Ostomy continence devices: a systematic review of the literature and meta-analysis

AIM

Colostomy complication rates range widely from 10% to 70%. The psychological burden on patients, leading to lifestyle changes and decreased quality of life (QoL), is one of the largest factors. The aim of this work was to assess the history and efficacy of ostomy continence devices in improving continence and QoL.

METHOD

In this PRISMA-compliant systematic review and meta-analysis, we searched PubMed, Scopus, Google Scholar and clinicaltrials.gov for studies on continence devices for all ostomies up to April 2023. Primary outcomes were continence and improvement in QoL. Secondary outcomes were leakage, patient's device preference and complications. Risk of Bias 2 and the revised tool to assess risk of bias in non-randomized studies of interventions (ROBINS-1) were used to assess risk of bias. Certainty of evidence was graded using GRADE.

RESULTS

Twenty-two studies assessed devices from 1978 to 2022. The two main types identified were ball-valve devices and plug systems. Conseal and Vitala were the two main devices with significant evidence allowing for pooled analyses. Conseal, the only currently marketed device, had a pooled rate of continence of 67.4%, QoL improvement was 74.9%, patient preference over a traditional appliance was 69.1%, leakage was 10.1% and complications was 13.7%. Since 2011, five studies have investigated experimental devices on both human and animal models.

CONCLUSION

Ostomy continence has been a long-standing goal without a consistently reliable solution. We propose that selective and short-term usage of continence devices may lead to improved continence and QoL in ostomy patients. Further research is needed to develop a reliable daily device for ostomy continence. Future investigation should include the needs of ileostomates.

[Ambulatory laparoscopy]

We present our experience with laparoscopy in 600 outpatients with several diseases in seven years (1982-1988). We performed 707 studies in 594 patients (99%), in six cases (1%) the examination was not feasible because of intra-abdominal adhesions. In 235 patients (39.16%) previous abdominal surgery was not considered a contraindication for the examination. We performed 295 hepatic biopsies, 69 adhesions cuts, 9 laparoscopic placement of Tenckhoff catheter and other procedures. The incidence of complications was 5.23%, related to laparoscopy 3.67% and to procedures 1.55%. Major complications occurred in four patients (0.56%), surgical intervention was required in one patient (0.14%). We neither had infectious complications, nor mortality. We conclude that laparoscopy can be an ambulatory procedure, because it has a low incidence of complications in skilled hands and is well tolerated.

[Cancer of the ampullar region]

The clinical-pathological spectrum of ampullary cancer in 18 patients studied at the Department of Gastroenterology (Hospital Oncológico Padre Machado) during the last decade (1980-88) is presented. Involvement of the extrahepatic bile ducts was due to cancer of the ampullary region. In all cases diagnosis was confirmed by pathology. The value of ERCP is presented and the need to set apart this tumors from carcinoma of the head of the pancreas is emphasized. None of the nine cases treated with radical resection (Whipple) had operative mortality, and although follow-up for all cases is not long enough, two patients are alive and free of disease, five years after surgery. The value of prosthesis and biliary drainage for palliation is commented upon. Emphasis is placed on the need of using the term ampullary cancer in its proper connotation. Criteria for differentiating periampullary tumors (specially cancer of the head of the pancreas) are presented.