to assess the effect of a skin barrier ring with assisted flow in preventing peristomal skin complications (PSCs) in patients with an ileostomy and to evaluate the participants' perceptions of the device. DESIGN Single-group, prospective cohort study. SUBJECTS AND SETTING Both inpatients and outpatients with newly created (n = 14) or established (n = 1) ileostomies were recruited from 2 clinical sites in the United States: one was an academic teaching hospital system in the Midwestern United States and the second was a teaching hospital located in the Southeastern United States. METHODS Participants used the skin barrier ring with assisted flow after receiving education on its use. The pouching system was changed on a routine basis as determined by the ostomy nurse specialist. The Ostomy Skin Tool (OST) was used to assess each participant's peristomal discoloration (D), erosion (E), and tissue overgrowth (T) on admission to the study (baseline) and at final assessment (60 ± 33 days). Secondary outcomes (device handling, comfort, and discretion) were assessed through a questionnaire administered during the final data collection visit. RESULTS The mean baseline DET score among the 14 participants with a new ileostomy was 2 or less, indicating no PSCs. The incidence of PSCs in this study was 40% (n = 6). Thirteen of 15 participants (86.7%) agreed that the skin barrier ring with assisted flow was easy to apply. Fourteen (93.4%) agreed that the device was comfortable and easy to remove. All 15 participants (100%) agreed it was discreet under clothing. CONCLUSIONS Sixty percent of participants (n = 9) using the investigational device experienced a PSC. More than 90% of participants agreed that the device was comfortable and easy to remove, and all participants (100%) agreed it was discreet when worn under clothing.
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Affiliation(s)
- Janice C Colwell
- Janice C. Colwell, APRN, CWOCN, FAAN, University of Chicago Medicine, Chicago, Illinois
- Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, College of Nursing, University of South Alabama, Mobile
- Paul Rider, MD, FACS, FASCRS, University of South Alabama, Mobile
- Helen Purtill, PhD, University of Limerick, Limerick, Ireland
- Taylor Duckworth, MEngSc, Ostoform Limited, Westmeath, Ireland
| | - Joyce Pittman
- Janice C. Colwell, APRN, CWOCN, FAAN, University of Chicago Medicine, Chicago, Illinois
- Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, College of Nursing, University of South Alabama, Mobile
- Paul Rider, MD, FACS, FASCRS, University of South Alabama, Mobile
- Helen Purtill, PhD, University of Limerick, Limerick, Ireland
- Taylor Duckworth, MEngSc, Ostoform Limited, Westmeath, Ireland
| | - Paul Rider
- Janice C. Colwell, APRN, CWOCN, FAAN, University of Chicago Medicine, Chicago, Illinois
- Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, College of Nursing, University of South Alabama, Mobile
- Paul Rider, MD, FACS, FASCRS, University of South Alabama, Mobile
- Helen Purtill, PhD, University of Limerick, Limerick, Ireland
- Taylor Duckworth, MEngSc, Ostoform Limited, Westmeath, Ireland
| | - Helen Purtill
- Janice C. Colwell, APRN, CWOCN, FAAN, University of Chicago Medicine, Chicago, Illinois
- Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, College of Nursing, University of South Alabama, Mobile
- Paul Rider, MD, FACS, FASCRS, University of South Alabama, Mobile
- Helen Purtill, PhD, University of Limerick, Limerick, Ireland
- Taylor Duckworth, MEngSc, Ostoform Limited, Westmeath, Ireland
| | - Taylor Duckworth
- Janice C. Colwell, APRN, CWOCN, FAAN, University of Chicago Medicine, Chicago, Illinois
- Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN, College of Nursing, University of South Alabama, Mobile
- Paul Rider, MD, FACS, FASCRS, University of South Alabama, Mobile
- Helen Purtill, PhD, University of Limerick, Limerick, Ireland
- Taylor Duckworth, MEngSc, Ostoform Limited, Westmeath, Ireland
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Yang K, Sambandam S. Total hip arthroplasty in patients with colostomy: impact on inpatient complications, hospital costs, and length of stay. Arch Orthop Trauma Surg 2024; 144:509-516. [PMID: 37755481 DOI: 10.1007/s00402-023-05060-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/01/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION The presence of permanent end-colostomy is traditionally thought of as a risk factor for complications following orthopedic joint replacement; however, literature supporting this association is scarce. This study aims to discern how length of stay, cost of stay, and inpatient complications following total hip arthroplasty (THA) are impacted by presence of colostomy. METHODS Data from the National Inpatient Sample was analyzed by International Classification of Diseases, 10th Revision, Clinical Modification regarding THA in patients with and without end-colostomy. Unmatched and matched analyses comparing length of stay, cost of stay, and post-operative adverse outcomes between the two groups were conducted. In the unmatched analysis, 445 THA patients with colostomy were compared to 367,449 THA patients without colostomy. The colostomy patients were then matched for age, sex, race, diabetes, obesity, and the matched groups consisted of 445 patients with and 425 patients without colostomy, respectively. RESULTS Compared to the THA without colostomy group, the colostomy group was significantly older, had longer hospital stays, and greater cost of stay. When matched for age and comorbidities, length of hospital stay (p < 0.001) and cost of stay (p = 0.002) remained significantly higher. The colostomy group was at significantly increased risk for periprosthetic fracture, dislocation, and infection compared to all THA patients. When matched for age and common comorbidities, the colostomy group had significantly higher risk in only periprosthetic dislocation [p = 0.003, OR 11.8 (1.6-4.6, 95% CI)] and periprosthetic infection [p < 0.05, OR 2.7 (0.97-7.7 95% CI)]. CONCLUSION Patients with colostomy are at risk of longer hospital courses and greater incurred costs following THA compared to patients without colostomy. They are additionally at significantly increased risk of periprosthetic dislocation and periprosthetic infection, warranting treatment as high-risk patients. STUDY DESIGN Retrospective cohort study.
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Affiliation(s)
- Kristine Yang
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
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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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22
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Bloemendaal ALA. Robotic Retromuscular (Recurrent) Parastomal Hernia Repair (r-Pauli-Repair) With Synthetically Reinforced Biological Mesh; Technique, Early Experience, and Short-Term Follow-Up. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2023; 2:12059. [PMID: 38312416 PMCID: PMC10831679 DOI: 10.3389/jaws.2023.12059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/30/2023] [Indexed: 02/06/2024]
Abstract
Introduction: Parastomal hernia repair remains a challenge. We describe a robotic retromuscular non-keyhole mesh repair using a synthetically reinforced biological mesh (Ovitex) for the repair of complex and/or recurrent parastomal hernia and technical modifications we made along the way to improve our technique. Methods: All patients underwent the described retromuscular parastomal hernia repair. Data was collected in a database and a retrospective analysis was performed on direct postoperative results and early follow-up. Results: Eleven patients underwent the operation. Median follow-up was 12 months. Median LOS was 6 days. Two recurrences occurred. One patient suffered postoperative hematoma and skin necrosis, which healed completely, but did lead to a recurrence. One patient had a significant seroma, which subsided without intervention. Both recurrences were reoperated, and a local repair was performed. Conclusion: This paper is the first to describe a modified robotic Pauli repair for complex and recurrent parastomal hernia, using a synthetically reinforced biological mesh. Results are satisfying so far, especially considering the complexity of the cases.
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23
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Clancy C, Connelly TM, Jia X, Lipman J, Lightner AL, Hull T, Steele SR, Holubar SD. Defining the safety of early ileostomy closure after ileal pouch anal anastomosis. Tech Coloproctol 2023; 27:1257-1263. [PMID: 37209279 DOI: 10.1007/s10151-023-02811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/24/2023] [Indexed: 05/22/2023]
Abstract
PURPOSE The safety of early ileostomy reversal after ileal pouch anal anastomosis (IPAA) has not been established. Our hypothesis was that ileostomy reversal before 8 weeks is associated with negative outcomes. METHODS This was a retrospective cohort study from a prospectively maintained institutional database. Patients who underwent primary IPAA with ileostomy reversal between 2000 and 2021 from a Pouch Registry were stratified on the basis of timing of reversal. Those reversed before 8 weeks (early) and those reversed from 8 weeks to 116 days (routine) were compared. The primary outcome was overall complications according to timing and reason for closure. RESULTS Ileostomy reversal was performed early in 92 patients and routinely in 1908. Median time to closure was 49 days in the early group and 93 days in the routine group. Reasons for early reversal were stoma-related morbidity in 43.3% (n = 39) and scheduled closure in 56.7% (n = 51). The complication rate in the early group was 17.4% versus 11% in the routine group (p = 0.085). When early patients were stratified according to reason for reversal, those reversed early for stoma-related morbidity had an increased complication rate compared to the routine group (25.6% vs. 11%, p = 0.006). Patients undergoing scheduled reversal in the early group did not have increased complications (11.8% vs. 11%, p = 0.9). There was a higher likelihood of pouch anastomotic leak when reversal was performed early for stoma complications compared to routinely (OR 5.13, 95% CI 1.01-16.57, p = 0.049). CONCLUSIONS Early closure is safe but could be delayed in stoma morbidity as patients may experience increased complications.
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Affiliation(s)
- C Clancy
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - T M Connelly
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - X Jia
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J Lipman
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - A L Lightner
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - T Hull
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - S R Steele
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - S D Holubar
- Department of Colon and Rectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
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24
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Martín-Gil B, Rivas-González N, Santos-Boya T, López M, Jiménez JM, Redondo-Pérez N, Del Río-García I, Berdón-Berdón M, Fernández-Castro M. Changes in the quality of life of adults with an ostomy during the first year after surgery as part of the Best Practice Spotlight Organisation® Programme. Int Wound J 2023; 21:e14456. [PMID: 37963817 PMCID: PMC10898385 DOI: 10.1111/iwj.14456] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023] Open
Abstract
The aim was to analyse changes in the perceived quality of life of patients with an ostomy during the first year after surgery at two or three follow-ups. This is a prospective study of a cohort of 55 patients who were ostomised between June 2021 and September 2022 and cared for under the recommendations set out in the Registered Nurses' Association of Ontario® best practice guideline Supporting Adults Who Anticipate or Live with an Ostomy as part of the Best Practice Spotlight Organisation® (BPSO®) programme. The Stoma Quality of Life tool was used. A univariate analysis was performed to identify variables associated with a non-improvement in quality of life. Variables showing p < 0.1 were included in a multivariate model. Patients with an ostomy exhibited a moderate-to-good perception of quality of life in both the personal and social dimensions, with no worsening over the first year. Being female (OR = 10.32) and being younger (OR = 0.89) were associated with a higher risk of no improvement in quality of life. The most frequent complications were urinary leakage (p = 0.027) and dermatitis (p = 0.052) at first follow-up; and parastomal hernia (p = 0.009) and prolapse (p = 0.05) at third follow-up. However, they did not lead to a worsening of quality of life, suggesting that these patients were adequately supported under the BPSO® programme.
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Affiliation(s)
- Belén Martín-Gil
- Department of Nursing Care Information Systems, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Noel Rivas-González
- Continual Trainig Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - María López
- Nursing Faculty, University of Valladolid, Valladolid, Spain
| | | | - Natán Redondo-Pérez
- Nursing Direction, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - María Berdón-Berdón
- Nursing Direction, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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25
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Krogsgaard M, Dreyer P, Thomsen T. Understanding patients' perspectives when unprepared for the emergence of a parastomal bulge-a qualitative study. Colorectal Dis 2023; 25:2198-2205. [PMID: 37814485 DOI: 10.1111/codi.16750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/14/2023] [Accepted: 08/03/2023] [Indexed: 10/11/2023]
Abstract
AIM The aim was to investigate patients' experiences of being prepared for the development of a parastomal bulge in relation to a stoma. METHODS The paper draws on a qualitative interview study conducted with 20 Danish patients participating in five focus groups. Analysis was performed using a phenomenological-hermeneutic approach. RESULTS We identified three themes. The first theme is 'The unforeseen bulge gives rise to increasing concern and a search for an explanation'. Patients searched for explanations in their own life and suspected that their behaviour or previous illness induced the bulge. The second theme is 'Missing or confusing information leads to counterproductive behaviour'. Patients lacked information on the prevention and treatment of parastomal bulging which led to disappointment with healthcare professionals. The third theme is 'Weighing the pros and cons of life with the bulge against the gamble of surgical repair'. Some patients came to terms with their situation, but for others a deadlocked situation arose when surgical repair was not an option. CONCLUSION Healthcare communication directly impacts on patients' experiences and outcomes. When unprepared for the emergence of a parastomal bulge, patients' emotional and psychological well-being are affected and likewise patients' possibility of using their own health beliefs as a preventive strategy. To preserve patient autonomy, satisfaction and well-being, surgeons and stoma nurses should provide patients with tailored information bearing in mind the current lack of clear evidence on the prevention and treatment of parastomal bulging.
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Affiliation(s)
- Marianne Krogsgaard
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege, Denmark
| | - Pia Dreyer
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark
| | - Thordis Thomsen
- Department of Anaesthesiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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26
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Brady RRW, Scott J, Grieveson S, Aibibula M, Cawson M, Marks T, Page J, Artignan A, Boisen EB. Complications and Healthcare Costs Associated With the First Year Following Colostomy and Ileostomy Formation: A Retrospective Study. J Wound Ostomy Continence Nurs 2023; 50:475-483. [PMID: 37966075 DOI: 10.1097/won.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE The purpose of this study was to evaluate clinical and economic outcomes during the first year following ostomy formation. DESIGN Single-center retrospective audit. SUBJECTS AND SETTING The sample comprised 200 patients who underwent surgery leading to ileostomy or colostomy at a large English National Health Service (NHS) Trust. METHODS Clinical complications, medicine prescriptions, and interactions with healthcare services were reported over 12 months postsurgery, and interactions with the NHS were matched to the closest NHS unit cost to determine mean patient cost. RESULTS The most common ostomy-related surgical site complications were high output (35.0%; n = 70), followed by moderate/severe peristomal skin complications (24.5%; n = 49) and bleeding (23.5%; n = 47). Ostomy management-related complications included general difficulties with ostomy management (50.0%; n = 100) and leakage-related mild peristomal skin issues (48.5%; n = 97). Clinical complication rates were highest in the first quarter following ostomy formation, except parastomal hernia, which increased in incidence over time. Ileostomy patients more frequently experienced high output, acute renal failure, and ostomy management-related complications and had increased length of inpatient admission. However, healthcare resource use was high in both groups, with a median of 13 inpatient admission days and 12 outpatient contacts overall within the first year. Mean cost per patient was £20,444.60 (US $26,018.41); 90.5% of these costs were attributed to ostomy-related factors. CONCLUSIONS Patients are likely to experience at least one clinical complication following intestinal ostomy formation and have multiple interactions with the NHS. While a number of complications are more frequent in patients with ileostomies, both groups experienced considerable costs within the first year following surgery associated with ostomy management and recovery.
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Affiliation(s)
- Richard R W Brady
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Julia Scott
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Stephanie Grieveson
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Miriayi Aibibula
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Matthew Cawson
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Tatjana Marks
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Jennifer Page
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Audrey Artignan
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
| | - Esben Bo Boisen
- Richard R. W. Brady, FRCSEd, MD, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Julia Scott, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Stephanie Grieveson, Newcastle Centre for Bowel Disease Research Group, Newcastle Hospitals and Newcastle University, Royal Victoria Hospital, Newcastle, United Kingdom
- Miriayi Aibibula, PhD, Coloplast Ltd, Peterborough, United Kingdom
- Matthew Cawson, MEnt, Coloplast Ltd, Peterborough, United Kingdom
- Tatjana Marks, MSc, Costello Medical Consulting Ltd, London, United Kingdom
- Jennifer Page, BSc, Costello Medical Consulting Ltd, Manchester, United Kingdom
- Audrey Artignan, MPhil, Costello Medical Consulting Ltd, Cambridge, United Kingdom
- Esben Bo Boisen, MSc, Coloplast A/S, Humlebaek, Denmark
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27
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Hasnaoui A, Trigui R, Heni S, Kacem S. Early postoperative parastomal evisceration after explorative laparotomy: case report of a rare and potentially life-threatening surgical complication. Patient Saf Surg 2023; 17:26. [PMID: 37872589 PMCID: PMC10591356 DOI: 10.1186/s13037-023-00379-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Parastomal evisceration represents a preventable surgical complication that should not occur with appropriate technical diligence and surgical skills. While late parastomal hernias are well described in the literature, there is a paucity of reports on the early postoperative occurrence of parastomal intestinal evisceration. CASE PRESENTATION An urgent laparotomy was performed on a 58-year-old female patient for an acute cecal perforation with generalized peritonitis related to underlying colon cancer. Intraoperative revelations necessitated a carcinologic right colectomy and the creation of an end-loop ileocolostomy. Following six sessions of adjuvant chemotherapy, Computed tomography scans raised uncertainties about the presence of peritoneal carcinomatosis. Consequently, a collaborative decision was reached in a multidisciplinary discussion to conduct a surgical biopsy of these deposits before reinstating digestive continuity. The surgical procedure started with stoma mobilization. However, adhesions and a relatively confined aperture curtailed a comprehensive peritoneal cavity exploration. Thus, a midline incision was executed. The verdict from the frozen section examination affirmed metastatic presence, prompting the retention of the stoma. Within 48 h post-surgery, an early-stage parastomal evisceration occurred, stemming from an inadequately sealed aponeurotic sheath. The exposed bowel surface was encased in fibrin, necessitating meticulous irrigation with a warm saline solution before repositioning it within the peritoneal cavity. Accurate adjustment of the aponeurosis closure ensued, coupled with a meticulous reconstitution of the stoma. The postoperative course was uneventful. The patient was subsequently referred for hyperthermic intraperitoneal chemotherapy. CONCLUSIONS Preventing parastomal evisceration requires adherence to established stoma-creation protocols, including creating a properly sized fascial opening and secure fixation. In instances of excessive fascial opening, ensuring a tension-free and meticulous closure is imperative.
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Affiliation(s)
- Anis Hasnaoui
- Department of General Surgery, Menzel Bourguiba Hospital, Bizerta, Tunisia.
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar 100, Tunis, Tunisia.
| | - Racem Trigui
- Department of General Surgery, Menzel Bourguiba Hospital, Bizerta, Tunisia
| | - Sihem Heni
- Department of General Surgery, Menzel Bourguiba Hospital, Bizerta, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar 100, Tunis, Tunisia
| | - Salma Kacem
- Department of General Surgery, Menzel Bourguiba Hospital, Bizerta, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar 100, Tunis, Tunisia
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28
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Parini D, Bondurri A, Ferrara F, Rizzo G, Pata F, Veltri M, Forni C, Coccolini F, Biffl WL, Sartelli M, Kluger Y, Ansaloni L, Moore E, Catena F, Danelli P. Surgical management of ostomy complications: a MISSTO-WSES mapping review. World J Emerg Surg 2023; 18:48. [PMID: 37817218 PMCID: PMC10563348 DOI: 10.1186/s13017-023-00516-5] [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: 05/19/2023] [Accepted: 09/09/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The creation of an ileostomy or colostomy is a common surgical event, both in elective and in emergency context. The main aim of stoma creation is to prevent postoperative complications, such as the anastomotic leak. However, stoma-related complications can also occur and their morbidity is not negligible, with a rate from 20 to 70%. Most stomal complications are managed conservatively, but, when this approach is not resolutive, surgical treatment becomes necessary. The aim of this mapping review is to get a comprehensive overview on the incidence, the risk factors, and the management of the main early and late ostomy complications: stoma necrosis, mucocutaneous separation, stoma retraction, stoma prolapse, parastomal hernia, stoma stenosis, and stoma bleeding. MATERIAL AND METHODS A complete literature research in principal databases (PUBMED, EMBASE, SCOPUS and COCHRANE) was performed by Multidisciplinary Italian Study group for STOmas (MISSTO) for each topic, with no language restriction and limited to the years 2011-2021. An international expert panel, from MISSTO and World Society of Emergency Surgery (WSES), subsequently reviewed the different issues, endorsed the project, and approved the final manuscript. CONCLUSION Stoma-related complications are common and require a step-up management, from conservative stoma care to surgical stoma revision. A study of literature evidence in clinical practice for stoma creation and an improved management of stoma-related complications could significantly increase the quality of life of patients with ostomy. Solid evidence from the literature about the correct management is lacking, and an international consensus is needed to draw up new guidelines on this subject.
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Affiliation(s)
- Dario Parini
- General Surgery Department, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Andrea Bondurri
- General Surgery Department, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milano, Italy.
| | - Francesco Ferrara
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Gianluca Rizzo
- Digestive and Colorectal Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Pata
- Department of Pharmacy, Health and Nutricional Sciences, University of Calabria, Cosenza, Italy
- Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, Italy
| | - Marco Veltri
- General Surgery Unit, San Jacopo Hospital, Pistoia, Italy
| | - Cristiana Forni
- Nursing and allied profession research Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Walt L Biffl
- Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | | | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Luca Ansaloni
- General Surgery Department, Pavia University Hospital, Pavia, Italy
| | - Ernest Moore
- E. Moore Shock and Trauma Centre, Denver, CO, USA
| | - Fausto Catena
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Piergiorgio Danelli
- General Surgery Department, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milano, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milano, Italy
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29
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Rendell VR, Pauli EM. Parastomal Hernia Repair. Surg Clin North Am 2023; 103:993-1010. [PMID: 37709401 DOI: 10.1016/j.suc.2023.04.008] [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] [Indexed: 09/16/2023]
Abstract
Parastomal hernias (PHs) are common and contribute to significant patient morbidity. Despite 45 years of evolution, mesh-based PH repairs continue to be challenging to perform and remain associated with high rates of postoperative complications and recurrences. In this article, the authors summarize the critical factors to consider when evaluating a patient for PH repair. The authors provide an overview of the current techniques for repair, including both open and minimally invasive approaches. The authors detail the mesh-based repair options and review the evidence for choice of mesh to use for repair.
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Affiliation(s)
- Victoria R Rendell
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Eric M Pauli
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA.
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Batistotti P, Montale A, Bruzzone M, Amato A, Binda GA. Protective ileostomy after low anterior resection for extraperitoneal rectal cancer: does the reversal surgery timing affect closure failure? Updates Surg 2023; 75:1811-1818. [PMID: 37428410 DOI: 10.1007/s13304-023-01573-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
Loop ileostomy is commonly performed after LAR with TME to temporarily protect the anastomosis. Usually, defunctioning stoma is closed after 1-6 months, although sometimes it becomes definitive de facto. The aim of this study is to investigate the long-term risk of no-reversal of protective ileostomy after LAR for middle-low rectal cancer and the predictive risk factors. A retrospective analysis of a consecutive cohort of patients who underwent curative LAR with covering ileostomy for extraperitoneal rectal cancer in two colorectal units was performed. A different policy for scheduling stoma closure was applied between centers. All the data were collected through an electronic database (Microsoft Excel®). Descriptive statistical analysis was performed using Fisher's exact and Student's t test. Multivariate logistic regression analysis was conducted. Two-hundred twenty-two patients were analysed: reversal procedure was carried out in 193 patients, in 29 cases stoma was never closed. The mean interval time from index surgery was 4.9 months (Center1: 3 vs. Center2: 7.8). At the univariate analysis, mean age and tumor stage were significantly higher in the "no-reversal" group. Unclosed ostomies were significantly lower in Center 1 than Center 2 (8% vs. 19.6%). At the multivariate analysis female gender, anastomotic leakage and Center 2 had significant higher risk of unclosed ileostomy. Currently, no clinical recommendations have been established and the policy of scheduling stoma reversal is variable. Our study suggests that an established protocol could avoid closure delay, decreasing permanent stomas. Consequently, ileostomy closure should be weighed as standardized step in cancer therapeutic pathway.
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Affiliation(s)
- P Batistotti
- General Surgical Department, Ospedale Di Imperia, Via Sant'Agata 57, 18100, Imperia, Italy.
| | - A Montale
- Department of Gastroenterology and Digestive Endoscopy, E. O. Ospedali Galliera, Mura Delle Cappuccine 14, 16128, Genoa, Italy
| | - M Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale San Martino, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | - A Amato
- General Surgical Department, Ospedale Di Imperia, Via Sant'Agata 57, 18100, Imperia, Italy
| | - G A Binda
- General Surgery, Biomedical Institute, Genoa, Italy
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Pividori M, Gangloff D, Ferron G, Meresse T, Delay E, Rivoire M, Perez S, Vaucher R, Frobert P. Outcomes of DIEP flap reconstruction after pelvic cancer surgery: A retrospective multicenter case series. J Plast Reconstr Aesthet Surg 2023; 85:242-251. [PMID: 37531805 DOI: 10.1016/j.bjps.2023.07.005] [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: 08/23/2022] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Flap reconstruction is often required after pelvic tumor resection to reduce wound complications. The use of perforator flaps has been shown to reduce donor site morbidity. The purpose of this study was to evaluate the outcomes of pedicled deep inferior epigastric perforator (pDIEP) flap reconstruction. METHODS This was a retrospective multicenter study of patients who underwent immediate pDIEP flap reconstruction for a pelvic or perineal defect after tumor resection between November 2012 and June 2022. The primary outcome was abdominal donor site morbidity, and the secondary outcome was perineal morbidity. RESULTS Thirty-four patients (median age, 57.5 years) who underwent pelvic exenteration (n = 31), extralevator abdominoperineal excision (n = 2), or extended vaginal hysterectomy (n = 1) were included. The most common indications were recurrent cervical (n = 19) and anal (n = 4) squamous cell carcinoma. Twenty-nine patients (85%) had a history of radiotherapy. Only one patient (3%) had major (Clavien-Dindo ≥ III) donor site complications (surgical site infection due to tumor recurrence). Eleven patients (32%) had at least one major recipient site complication (surgical site infection [n = 1], total [n = 2] or partial [n = 1] flap loss, perineal dehiscence [n = 2], hematoma [n = 1], fistula [n = 5]). No incisional or perineal hernias were observed during follow-up. Ninety-day survival was 100%. CONCLUSION Pedicled DIEP flap reconstructions performed by experienced surgical teams had good outcomes for perineal or vaginal reconstruction, with low abdominal morbidity, in patients with advanced pelvic malignancies who had undergone median laparotomy. The risks and benefits of this procedure should be carefully evaluated preoperatively using clinical and imaging data.
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Affiliation(s)
- Marc Pividori
- Department of Reconstructive and Plastic Surgery, Hospices Civils de Lyon, 103, Grande-Rue de la Croix-Rousse, 69317 Lyon, France; Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France.
| | - Dimitri Gangloff
- Department of Plastic Surgery, Institut Claudius Regaud Institut Universitaire du Cancer de Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse Cedex 9, France
| | - Gwenaël Ferron
- Department of Surgical Oncology, Institut Claudius Regaud Institut Universitaire du Cancer de Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse Cedex 9, France
| | - Thomas Meresse
- Department of Plastic Surgery, Institut Claudius Regaud Institut Universitaire du Cancer de Toulouse-Oncopole, 1 Avenue Irène Joliot-Curie, 31059 Toulouse Cedex 9, France
| | - Emmanuel Delay
- Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Michel Rivoire
- Department of Surgical Oncology, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Simon Perez
- Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Richard Vaucher
- Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
| | - Paul Frobert
- Department of Reconstructive and Plastic Surgery, Centre Léon Bérard, 28, rue Laennec, 69008 Lyon, France
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Skovsen AP, Burcharth J, Gögenur I, Tolstrup MB. Small bowel anastomosis in peritonitis compared to enterostomy formation: a systematic review. Eur J Trauma Emerg Surg 2023; 49:2047-2055. [PMID: 36526812 DOI: 10.1007/s00068-022-02192-7] [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: 09/08/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Anastomotic leakage after small bowel resection in emergency laparotomy is a severe complication. A consensus on the risk factors for anastomotic leakage has not been established, and it is still unclear if peritonitis is a risk factor. This systematic review aimed to evaluate if an entero-entero/entero-colonic anastomosis is safe in patients with peritonitis undergoing abdominal acute care surgery. METHODS A systematic literature review based on PRISMA guidelines was performed, searching the databases Pubmed/MEDLINE, Cochrane Library, and Science Direct for studies of anastomosis in peritonitis. Patients with an anastomosis after non-planned small bowel resection (ischemia, perforation, or strangulation), including secondary peritonitis, were included. Elective laparotomies and colo-colonic anastomoses were excluded. Due to the etiology, traumatic perforation, in-vitro, and animal studies were excluded. RESULTS This review identified 26 studies of small-bowel anastomosis in peritonitis with a total of 2807 patients. This population included a total of 889 small-bowel/right colonic resections with anastomoses, and 242 enterostomies. All studies, except two, were retrospective reviews or case series. The overall mortality rates were 0-20% and anastomotic leakage rates 0-36%. After performing a risk of bias evaluation there was no basis for conducting a meta-analysis. The quality of evidence was rated as low. CONCLUSION There was no evidence to refute performing a primary small-bowel anastomosis in acute laparotomy with peritonitis. There is currently insufficient evidence to label peritonitis as a risk factor for anastomotic leakage in acute care laparotomy with small-bowel resection. TRIAL REGISTRATION The review was registered with the PROSPERO register of systematic reviews on 14/07/2020 with the ID: CRD42020168670.
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Affiliation(s)
- Anders Peter Skovsen
- Surgical Department, Hillerød Hospital, University of Copenhagen, Hillerød, Denmark.
| | - Jakob Burcharth
- Surgical Department, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Ismail Gögenur
- Surgical Department, Zealand University Hospital, University of Copenhagen, Køge, Denmark
- Center for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Mai-Britt Tolstrup
- Surgical Department, Hillerød Hospital, University of Copenhagen, Hillerød, Denmark
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Chan MS, Moore Z, Patton D, McNamara D, O'Connor T, Avsar P. A systematic review of patient risk factors for complications following stoma formation among adults undergoing colorectal surgery. Int J Colorectal Dis 2023; 38:238. [PMID: 37747515 DOI: 10.1007/s00384-023-04523-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Stoma formation is a commonly performed procedure both during and following colorectal surgery. When designed correctly, stomas can dramatically improve patients' quality of life, but the reverse may occur when complications arise. Given the significant negative impact of complications following stoma formation, understanding risk factors that may be mitigated pre-operatively is important. METHOD A systematic search of publications using MEDLINE, CINAHL, and Cochrane databases was conducted in May 2022. Data was extracted and a narrative synthesis undertaken. The evidence-based librarianship (EBL) checklist assessed the methodological quality of the included studies. The systematic review includes various research designs such as randomised controlled trials (RCT), case-control studies, and observational cohort studies written in English. Reviews, conference papers, opinion papers, and those including participants < 18 years old were excluded. No restrictions on the date of publication and study setting were applied. RESULTS This review included 17 studies, conducted between 2001 and 2020. The study designs were prospective audit, prospective analysis, retrospective analysis, longitudinal analysis and multivariate analysis of self-reported questionaires/surveys. Twenty-two possible risk factors for the development of stoma complications following stoma formation were identified. These include demographical risk factors, underlying medical condition, type of surgery, elective vs emergency surgery, stoma factors, surgical factors, indications for surgery and factors which may impact healing. Furthermore, high BMI, emergency surgery, and stoma type were identified as the most frequently occurring risk factors. CONCLUSION Given the large number of risk factors identified, the implementation of a risk stratification tool may decrease the incidence and prevalence of stoma complication development. This, in turn, would decrease the associated healthcare-related costs, and negative impact on mortality, length of stay and quality of life.
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Affiliation(s)
- Mai Shanley Chan
- School of Medicine, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Zena Moore
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash, Australia
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Lida Institute, Shanghai, China
- University of Wales, Cardiff, UK
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith, QLD, Australia
| | - Declan Patton
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Deborah McNamara
- Beaumont Hospital, Dublin, Ireland
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tom O'Connor
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
- Lida Institute, Shanghai, China
| | - Pinar Avsar
- Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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Krogsgaard M, Borglit TB, Eriksen JR. The perfect stoma: tips from a stoma nurse. Br J Surg 2023; 110:1249-1251. [PMID: 37035888 DOI: 10.1093/bjs/znad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Marianne Krogsgaard
- Department of Surgery, Zealand University Hospital, Koege, Denmark
- Centre for Surgical Science, Zealand University Hospital, Koege, Denmark
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Cronin E. Using a convex ostomy appliance to manage peristomal skin complications: introducing Aura Plus Soft Convex. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S1-S7. [PMID: 37708054 DOI: 10.12968/bjon.2023.32.sup16a.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
This article explores convex stoma appliances, introduces Aura Plus Soft Convex (CliniMed) and presents three case studies of its use. Convexity applies pressure to flatten uneven peristomal skin and form an effective adhesive seal, as well as increase protrusion of a poorly spouted stoma. This reduces the risk of leaks and peristomal skin damage, as well as minimising accessory use. Excess pressure can damage the skin, so convexity should be used with caution at the appropriate depth and firmness for the ostomate's body profile and stomal complications. Aura Plus Soft Convex has a soft and flexible baseplate for easy application and adherence, as well as a unique shape, comfort curves and a large adhesive area to reduce creases and leaks. The hydrocolloid contains Manuka honey to promote skin health, and integral belt loops offer additional security. The case studies show how this appliance can restore peristomal skin integrity and relieve stoma-related anxiety; provide gentle support for a flush stoma and a rounded abdomen; and prevent leaks and improve quality of life after years of stoma-related complications.
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Affiliation(s)
- Elaine Cronin
- Colorectal and Stoma Clinical Nurse Specialist, the London Clinic
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36
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Cronin E. Using a convex ostomy appliance to manage peristomal skin complications: introducing Aura Plus Soft Convex. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S2-S7. [PMID: 37861434 DOI: 10.12968/bjon.2023.32.sup16c.s2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
This article explores convex stoma appliances, introduces Aura Plus Soft Convex (CliniMed) and presents three case studies of its use. Convexity applies pressure to flatten uneven peristomal skin and form an effective adhesive seal, as well as increase protrusion of a poorly spouted stoma. This reduces the risk of leaks and peristomal skin damage, as well as minimising accessory use. Excess pressure can damage the skin, so convexity should be used with caution at the appropriate depth and firmness for the ostomate's body profile and stomal complications. Aura Plus Soft Convex has a soft and flexible baseplate for easy application and adherence, as well as a unique shape, comfort curves and a large adhesive area to reduce creases and leaks. The hydrocolloid contains Manuka honey to promote skin health, and integral belt loops offer additional security. The case studies show how this appliance can restore peristomal skin integrity and relieve stoma-related anxiety; provide gentle support for a flush stoma and a rounded abdomen; and prevent leaks and improve quality of life after years of stoma-related complications.
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Affiliation(s)
- Elaine Cronin
- Colorectal and Stoma Clinical Nurse Specialist, the London Clinic
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Carlsson E, Forsmark A, Sternhufvud C, Scheffel G, Andersen FB, Persson EI. Short- and long-term direct and indirect costs of illness after ostomy creation - a Swedish nationwide registry study. BMC Health Serv Res 2023; 23:837. [PMID: 37553576 PMCID: PMC10408161 DOI: 10.1186/s12913-023-09850-5] [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: 01/27/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Despite advance in care of people with an ostomy, related complications remain prevalent. The objective of this study was to examine short- and long-term healthcare resource utilization and associated costs after ostomy creation. METHODS This observational study was based on retrospectively collected data from national and regional Swedish registries. The population consisted of people living in Sweden, who had an ostomy created. The earliest index date was 1 January 2006, and people were followed for ten years, until death, reversal of temporary ostomy, termination of purchases of ostomy products, or end of study, which was 31 December 2019. Each person with an ostomy was matched with two controls from the general population based on age, gender, and region. RESULTS In total, 40,988 persons were included: 19,645 with colostomy, 16,408 with ileostomy, and 4,935 with urostomy. The underlying diseases for colostomy and ileostomy creations were primarily bowel cancer, 50.0% and 55.8% respectively, and additionally inflammatory bowel disease for 20.6% of ileostomies. The underlying cause for urostomy creation was mainly bladder cancer (85.0%). In the first year after ostomy creation (excl. index admission), the total mean healthcare cost was 329,200 SEK per person with colostomy, 330,800 SEK for ileostomy, and 254,100 SEK for urostomy (100 SEK was equivalent to 9.58 EUR). Although the annual mean healthcare cost decreased over time, it remained significantly elevated compared to controls, even after 10 years, with hospitalization being the main cost driver. The artificial opening was responsible for 19.3-22.8% of 30-day readmissions after ostomy creation and for 19.7-21.4% of hospitalizations during the entire study period. For the ileostomy group, dehydration was responsible for 13.0% of 30-day readmissions and 4.5% of hospitalization during the study period. CONCLUSIONS This study reported a high disease burden for persons with an ostomy. This had a substantial impact on the healthcare cost for at least ten years after ostomy creation. Working ability seemed to be negatively impacted, indicated by increased cost of sickness absence and early retirement. This calls for improved management and support of ostomy care for the benefit of the affected persons and for the cost of society.
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Affiliation(s)
- Eva Carlsson
- Department of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | - Eva I Persson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
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Cwaliński J, Hermann J, Banasiewicz T. Healing Peristomal Wounds Around Retracted Stomas with Negative-Pressure Wound Therapy: A Case Series. Adv Skin Wound Care 2023; 36:435-440. [PMID: 37471448 DOI: 10.1097/asw.0000000000000006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
ABSTRACT One method for treating a retracted stoma is a vacuum dressing that cleans the wound and protects against intestinal leakage. This case series describes the use of an integrated, single-use negative-pressure wound therapy (NPWT) dressing to treat retracted stomas as an alternative to other noninvasive remedies. The report includes seven patients who were hospitalized in the authors' surgical department from 2019 to 2020. All patients developed severe peristomal infection that failed to respond to local treatment with proper ostomy appliances or specialist dressings. After cleaning each wound and removing necrotic lesions, the authors applied a single-use hydrofiber NPWT dressing to each patient. The dressing was changed every 2 to 5 days, depending on the effects of the therapy. The stoma orifice was covered with a bag with two-piece ostomy systems. The peristomal wound healed in all cases, and leakage was eliminated. The mean time of treatment was 14 days (range, 10-21 days), and the vacuum dressings were changed an average of four times (range, 3-7 times). None of the patients required a stoma translocation or other additional surgery. Three patients received systemic IV antibiotic therapy to treat general infection. Single-use NPWT dressings protect peristomal wounds from bowel leakage and do not hinder the application of stoma bags. This system, similar to standard NPWT devices, effectively protects infected stomas from retraction.
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Affiliation(s)
- Jarosław Cwaliński
- In the Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland, Jaroslaw Cwalinski, MD, PhD, and Jacek Hermann, MD, PhD, are Senior Assistants and Tomasz Banasiewicz, MD, PhD, is Professor and Head of Clinic. The authors have disclosed no financial relationships related to this article. Submitted February 16, 2022; accepted in revised form April 29, 2022
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Qassim T, Saeed MF, Qassim A, Al-Rawi S, Al-Salmi S, Salman MT, Al-Saadi I, Almutawea A, Aljahmi E, Fadhul MK, Juma IM. Intestinal Stomas-Current Practice and Challenges: An Institutional Review. Euroasian J Hepatogastroenterol 2023; 13:115-119. [PMID: 38222947 PMCID: PMC10785138 DOI: 10.5005/jp-journals-10018-1404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/20/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction A stoma is an artificial anastomosis of the gastrointestinal tract to the abdominal skin wall to reroute the stream of feces. Fecal diversion, bowel decompression, and anastomosis protection are common indications for stomas. Relative to other surgical operations, stomas have a high morbidity rate, with rates averaging 40% and ranging 14-79%. The most common early complication was peristomal skin irritation. In contrast, parastomal hernias were the most common late complication. Methods This research was performed at King Hamad University Hospital (KHUH) in the Kingdom of Bahrain. Our study included patients who had undergone ileostomies and colostomies. The inclusion criteria included adult patients who are 15 years and older, both emergency and elective cases, and with ASA score of 1-4. The excluded patients were those who had had their stomas performed outside of KHUH and those who were not following up in the hyperbaric department of our hospital. This study was performed using a retrospective study design. The sample size was 98 which included patients with stomas that were following up with the hyperbaric team between January 2018 and February 2021. Results We have broken down the indications for stoma formation. The breakdown of all our documented complications are illustrated in the given figure. Conclusion Within our institutional study, 63.3% of stoma complications consisted of skin problems. This formed the majority of complications. Establishing a stoma care unit would offer continuous support and care to patients and help them in returning to an optimal quality of life. Additionally, this goal can be met through preoperative and postoperative education regarding surgery and stoma formation. This includes preoperative stoma marking and siting, as well as improved recovery through instruction from knowledgeable stoma care specialists regarding hands-on stoma care.Finally, patients can be assisted through specialized stoma clinics. How to cite this article Qassim T, Saeed MF, Qassim A, et al. Intestinal Stomas-Current Practice and Challenges: An Institutional Review. Euroasian J Hepato-Gastroenterol 2023;13(2):115-119.
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Affiliation(s)
| | - Mirza Faraz Saeed
- Department of General Surgery, King Hamad University Hospital, Busaiteen, Muharraq, Bahrain
| | - Aya Qassim
- Royal College of Surgeons in Ireland, Bahrain
| | | | | | | | | | - Abdulaziz Almutawea
- Department of General Surgery, King Hamad University Hospital, Busaiteen, Muharraq, Bahrain
| | - Eman Aljahmi
- Department of General Surgery, King Hamad University Hospital, Busaiteen, Muharraq, Bahrain
| | - Mohamed Khalid Fadhul
- Department of General Surgery, King Hamad University Hospital, Busaiteen, Muharraq, Bahrain
| | - Isam Mazin Juma
- Department of General Surgery, King Hamad University Hospital, Busaiteen, Muharraq, Bahrain
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Ingwersen EW, van der Beek PJK, Dekker JWT, van Dieren S, Daams F. One Decade of Declining Use of Defunctioning Stomas After Rectal Cancer Surgery in the Netherlands: Are We on the Right Track? Dis Colon Rectum 2023; 66:1003-1011. [PMID: 36607894 DOI: 10.1097/dcr.0000000000002625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND The beneficial effect of a defunctioning stoma in mitigating the consequences of anastomotic leakage after rectal cancer surgery is still debated. OBJECTIVE This study aims to reflect on a decade of rectal cancer surgery in terms of stoma construction and anastomotic leakage. DESIGN Retrospective observational study. SETTING This study used data from the Dutch Colorectal Audit from 2011 to 2020. PATIENTS Patients undergoing rectal cancer surgery with a primary anastomosis. MAIN OUTCOME MEASURES Primary outcome was anastomotic leakage. Secondary outcomes were minor complications, admission to intensive care, length of stay, readmission, and patient death. RESULTS A total of 13,263 patients were included in this study. A defunctioning stoma was constructed in 7106 patients (53.6%). Patients with a defunctioning stoma were less likely to develop anastomotic leakage (7.9% vs 13.0%), and if anastomotic leakage occurred, fewer patients needed surgical reintervention (37.7% vs 81.1%). An annual decrease in the construction of a defunctioning stoma was seen (69.8% in 2011 vs 51.8% in 2015 vs 29.7% in 2020), accompanied by a 5% increase in anastomotic leakage (9.1% in 2011 vs 14.1% in 2020). A defunctioning stoma was associated with a higher occurrence of minor complications, increased admissions to the intensive care unit, longer length of stay, and more readmissions within 90 days. LIMITATION This retrospective study is susceptible to confounders by indications, and there could be risk factors for anastomotic leakage and the use of a stoma that were not regarded. CONCLUSIONS The reduction in defunctioning stomas is paralleled with an increase in anastomotic leakage. However, patients with a defunctioning stoma also showed more minor complications, a prolonged length of stay, more intensive care admissions, and more readmissions. In our opinion, the trade-offs of selective use should be individually considered. See Video Abstract at http://links.lww.com/DCR/C137 . UNA DCADA DISMINUYENDO EL USO DE ESTOMAS DISFUNCIONANTES EN LOS CASOS DE CNCER DE RECTO EN HOLANDA ESTAMOS HACIENDO LO CORRECTO ANTECEDENTES:Aún se debate el efecto benéfico de la confección de un estoma disfuncionante para limitar las consecuencias de la fuga anastomótica en los casos de cirugía por cáncer de recto.OBJETIVO:Reflexiones sobre una década de cirugía por cáncer de recto en términos de confección de estomas y de fugas anastomóticas.DISEÑO:Estudio retrospectivo y observacional.AJUSTE:El presente estudio utilizó datos de la Auditoría Colorectal Holandesa entre 2011 y 2020.PACIENTES:Todos aquellos intervenidos por cáncer de recto con anastomosis primaria.PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue evaluar la fuga anastomótica. Los resultados secundarios fueron las complicaciones menores, la permanencia en cuidados intensivos, la duración de la hospitalización, las rehospitalizaciones y las causas de muerte en los pacientes.RESULTADOS:Un total de 13.263 pacientes fueron incluidos en el presente estudio. Se confeccionó un estoma disfuncionante en 7.106 (53,6%) pacientes. Aquellos portadores de un estoma disfuncionante tenían menos probabilidades de desarrollar una fuga anastomótica (7,9 % frente a 13,0 %) y, si ocurría una fuga anastomótica, menos pacientes necesitaban reintervención quirúrgica (37,7 % frente a 81,1 %). Se observó una disminución anual en la confección de un estoma disfuncionante (69,8 % en 2011 frente a 51,8 % en 2015 frente a 29,7 % en 2020), acompañada de un aumento del 5 % en la fuga anastomótica (9,1 % en 2011 frente a 14,1 % en 2020). Un estoma disfuncionante se asoció con una mayor incidencia de complicaciones menores, permanencia en la unidad de cuidados intensivos, una estadía más prolongada y más rehospitalizaciones dentro de los 90 días.LIMITACIÓN:Estudio retrospectivo susceptible de factores de confusión según las indicaciones, donde podrían no haber sido considerados ciertos factores de riesgo con relación a la fuga anastomótica y a la confección de un estoma disfuncionante.CONCLUSIÓN:La reducción de estomas disfuncionantes es paralela con el aumento de la fuga anastomótica. Sin embargo, los pacientes con un estoma disfuncionante también mostraron más complicaciones menores, una estadía prolongada, más admisiones a cuidados intensivos y más rehospitalizaciones. En nuestra opinión, las ventajas y desventajas del uso selectivo de estomas disfuncionantes deben ser consideradas caso por caso. Consulte Video Resumen en https://links.lww.com/DCR/C137 . (Traducción-Dr. Xavier Delgadillo ).
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Affiliation(s)
- Erik W Ingwersen
- Department of Gastrointestinal Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Paulien J K van der Beek
- Department of Gastrointestinal Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jan Willem T Dekker
- Department of Gastrointestinal Surgery, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Susan van Dieren
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Freek Daams
- Department of Gastrointestinal Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Treatment and Quality of Life, Amsterdam, the Netherlands
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Gillet J, Morgado L, Hamy A, Casa C, Mucci S, Drissi F, Le Naoures P, Hamel JF, Venara A. Does stoma modify compliance with enhanced recovery after surgery programs? Results of a cohort study. Int J Colorectal Dis 2023; 38:100. [PMID: 37067607 DOI: 10.1007/s00384-023-04396-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE Few studies have focused on enhanced recovery programs (ERPs) in patients who have received a stoma after colorectal surgery. The objective of the study was to compare ERP compliant patients who have not received a stoma, those who received a colostomy, and those who received an ileostomy. METHODS This study used data that had been prospectively collected as part of the ERP audit performed through the Groupe francophone de Réhabilitation Améliorée après Chirurgie [Francophone Group for Enhanced Recovery after Surgery] over a 4-year period. All patients who had undergone colorectal surgery were included and separated into three groups (no stoma, ileostomy, and colostomy). The primary outcome was ERP compliance, calculated through the use of 16 tracer items. RESULTS Of the 422 recruited patients, 317 had not received a stoma (75.12%), 59 had an ileostomy (13.98%), and 46 had a colostomy (10.90%). ERP compliance was 73% in the non-stoma group, 66.6% in the ileostomy group, and 66% in the colostomy group (p < 0.001). Multivariate analysis showed that patients from the ileostomy group had a higher risk of bowel preparation [OR = 9.1; 95% CI = 1.16-71.65] and of maintaining their urinary catheter [OR = 0.3; 95% CI = 0.14-0.81] than the group which did not receive a stoma. Patients from the colostomy group required significantly more drainage than those in the non-stoma group (OR = 4.3; 95% CI = 1.33-14.02). CONCLUSION ERP is feasible in colorectal surgery in the context of stomas, but in case of ileostomy protecting a rectal surgery, the audit system must be adapted to the protocols in use in the departments.
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Affiliation(s)
- J Gillet
- Department of Digestive Surgery, University Hospital of Angers, 4 Rue Larrey, Angers, 49933 Cedex 9, France
| | - L Morgado
- Department of Digestive Surgery, University Hospital of Angers, 4 Rue Larrey, Angers, 49933 Cedex 9, France
| | - A Hamy
- Department of Digestive Surgery, University Hospital of Angers, 4 Rue Larrey, Angers, 49933 Cedex 9, France
- Faculty of Health, Department of Medicine, University of Angers, Angers, France
- IHFIH, UPRES, University of Angers, Angers, EA, 3859, France
| | - C Casa
- Department of Digestive Surgery, University Hospital of Angers, 4 Rue Larrey, Angers, 49933 Cedex 9, France
| | - S Mucci
- Department of Digestive Surgery, University Hospital of Angers, 4 Rue Larrey, Angers, 49933 Cedex 9, France
| | - F Drissi
- The Enteric Nervous System in Gut and Brain Disorders, Université de Nantes, INSERM, TENS, 44000, Nantes, IMAD, France
- Department of Digestive Surgery, University Hospital of Nantes, Rue Alexis Ricordeau, Nantes, 44000, France
| | - P Le Naoures
- Department of Digestive Surgery, University Hospital of Angers, 4 Rue Larrey, Angers, 49933 Cedex 9, France
| | - J F Hamel
- Department of Biostatistics, La Maison de la Recherche, University Hospital of Angers, 4 Rue Larrey, Angers, 49933 Cedex 9, France
| | - A Venara
- Department of Digestive Surgery, University Hospital of Angers, 4 Rue Larrey, Angers, 49933 Cedex 9, France.
- Faculty of Health, Department of Medicine, University of Angers, Angers, France.
- IHFIH, UPRES, University of Angers, Angers, EA, 3859, France.
- The Enteric Nervous System in Gut and Brain Disorders, Université de Nantes, INSERM, TENS, 44000, Nantes, IMAD, France.
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Nunes MLG, Martins L, Conceição de Gouveia Santos VL. Cultural Adaptation and Validation of the Ostomy Skin Tool to the Brazilian Portuguese. J Wound Ostomy Continence Nurs 2023; 50:124-130. [PMID: 36867035 DOI: 10.1097/won.0000000000000949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE To adapt the Ostomy Skin Tool (discoloration, erosion, and tissue overgrowth) to the Brazilian culture and to analyze psychometric properties of the adapted version. DESIGN Psychometric (methodologic) evaluation of the instrument. SUBJECTS AND SETTING Three ostomy/enterostomal therapy nurses evaluated the extent and severity of peristomal skin conditions in a sample of 109 adults 18 years or older with peristomal skin complications. These participants were receiving care in an ambulatory care center in outpatient health services in Sao Paulo and Curitiba, Brazil. In addition, interobserver reliability was measured using a group of 129 nurse participants who attended the Brazilian Congress of Stomatherapy held from November 12 to 15, 2017, in Belo Horizonte, a city located in the state of Minas Gerais, Brazil. Nurse participants assessed the descriptions of peristomal skin complications of the Portuguese version, using the same photographs used in the original DET score, purposely placed out of original order. METHODS The study was performed in 2 stages. The instrument was translated into Brazilian Portuguese by 2 bilingual translators, and back-translated into English. The back-translated version was sent to one of the developers of the instrument for additional evaluation. During stage 2, content validity was evaluated by 7 nurses with expertise in ostomy and peristomal skin care. Convergent validity was evaluated by correlating the severity of peristomal skin complications to pain intensity. Discriminant validity was evaluated based on type and time of ostomy creation, presence of retraction, and preoperative stoma site marking. Finally, interrater reliability was evaluated using standardized photograph evaluation reproduced in the same sequence as the original English language version of the instrument, along with paired scores from assessment of adults living with an ostomy generated by an investigator and nurse data collectors. RESULTS The Content Validity Index for the Ostomy Skin Tool was 0.83. Levels of mild agreements were obtained for the nurses' observations in the evaluation of peristomal skin complications using standardized photographs (κ= 0.314). In contrast, moderate to almost perfect agreements were obtained when scores were compared in the clinical setting (κ= 0.48-0.93, according to the domains). Positive correlations between the instrument and pain intensity (r = 0.44; P = .001) indicate convergent validity of the adapted version of the Ostomy Skin Tool. In contrast, analysis of discriminant validity was mixed and definitive conclusions about this form of construct validity cannot be made based on this study. CONCLUSION This study supports convergent validity and interrater reliability of the adapted version of the Ostomy Skin Tool.
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Affiliation(s)
- Maristela Lopes Gonçalves Nunes
- Maristela Lopes Gonçalves Nunes, RN, MSN, ETN , University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
- Lina Martins, MScN, RN, NSWOC, WOCC(C), London Health Sciences Centre, London, Ontario, Canada
- Vera Lucia Conceição de Gouveia Santos, PhD, RN, CETN , Medical-Surgical Nursing Department, University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
| | - Lina Martins
- Maristela Lopes Gonçalves Nunes, RN, MSN, ETN , University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
- Lina Martins, MScN, RN, NSWOC, WOCC(C), London Health Sciences Centre, London, Ontario, Canada
- Vera Lucia Conceição de Gouveia Santos, PhD, RN, CETN , Medical-Surgical Nursing Department, University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
| | - Vera Lucia Conceição de Gouveia Santos
- Maristela Lopes Gonçalves Nunes, RN, MSN, ETN , University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
- Lina Martins, MScN, RN, NSWOC, WOCC(C), London Health Sciences Centre, London, Ontario, Canada
- Vera Lucia Conceição de Gouveia Santos, PhD, RN, CETN , Medical-Surgical Nursing Department, University of Sao Paulo School of Nursing (EE-USP), Sao Paulo, SP, Brazil
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Post-Surgical Imaging Assessment in Rectal Cancer: Normal Findings and Complications. J Clin Med 2023; 12:jcm12041489. [PMID: 36836024 PMCID: PMC9966470 DOI: 10.3390/jcm12041489] [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: 11/17/2022] [Revised: 12/30/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Rectal cancer (RC) is one of the deadliest malignancies worldwide. Surgery is the most common treatment for RC, performed in 63.2% of patients. The type of surgical approach chosen aims to achieve maximum residual function with the lowest risk of recurrence. The selection is made by a multidisciplinary team that assesses the characteristics of the patient and the tumor. Total mesorectal excision (TME), including both low anterior resection (LAR) and abdominoperineal resection (APR), is still the standard of care for RC. Radical surgery is burdened by a 31% rate of major complications (Clavien-Dindo grade 3-4), such as anastomotic leaks and a risk of a permanent stoma. In recent years, less-invasive techniques, such as local excision, have been tested. These additional procedures could mitigate the morbidity of rectal resection, while providing acceptable oncologic results. The "watch and wait" approach is not a globally accepted model of care but encouraging results on selected groups of patients make it a promising strategy. In this plethora of treatments, the radiologist is called upon to distinguish a physiological from a pathological postoperative finding. The aim of this narrative review is to identify the main post-surgical complications and the most effective imaging techniques.
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Li S, Zhong L, Zhou D, Zhang X, Liu Y, Zheng B. Predictors of Psychological Distress among Patients with Colorectal Cancer-Related Enterostomy: A Cross-sectional Study. Adv Skin Wound Care 2023; 36:85-92. [PMID: 36662041 DOI: 10.1097/01.asw.0000911012.63191.4c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To identify variables that may predict psychological distress in patients with an enterostomy. METHODS Investigators recruited 77 patients with a stoma from a stoma clinic according to the inclusion criteria. Patients' psychological distress was assessed with the Distress Thermometer (DT) tool, and their personality type was determined by the Eysenck Personality Questionnaire. Researchers also collected demographic and disease-related data. Predictive values were estimated using multiple regression analyses. RESULTS The mean DT score of all patients was 5.94 (SD, 1.81), and approximately 85.7% consistently suffered from psychological distress. Being unmarried and having peristomal complications were associated with higher psychological distress, whereas having a monthly income 5,000 ¥ or more was associated with lower levels of distress. Moreover, patients with a melancholic personality type tended to have higher DT scores, which could act as a strong independent predictor for psychological distress. CONCLUSIONS The majority of patients with a stoma endured moderate to severe psychological distress during follow-up care. Exploring the related factors that predict the levels of psychological distress could enable clinicians to identify at-risk patients as early as possible and thus provide optimal care for improving patients' quality of life.
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Affiliation(s)
- Siqing Li
- At the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China, Siqing Li, MD, is Enterostomal Therapist, Department of Gastrointestinal Surgery and Liping Zhong, MS, is Enterostomal Therapist, Radiology Department. Danyan Zhou, MS, is Nursing Student, Xinhua College of Sun Yat-sen University, Guangzhou, China. Also at the Fifth Affiliated Hospital of Sun Yat-sen University, Xiumin Zhang, MS, is Nurse, Intensive Care Unit; Yuxia Liu, MS, is Nurse, Department of Gastrointestinal Surgery; and Baojia Zheng, MD, is Health Manager, Health Management Center. Acknowledgment: Siqing Li and Liping Zhong contributed equally to this study, and Baojia Zheng and Yuxia Liu contributed equally to this study. The authors thank the Fifth Affiliated Hospital of Sun Yat-sen University for its free database use. This study was supported financially by the Young Talents of Sun Yat-sen University (N: N2020Y05). The authors have disclosed no other financial relationships related to this article. Submitted March 19, 2022; accepted in revised form May 2, 2022
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García-Manzanares ME, Lancharro-Bermúdez M, Fernandez-Lasquetty-Blanc B, Hernández-Martínez A, Rodríguez-Almagro J, Caparros-Sanz MR. Assessment, diagnosis and treatment of peristomal skin lesions by remote imaging: An expert validation study. J Adv Nurs 2023; 79:630-640. [PMID: 36394252 PMCID: PMC10100438 DOI: 10.1111/jan.15497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/25/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Prevention and treatment of peristomal skin problems should be a priority for nurses caring for ostomates, even when the assessment of lesions must be done remotely. OBJECTIVE To measure the level of agreement on assessment, diagnosis and care indications for peristomal skin lesions using remote imaging among nurses in Spain. DESIGN Prospective observational multicentre study to assess the diagnostic validity and inter- and intraobserver agreement between nurses in peristomal skin lesions. Data were collected between March and October 2019. SETTINGS AND PARTICIPANTS The research sample consisted of a group of 39 nurses with expertise in the care of ostomates. METHODS A panel of experts established a list of 24 common signs/findings, 15 diagnostic options and 35 treatment approaches for peristomal skin lesions. Three expert stoma therapy nurses compiled the clinical cases, which they described thoroughly and documented with photographs. The 39 participating nurses evaluated the cases in two rounds to measure inter and intraobserver agreement. RESULTS A high or very high level of agreement (κ > 0.61) was observed for the following signs: encrustation, nodules, mucocutaneous separation and varicose veins; for the following diagnoses: mucocutaneous dehiscence, allergic contact dermatitis, encrustation and varicose veins (caput medusae); for the following treatments: recommending a diet rich in vitamin C/blueberries, applying acetic acid dressings, applying cold and topical tacrolimus treatment. CONCLUSIONS The most easily identifiable lesions were those most prevalent and with visible signs. There was a lower level of agreement in identifying lesions for which photographs required additional information (laboratory data, description of signs and symptoms, type of diet and level of self-care). It is important to train nurses caring for ostomates to correctly describe ostomy-related lesions, which is important for nursing records, continuity of care and telehealth care.
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Affiliation(s)
- Maria-Elena García-Manzanares
- Department of Nursing, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Faculty of Nursing, University (Complutense of Madrid), Spain
| | | | | | - Antonio Hernández-Martínez
- Department of Nursing, Physiotherapy, and Occupational Therapy, Ciudad Real Faculty of Nursing, University of Castilla-La Mancha, Ciudad Real, Spain
| | - Julián Rodríguez-Almagro
- Department of Nursing, Physiotherapy, and Occupational Therapy, Ciudad Real Faculty of Nursing, University of Castilla-La Mancha, Ciudad Real, Spain
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Rivera García S, Espejo Lunar EM, Rodríguez-Almagro J, Louzao Méndez S. Evaluation of Clinical Results regarding Peristomal Skin Health Associated with the Adjustment and Formulation of the New Moderma Flex One-Piece Ostomy Devices. J Pers Med 2023; 13:jpm13020219. [PMID: 36836453 PMCID: PMC9962063 DOI: 10.3390/jpm13020219] [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: 10/16/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
In order to determine the perception of ostomized patients about the performance and safety of the new one-piece device Moderma Flex, as well as the evolution of peristomal skin health after its use. The pre- and post-experimental multicenter study after the use of the Moderma Flex one-piece ostomy device on 306 ostomized people from 68 hospitals in Spain. We used a self-made questionnaire on the usefulness of different parts of the device and the perception of peristomal skin improvement. The sample was composed of 54.6% (167) men and had an average age of 64.5 years (standard deviation = 15.43). The type of device most commonly used according to its opening was closed by 45.1% (138). In addition, for the type of barrier, the most frequently used is the flat one; 47.7% (146) and 38.9% (119) used a model of soft convexity. A total of 48% scored with the highest assessment in the perception of skin improvement. The percentage of patients with peristomal skin problems decreased from 35.9% at the first visit to less than 8% after the use of Moderma Flex. Further, 92.4% (257) had no skin problems, the most frequent being erythema. The use of the Moderma Flex device seems to be related to a reduction in peristomal skin complications and a perception of improvement.
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D’Ambrosio F, Pappalardo C, Scardigno A, Maida A, Ricciardi R, Calabrò GE. Peristomal Skin Complications in Ileostomy and Colostomy Patients: What We Need to Know from a Public Health Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010079. [PMID: 36612395 PMCID: PMC9819694 DOI: 10.3390/ijerph20010079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Peristomal skin complications (PSCs) are the most common skin problems seen after ostomy surgery. They have a considerable impact on a patient's quality of life and contribute to a higher cost of care. METHODS A systematic review was conducted, querying three databases. The analysis was performed on international studies focused on the clinical-epidemiological burden of PSCs in adult patients with ileostomy/colostomy. RESULTS Overall, 23 studies were considered. The main diseases associated with ostomy surgery were rectal, colon and gynecological cancers, inflammatory bowel diseases, diverticulitis, bowel obstruction and intestinal perforation. Erythema, papules, skin erosions, ulcers and vesicles were the most common PSCs for patients with an ostomy (or stoma). A PSCs incidence ranging from 36.3% to 73.4% was described. Skin complications increased length of stay (LOS) and rates of readmission within 120 days of surgery. CONCLUSIONS PSCs data are still limited. A knowledge of their burden is essential to support health personnel and decision-makers in identifying the most appropriate responses to patients' needs. Proper management of these complications plays a fundamental role in improving the patient's quality of life. A multidisciplinary approach, as well as increased patient education and their empowerment, are priority measures to be implemented to foster a value-based healthcare.
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Affiliation(s)
- Floriana D’Ambrosio
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ciro Pappalardo
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Anna Scardigno
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ada Maida
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberto Ricciardi
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanna Elisa Calabrò
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- VIHTALI (Value in Health Technology and Academy for Leadership & Innovation), Spin-Off of Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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de Faria MF, Ferreira MBG, dos Santos Felix MM, Bessa RMV, Barbosa MH. Prevention of medical adhesive-related skin injury during patient care: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100078. [PMID: 38745606 PMCID: PMC11080338 DOI: 10.1016/j.ijnsa.2022.100078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background : Medical adhesive-related skin injury can occur during health care. Professionals must adopt preventive measures to maintain the integrity of the skin and patient comfort and safety. Objective : To map the existing scientific evidence on preventing medical adhesive-related skin injury in adults. Design : Scoping Review. Methods : Searches were conducted in PubMed/Medline, Cochrane Library, Embase®, Latin American and Caribbean Literature in Health Sciences, Cumulative Index for Nursing and Allied Health Literature, and Google Scholar, without period delimitation. Duplicate studies and those that didn´t answer the research question were excluded. Results : Of the 209 studies identified in the search process, 30 made up the final sample. The prevention of injury by adhesives mainly involves identifying risk factors, proper adhesive selection, and correct application and removal. Health education and medical records about injuries related to medical adhesives are essential. Conclusions : The prevention of medical adhesive-related skin injury should be done by adopting multifactorial measures, which range from identifying risk factors and correct handling of adhesives to the process of educating professionals, patients and communities about these injuries. Registration : The research was registered on the Open Science Framework DOI 10.17605/OSF.IO/NSWP8.
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Affiliation(s)
- Maíla Fidalgo de Faria
- Stricto Sensu Graduate Program in Health Care, Federal University of Triângulo Mineiro, Uberaba/MG, Brazil
| | | | | | | | - Maria Helena Barbosa
- Stricto Sensu Graduate Program in Health Care, Federal University of Triângulo Mineiro, Uberaba/MG, Brazil
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Dewulf M, Dietz UA, Montgomery A, Pauli EM, Marturano MN, Ayuso SA, Augenstein VA, Lambrecht JR, Köhler G, Keller N, Wiegering A, Muysoms F. Robotic hernia surgery IV. English version : Robotic parastomal hernia repair. Video report and preliminary results. CHIRURGIE (HEIDELBERG, GERMANY) 2022; 93:129-140. [PMID: 36480037 DOI: 10.1007/s00104-022-01779-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 12/14/2022]
Abstract
The surgical treatment of parastomal hernias is considered complex and is known to be prone to complications. Traditionally, this condition was treated using relocation techniques or local suture repairs. Since then, several mesh-based techniques have been proposed and are nowadays used in minimally invasive surgery. Since the introduction of robot-assisted surgery to the field of abdominal wall surgery, several adaptations to these techniques have been made, which may significantly improve patient outcomes. In this contribution, we provide an overview of available techniques in robot-assisted parastomal hernia repair. Technical considerations and preliminary results of robot-assisted modified Sugarbaker repair, robot-assisted Pauli technique, and minimally invasive use of a funnel-shaped mesh in the treatment of parastomal hernias are presented. Furthermore, challenges in robot-assisted ileal conduit parastomal hernia repair are discussed. These techniques are illustrated by photographic and video material. Besides providing a comprehensive overview of robot-assisted parastomal hernia repair, this article focuses on the specific advantages of robot-assisted techniques in the treatment of this condition.
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Affiliation(s)
- Maxime Dewulf
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten, Olten, Switzerland
| | | | - Eric M Pauli
- Department of Surgery, Division of Minimally Invasive and Bariatric, PennState Hershey Medical Center, Hershey, PA, USA
| | - Matthew N Marturano
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Sullivan A Ayuso
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Vedra A Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Jan R Lambrecht
- Department of Surgery, Sykehuset Innlandet Hospital Trust, Brumunddal, Norway
| | - Gernot Köhler
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
| | - Nicola Keller
- Department of Urology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduer. Str. 6, 97080, Wuerzburg, Germany.
| | - Filip Muysoms
- Department of Surgery, Maria Middelares Hospital, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium.
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Bulut A, Attaallah W. Completely Diverted Tube Ileostomy Versus Conventional Loop Ileostomy. Cureus 2022; 14:e30997. [DOI: 10.7759/cureus.30997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
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