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Lien GI, Jaioun K, Bock G, Løvall C, Vollen B, Lauzikas G, Hoff G. Association between the protrusion of ileostomies and peristomal dermatitis: an observational study. Scand J Gastroenterol 2025; 60:322-326. [PMID: 40081969 DOI: 10.1080/00365521.2025.2475092] [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: 09/27/2024] [Revised: 02/24/2025] [Accepted: 02/26/2025] [Indexed: 03/16/2025]
Abstract
OBJECTIVE This is an observational study to explore possible changes in end-ileostomy stoma protrusion through years of modified surgical methods. MATERIALS AND METHODS Patients with permanent end-ileostomy were eligible for inclusion. Patients were recruited from two outpatient clinics in South-East Norway and from the Norwegian society for patients with ostomy (NORILCO). Stoma protrusion was measured in upright and supine positions by study nurse (outpatient cohort) or by the patient (NORILCO cohort). Clinical information was obtained through patients' questionnaire replies. For analyses, a pragmatic 24-hour ileostomy protrusion score was created, where 16/24 of upright measurement constituted protrusion during daytime and 8/24 of supine measurement protrusion at sleep. RESULTS 93 participated in the study, 32 from outpatient clinics and 61 from NORILCO. The outpatients cohort had shorter stoma history than the NORILCO cohort. There was a weak positive correlation between stoma protrusion and years since stoma was created (rs =0.303, p < 0.003), but stoma protrusion appeared not to be related to surgical method. In both groups, there was some reduction in stoma protrusion from upright to supine position, from 2.5 cm upright in both groups to 2.0-2.2 cm supine. CONCLUSIONS Stoma protrusion was positively associated with years since stoma was created, but not with surgical method (laparotomy or laparoscopy). A functional 24-hour protrusion score may reduce the effect of clustering of measurements due to end-digit preferences and a preoccupied focus on 2 cm as the tipping point for skin problems. Further and larger studies are needed with special attention to reduce selection bias.
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Affiliation(s)
| | - Keson Jaioun
- Department of Research and Development, Telemark Hospital, Skien, Norway
| | - Gunter Bock
- Department of Gastrointestinal Surgery, Telemark Hospital, Skien, Norway
| | - Camilla Løvall
- Department of Surgery, Vestfold Hospital, Tønsberg, Norway
| | - Berit Vollen
- Department of Surgery, Telemark Hospital, Skien, Norway
| | - Giedrius Lauzikas
- Department of Gastrointestinal Surgery, Telemark Hospital, Skien, Norway
| | - Geir Hoff
- Department of Research and Development, Telemark Hospital, Skien, Norway
- Cancer Registry of Norway at The Institute of Public Health, Oslo, Norway
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Isah AD, Wang X, Shaibu Z, Yuan X, Dang SC. Systematic review and meta-analysis comparing extraperitoneal and transperitoneal routes of colostomy-related complications. World J Gastrointest Surg 2025; 17:98947. [PMID: 40162385 PMCID: PMC11948114 DOI: 10.4240/wjgs.v17.i3.98947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 12/10/2024] [Accepted: 01/17/2025] [Indexed: 02/24/2025] Open
Abstract
BACKGROUND Complications associated with stomas-including parastomal hernia (PSH), prolapse, mucocutaneous separation, and stoma retraction-provide considerable postoperative challenges for colostomy patients. Selecting between extraperitoneal colostomy (EPC) and transperitoneal colostomy (TPC) pathways is therefore essential for mitigating these complications. AIM To analyze the existing data regarding the efficacy of EPC compared to TPC in reducing stoma-related complications post-colostomy. METHODS PubMed, Google Scholar, EMBASE, MEDLINE, and the Cochrane Library were adopted to uncover pertinent papers in which EPC and TPC approaches were compared. We then conducted a meta-analysis using RevMan 5.4.1. RESULTS Both laparoscopic (Lap) and open approaches showed a reduced incidence of PSH in EPC relative to TPC (P < 0.00001 and P = 0.02 respectively). In addition, Lap EPC depicted a lesser incidence of prolapse, mucocutaneous separation, and stoma retraction (P = 0.007, P = 0.03, and P = 0.01, respectively) compared to Lap TPC. However, EPC and TPC did not differ with respect to operation time, blood loss, edema, ischemia, necrosis, or infection after the LAP approach. CONCLUSION The extraperitoneal approach may provide benefits in minimizing some stoma-related problems such as PSH, prolapse, mucocutaneous separation, and stoma retraction after colostomy surgery.
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Affiliation(s)
- Adamu D Isah
- Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
- Department of Radiation Oncology, Institute of Oncology, Affiliated Hospital, Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Xu Wang
- Department of Radiation Oncology, Cancer Institute of Jiangsu University, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Zakari Shaibu
- School of Medicine, Jiangsu University, Zhenjiang 212013, Jiangsu Province, China
| | - Xiao Yuan
- Department of Radiation Oncology, Cancer Institute of Jiangsu University, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, Jiangsu Province, China
| | - Sheng-Chun Dang
- Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
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Miyo M, Uemura M, Ozato Y, Nishimura J, Nakata K, Suzuki Y, Kagawa Y, Hata T, Munakata K, Tei M, Sawada G, Yoshioka S, Takahashi Y, Oba K, Hata T, Ogino T, Miyoshi N, Yamamoto H, Murata K, Doki Y, Eguchi H. Influence of the rotation of the diverting loop ileostomy in rectal cancer surgery on small-bowel obstruction: A multicenter prospective study conducted by the Clinical Study Group of Osaka University, Colorectal Group. Surgery 2025; 178:108874. [PMID: 39516112 DOI: 10.1016/j.surg.2024.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 09/11/2024] [Accepted: 09/16/2024] [Indexed: 11/16/2024]
Abstract
AIMS Whether rotation of a diverting loop ileostomy during rectal cancer surgery, for reducing the catastrophic effect of an anastomotic leakage, affects the incidence of small-bowel obstruction has not been fully investigated. The purpose of this study is to explore whether technical maneuvers in diverting loop ileostomy creation, including its rotation, are associated with increased incidence of small-bowel obstruction in rectal tumor surgery. METHODS This multicenter prospective study was conducted by the Clinical Study Group of Osaka University, which comprises 24 major institutions. Patients with rectal adenocarcinoma scheduled for laparoscopic/robotic low anterior resection or intersphincteric resection with a diverting loop ileostomy were included. A total of 451 patients were prospectively enrolled between July 2015 and April 2021. The primary endpoint was the relevance of loop ileostomy rotation to the incidence of small-bowel obstruction; the secondary endpoints included the origin of the small-bowel obstruction and length of hospital stay. RESULTS Small-bowel obstruction was observed in 10.8% in the nonrotated group and 12.3% in the rotated group, with no significant difference (P > .99). The only risk factor identified for small-bowel obstruction was distance from the ileocecal valve, with a significant difference in 16 patients (7.3%) with a distance of ≤30 cm and 16 patients (15.4%) in a distance of >30 cm (P = .028). CONCLUSION Rotation of the diverting loop ileostomy had no significant effect on the incidence of small-bowel obstruction.
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Affiliation(s)
- Masaaki Miyo
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan; Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Mamoru Uemura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan.
| | - Yuki Ozato
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Junichi Nishimura
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Ken Nakata
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan
| | - Yozo Suzuki
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Yoshinori Kagawa
- Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan
| | - Taishi Hata
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Koji Munakata
- Department of Gastroentrological Surgery, Ikeda City Hospital, Ikeda, Japan
| | - Mitsuyoshi Tei
- Department of Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Genta Sawada
- Department of Surgery, Itami City Hospital, Itami, Japan
| | | | - Yusuke Takahashi
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Koji Oba
- Department of Biostatistics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tsuyoshi Hata
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Takayuki Ogino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Norikatsu Miyoshi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hirofumi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kohei Murata
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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Liu Y, Li H, Wu JJ, Ye JH. Risk factors and risk prediction model for mucocutaneous separation in enterostomy patients: A single center experience. World J Clin Cases 2024; 12:6620-6628. [PMID: 39600483 PMCID: PMC11514340 DOI: 10.12998/wjcc.v12.i33.6620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 09/05/2024] [Accepted: 09/11/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Mucocutaneous separation (MCS) is a common postoperative complication in enterostomy patients, potentially leading to significant morbidity. Early identification of risk factors is crucial for preventing this condition. However, predictive models for MCS remain underdeveloped. AIM To construct a risk prediction model for MCS in enterostomy patients and assess its clinical predictive accuracy. METHODS A total of 492 patients who underwent enterostomy from January 2019 to March 2023 were included in the study. Patients were divided into two groups, the MCS group (n = 110), and the non-MCS (n = 382) based on the occurrence of MCS within the first 3 weeks after surgery. Univariate and multivariate analyses were used to identify the independent predictive factors of MCS and the model constructed. Receiver operating characteristic curve analysis was used to assess the model's performance. RESULTS The postoperative MCS incidence rate was 22.4%. Suture dislodgement (P < 0.0001), serum albumin level (P < 0.0001), body mass index (BMI) (P = 0.0006), hemoglobin level (P = 0.0409), intestinal rapture (P = 0.0043), incision infection (P < 0.0001), neoadjuvant therapy (P = 0.0432), stoma site (P = 0.0028) and elevated intra-abdominal pressure (P = 0.0395) were potential predictive factors of MCS. Suture dislodgement [P < 0.0001, OR: 28.0075 95%CI: (11.0901-82.1751)], serum albumin level (P = 0.0008, OR: 0.3504, 95%CI: [0.1902-0.6485]), BMI [P = 0.0045, OR: 2.1361, 95%CI: (1.2660-3.6235)], hemoglobin level [P = 0.0269, OR: 0.5164, 95%CI: (0.2881-0.9324)], intestinal rapture [P = 0.0351, OR: 3.0694, 95%CI: (1.0482-8.5558)], incision infection [P = 0.0179, OR: 0.2885, 95%CI: (0.0950-0.7624)] and neoadjuvant therapy [P = 0.0112, OR: 1.9769, 95%CI: (1.1718-3.3690)] were independent predictive factors and included in the model. The model had an area under the curve of 0.827 and good clinical utility on decision curve analysis. CONCLUSION The mucocutaneous separation prediction model constructed in this study has good predictive performance and can provide a reference for early warning of mucocutaneous separation in enterostomy patients.
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Affiliation(s)
- Yun Liu
- Department of Reconstructive, Hand and Plastic Surgery, Zhejiang Chinese Medical University, Lishui Central Hospital, 289 Kuocang Road, Liandu District, Lishui 323000, Zhejiang Province, China
| | - Hong Li
- Department of Reconstructive, Hand and Plastic Surgery, Zhejiang Chinese Medical University, Lishui Central Hospital, 289 Kuocang Road, Liandu District, Lishui 323000, Zhejiang Province, China
| | - Jin-Jing Wu
- Department of Reconstructive, Hand and Plastic Surgery, Zhejiang Chinese Medical University, Lishui Central Hospital, 289 Kuocang Road, Liandu District, Lishui 323000, Zhejiang Province, China
| | - Jian-Hong Ye
- Department of Operation Room, Zhejiang Chinese Medical University, Lishui Central Hospital, 289 Kuocang Road, Liandu District, Lishui 323000, Zhejiang Province, China
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Wu TW, Chung WY, Ng HEJ, Yap A, Baronos K, Paul D, Neal CP, Bowrey D. The Frequency of Stoma-Related Readmissions After Emergency and Elective Ileostomy Formation: The Leicester Experience. Cureus 2024; 16:e73158. [PMID: 39650897 PMCID: PMC11623960 DOI: 10.7759/cureus.73158] [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] [Accepted: 11/06/2024] [Indexed: 12/11/2024] Open
Abstract
Background Approximately 9,000 patients undergo ileostomy formation each year in England. This includes those formed in both the elective and emergency settings. Recent studies have indicated a stoma-related complication rate of up to 83%.The aim of the current study was to ascertain the most common indications for ileostomy formation and to determine whether there were differences in the complication rates depending on whether the surgery occurred in the emergency or elective setting. Methods The study was a retrospective audit conducted at the University Hospitals of Leicester. Inclusion criteria were patients who underwent ileostomy formation between January 1 and December 31, 2023. Results The study cohort comprised 97 patients. Eleven of 44 (25.0%) patients in the emergency cohort had stoma-related complications, with their main reasons being high output stomas and bowel obstruction, which is higher compared to the elective patient cohort which had a complication rate of 5/53 (9.4%), with their main reasons being parastomal hernias and stoma prolapse. Ileostomies formed as a result of colorectal malignancy also led to a higher complication rate. Conclusion Our study suggests that ileostomies formed in the emergency setting as well as those formed due to colorectal malignancies had a higher rate of stoma-related complications. Stoma-related complications continue to be a common presentation to the emergency department.
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Affiliation(s)
- Ting-Wei Wu
- General Surgery, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Wen Yuan Chung
- General Surgery, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Hui En Jewel Ng
- General Surgery, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Ashley Yap
- General Surgery, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | | | - Deepak Paul
- General Surgery, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Christopher P Neal
- General Surgery, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - David Bowrey
- General Surgery, University Hospitals of Leicester NHS Trust, Leicester, GBR
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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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Takemasa I, Hamabe A, Miyo M, Akizuki E, Okuya K. Essential updates 2020/2021: Advancing precision medicine for comprehensive rectal cancer treatment. Ann Gastroenterol Surg 2023; 7:198-215. [PMID: 36998300 PMCID: PMC10043777 DOI: 10.1002/ags3.12646] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/16/2022] [Accepted: 11/23/2022] [Indexed: 12/28/2022] Open
Abstract
In the paradigm shift related to rectal cancer treatment, we have to understand a variety of new emerging topics to provide appropriate treatment for individual patients as precision medicine. However, information on surgery, genomic medicine, and pharmacotherapy is highly specialized and subdivided, creating a barrier to achieving thorough knowledge. In this review, we summarize the perspective for rectal cancer treatment and management from the current standard-of-care to the latest findings to help optimize treatment strategy.
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Affiliation(s)
- Ichiro Takemasa
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Atsushi Hamabe
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
- Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversityOsakaJapan
| | - Masaaki Miyo
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Emi Akizuki
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
| | - Koichi Okuya
- Department of Surgery, Surgical Oncology and ScienceSapporo Medical UniversitySapporoJapan
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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery. Dis Colon Rectum 2022; 65:1173-1190. [PMID: 35616386 DOI: 10.1097/dcr.0000000000002498] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Effects of Evidence-Based Continuing Care Bundle on Health Outcomes in Rectal Cancer Patients With Temporary Stomas: A Multicenter Randomized Controlled Trial. Cancer Nurs 2021; 44:223-234. [PMID: 31833919 DOI: 10.1097/ncc.0000000000000762] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The patients with temporary stomas after anterior resection for rectal cancer may experience significant impact on their health outcomes, and hence continuing care is necessary and important for these patients. However, the effects of some single continuing care interventions remain unclear. Continuing care bundle may be an effective approach to address this uncertainty. OBJECTIVE The aim of this study was to investigate the effects of an evidence-based continuing care bundle on selected health outcomes in patients with temporary stomas after anterior resection for rectal cancer. METHODS This was a multicenter randomized controlled trial. A total of 124 patients with temporary stomas after anterior resection for rectal cancer were recruited from 4 general tertiary hospitals in Guangzhou, China, and were randomly assigned to a control group or an intervention group. Both groups received usual care, whereas the intervention group additionally received evidence-based continuing care bundle. Self-efficacy, quality of life, and stoma-related complications were collected at baseline and 4 and 12 weeks after surgery. Satisfaction and outcomes of stoma reversal were collected at the end of the observation. RESULTS The intervention group had significantly improved the self-efficacy (F = 11.88, P = .001), quality of life (F = 17.99, P < .001) over time, satisfaction (t = 4.08, P < .001), and outcomes of stoma reversal (χ2 = 5.93, P = .015) and reduced the incidence of complications (P < .05). CONCLUSIONS Evidence-based continuing care bundle can be an effective method to improve the health outcomes among these patients. IMPLICATION FOR PRACTICE By using the evidence-based continuing care bundle, nurses can help these patients improve their health outcomes in stoma-specific nursing.
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Féres O, da Rocha JJR, Feitosa MR, Parra RS. A novel technique for superficial complicated stomas using the Dacron vascular prosthesis. Langenbecks Arch Surg 2021; 406:1239-1244. [PMID: 33988745 DOI: 10.1007/s00423-021-02194-w] [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: 03/28/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Despite the advances achieved in surgical techniques in recent years, an intestinal stoma is still needed in many patients undergoing colorectal surgery. However, the intestinal stoma may be associated with serious complications and the need for a second surgical procedure. In extreme cases, when it is not possible to access the abdominal cavity, the management of a complicated stoma is challenging. The purpose of this study was to describe the use of a Dacron vascular prosthesis (DVP) in patients with intestinal stoma complications. METHODS In patients with a shallow, superficial stoma or mucocutaneous separation (MCS), we sutured the prosthesis in the intestinal loop (at the edge of an intestinal fistula) to create a device to direct the fecal content to the collection bag. RESULTS We included 9 patients in this series (colorectal cancer, n = 5; Crohn's disease, n = 2; giant abdominal hernia and morbid obesity, n = 2). The results obtained were promising since they showed good evolution in patients with severe intestinal complications and an impossibility of surgical correction of the stoma. Five patients presented complete healing, and two patients presented partial healing. There were two deaths caused by sepsis, which were not related to the surgical procedure. With this technique, there was a reduction in the leakage of intestinal contents into the peritoneal cavity and an increase in the healing of the peristomal dermatitis in most of the patients. The DVP could possibly represent a surgical alternative in selected patients with complicated stomas when surgical correction may not be a suitable option. CONCLUSIONS The authors recommend this technique for selected complex cases of stoma complications after unsuccessful attempts to adapt collecting equipment. The placement of the DVP allowed the peristomal skin to heal and improved the contamination of the peritoneal cavity.
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Affiliation(s)
- Omar Féres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, 14048-900, Brazil
| | - José Joaquim Ribeiro da Rocha
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, 14048-900, Brazil
| | - Marley Ribeiro Feitosa
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, 14048-900, Brazil
| | - Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, 14048-900, Brazil.
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11
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Maeda S, Ouchi A, Komori K, Kinoshita T, Oshiro T, Ito S, Abe T, Shimizu Y. Risk factors for peristomal skin disorders associated with temporary ileostomy construction. Surg Today 2021; 51:1152-1157. [PMID: 33569690 DOI: 10.1007/s00595-020-02209-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Skin disorders are the most common stoma-related complications after temporary diverting loop ileostomy with proctectomy. The aim of the present study was to investigate risk factors for skin disorders associated with temporary ileostomy construction. METHODS A total of 185 consecutive patients who underwent curative proctectomy with temporary diverting loop ileostomy for rectal malignancies at a single comprehensive cancer center between 2013 and 2018 were collected and analyzed. RESULTS The most frequent stoma-related complications were skin disorders (n = 62, 33.5%), followed by mucocutaneous separation (n = 38, 20.5%) and high-output stoma (n = 34, 18.4%). Patients with skin disorders had a higher median body mass index (BMI; 22.4 vs. 21.3 kg/m2, P = 0.002) and lower stoma height (16 vs. 20 mm, P < 0.001) than those without skin disorders. According to a multivariable logistic regression analysis, independent predictors of skin disorders included overweight (median BMI ≥ 25 kg/m2 [odds ratio = 3.6, 95% confidence interval: 1.5-8.6], P = 0.004) and lower stomal height (median stoma height < 20 mm [odds ratio = 3.2, 95% confidence interval: 1.6-6.3], P < 0.001). CONCLUSION Overweight and lower stoma height are correlated with the presence of skin disorders. Construction of a well-elevated stoma can reduce skin disorders associated with temporary ileostomy construction.
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Affiliation(s)
- Shingo Maeda
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Akira Ouchi
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan.
| | - Koji Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Takashi Kinoshita
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Taihei Oshiro
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Tetsuya Abe
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa, Nagoya, Aichi, 464-8681, Japan
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Shao W, Wang H, Chen Q, Zhao W, Gu Y, Feng G. Enhanced recovery after surgery nursing program, a protective factor for stoma-related complications in patients with low rectal cancer. BMC Surg 2020; 20:316. [PMID: 33276751 PMCID: PMC7716511 DOI: 10.1186/s12893-020-00978-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/22/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This study aimed to investigate the association between enhanced recovery after surgery (ERAS) nursing program and stoma-related complications (SRCs) and prognosis in patients with low rectal cancer (LRC) undergoing abdominoperineal resection with sigmoidostomy. METHODS LRC patients who underwent elective abdominoperineal resection with sigmoidostomy between May 2016 and May 2019 were retrospectively enrolled. The occurrence of early major or minor SRCs (within postoperative 30 days) was set as the primary end-point. Clinicopathological variables and laboratory tests were compared between patients with or without SRCs. The univariate and multivariate logistic regression analyses were performed to investigate risk factors for SRCs. Hospitalization satisfaction-related and prognosis-related variables were compared between LRC patients with or without ERAS nursing program. RESULTS A total of 288 patients were enrolled and the incidence of SRCs was 26.7% (77/288). ERAS nursing program was the only independent risk factor for SRCs in LRC patients (OR 2.04, 95%CI 1.31-3.12, P = 0.016) by the multivariate logistic regression analysis. Moreover, ERAS nursing program was associated with higher hospitalization satisfaction rate, faster bowel function recovery, better psychological status, and higher quality of life. CONCLUSIONS ERAS nursing program was a protective factor for SRCs and associated with improved prognosis in LRC patients undergoing elective abdominoperineal resection with sigmoidostomy.
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Affiliation(s)
- Weiling Shao
- Department of General Surgery, Taizhou People's Hospital, Taizhou, China
| | - Honggang Wang
- Department of General Surgery, Taizhou People's Hospital, Taizhou, China
| | - Qun Chen
- Department of General Surgery, Taizhou People's Hospital, Taizhou, China
| | - Wen Zhao
- Department of General Surgery, Taizhou People's Hospital, Taizhou, China
| | - Yulian Gu
- Department of General Surgery, Taizhou People's Hospital, Taizhou, China
| | - Guoqin Feng
- Department of Nursing, Taizhou People's Hospital, No. 366 Taihu Road, Taizhou, 225300, Jiangsu Province, China.
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Abstract
Introduction Ileostomies are life-saving procedures used for temporary fecal diversion in complicated cases of ileal perforation. However, an ileostomy is associated with several complications. The goal of this study was to determine the frequency and complications of ileostomy in the Jinnah Postgraduate Medical Centre, Karachi, Pakistan. Methodology We conducted a longitudinal observational study from July 2019 to July 2020. All patients older than age 12 receiving an ileostomy were included. Patient examinations were conducted on the first postoperative day and were assessed for hemorrhage and necrosis. Examinations were conducted on the seventh postoperative day to assess stoma retraction, stenosis, prolapse, and high-output fistula. Patients were monitored via follow-up in the outpatient clinic every 15 days to record any complications for three months until the reversal was performed. All data were analyzed using IBM SPSS Statistics for Windows, Version 25.0. (Armonk, NY: IBM Corp.). Result A total of 84 patients who received ileostomies were included in the study. Most patients were male (n=62; 73.8%), and 22 were female (26.19%). Of the 84 patients in our study, 34 (40.48%) had tuberculous intestine, 23 (27.38%) had typhoid ileal perforation, 23 (27.38%) were trauma patients, and four patients (4.7%) had gangrenous appendicular perforation. 23 patients (27.3%) were discharged with no complications, and 61 patients (72.69%) developed complications. The most common complication was skin excoriation (19.4%), followed by wound infection (13%), nonfunctioning stoma (11.9%), prolapse and stenosis (6%), retraction (4.7%), high-output fistula (3.5%), parastomal hernia and necrosis (2.3% each), and hemorrhage (1.1%). Conclusion Ileostomy is a common and lifesaving surgical diverting procedure. It is still common in our clinic due to late presentation by patients who need the procedure. Complications are common but manageable. Therefore, it is essential to recognize these complications and manage them early to reduce the morbidity of the patients.
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Affiliation(s)
- Ayesha Mehboob
- General Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Sughra Perveen
- General Surgery, Jinnah Post Graduate Medical Centre, Karachi, PAK
| | - Mazhar Iqbal
- General Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | - Abdul Waheed
- General Surgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Evaluation of negative-pressure wound therapy for surgical site infections after ileostomy closure in colorectal cancer patients: a prospective multicenter study. Surg Today 2020; 50:1687-1693. [PMID: 32638132 DOI: 10.1007/s00595-020-02068-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Surgical site infection (SSI) occurs at a high rate after ileostomy closure. The effect of preventive negative-pressure wound therapy (NPWT) on SSI development in closed wounds remains controversial. We conducted a prospective multicenter study to evaluate the usefulness of preventive NPWT for SSI after ileostomy closure. METHODS From January 2018 to November 2018, 50 patients who underwent closure of ileostomy created after surgery for colorectal cancer participated in this study. An NPWT device was applied to each wound immediately after surgery and then treatment was continued for 3 days. The primary endpoint was 30-day SSI, and the secondary endpoints were the incidence of seroma, hematoma, and adverse events related to NPWT. RESULTS No patients developed SSI, seroma, or hematoma. Adverse events that may have been causally linked with NPWT were contact dermatitis in two patients and wound pain in one patient, and there were no cases of discontinuation or decompression of NPWT. CONCLUSION The use of NPWT following ileostomy closure may be useful for reducing the development of SSI in colorectal cancer patients. This is a prospective multicenter pilot study and we are planning a comparative study based on these successful results. TRAIL REGISTRATION Registration number: UMIN000032053 ( https://www.umin.ac.jp/ ).
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Tsujinaka S, Tan KY, Miyakura Y, Fukano R, Oshima M, Konishi F, Rikiyama T. Current Management of Intestinal Stomas and Their Complications. J Anus Rectum Colon 2020; 4:25-33. [PMID: 32002473 PMCID: PMC6989127 DOI: 10.23922/jarc.2019-032] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/30/2019] [Indexed: 12/14/2022] Open
Abstract
Inappropriate stoma site, improper management of stoma, and stoma complications lead to diminished quality of life of ostomates. Healthcare professionals involved in stoma creation and/or care should have the fundamental and updated knowledge of the management of stomas and their complications. This review article consists of the following major sections: principles of perioperative patient management, early complications, and late complications. In the "principles of perioperative patient management" section, the current concepts and trends in preoperative education, stoma site marking, postoperative education, and patient educational resources are discussed. In the "early complications" section, we have focused on the etiology and current management of ischemia/necrosis, fluid and electrolyte imbalances, mucocutaneous separation, and retraction. In the "late complications" section, we have focused on the etiology and current management of parastomal hernia, stoma prolapse, parastomal varices, and pyoderma gangrenosum. Pre- and postoperative patient education facilitates the patient's independence in stoma care and resumption of normal activities. Healthcare providers should have basic skills and updated knowledge on the management of stomas and complications of stomas, to act as the first crisis manager for ostomates.
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Affiliation(s)
- Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kok-Yang Tan
- Department of Surgery, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Rieko Fukano
- Department of Nursing, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Mitsuko Oshima
- Department of Nursing, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Fumio Konishi
- Department of Surgery, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Risk factors for the incidence and severity of peristomal skin disorders defined using two scoring systems. Surg Today 2019; 50:284-291. [DOI: 10.1007/s00595-019-01876-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/16/2019] [Indexed: 12/20/2022]
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Takeda M, Takahashi H, Haraguchi N, Miyoshi N, Hata T, Yamamoto H, Matsuda C, Mizushima T, Doki Y, Mori M. Factors predictive of high-output ileostomy: a retrospective single-center comparative study. Surg Today 2018; 49:482-487. [PMID: 30594951 PMCID: PMC6526144 DOI: 10.1007/s00595-018-1756-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/08/2018] [Indexed: 12/13/2022]
Abstract
Purpose High-output syndrome (HOS) is a complication of ileostomy, which can affect quality of life significantly; however, its exact cause remains unknown. The aim of this study was to establish the frequency, as well as the preoperative and intraoperative factors predictive of HOS. Methods The subjects of this study were 164 consecutive patients who underwent colorectal cancer surgery with ileostomy construction at our institute between January, 2011 and August, 2018. Thirteen patients with postoperative complications reported as causes of HOS, including intraperitoneal abscess, paralytic ileus, and outlet obstruction, were excluded. We used a logistic regression analysis to identify the factors predictive of HOS. Results HOS developed in 36 of the 151 patients (23.8%). There were significantly more diabetic patients in the HOS group (P = 0.03), but other patient factors such as age, gender, body mass index, and use of daily laxatives were not significantly different between the groups. The HOS group had significantly more cases of total proctocolectomy (P = 0.04), but other surgical factors such as operative time, and blood transfusion were not significantly different between the two groups. Conclusions These results indicate that diabetes and total proctocolectomy are preoperative predictors of HOS, allowing for the possibility of early intervention via post-surgical treatment.
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Affiliation(s)
- Mitsunobu Takeda
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hidekazu Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Naotsugu Haraguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Norikatsu Miyoshi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Taishi Hata
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hirofumi Yamamoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
- Division of Health Sciences, Department of Molecular Pathology, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita,, Osaka, 565-0871, Japan
| | - Chu Matsuda
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Postoperative complications of pediatric patients with inflammatory bowel disease treated with vedolizumab. J Pediatr Surg 2018; 53:1330-1333. [PMID: 29370898 DOI: 10.1016/j.jpedsurg.2017.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 12/04/2017] [Accepted: 12/10/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Vedolizumab is a biologic, which inhibits leukocyte adhesion in the gut and is used to treat ulcerative colitis (UC) and Crohn's disease (CD). Little is known of the surgical outcomes in patients treated with vedolizumab. We reviewed the postoperative complications in a cohort of pediatric UC and CD patients treated with vedolizumab. METHODS We identified pediatric UC and CD patients treated with vedolizumab at our institution from 2014 to 2016. We compared postoperative outcomes in the vedolizumab exposed group to a cohort of vedolizumab naïve patients who required diverting ileostomy. RESULTS Of the 31 patients who were treated with vedolizumab, 13 patients required surgery. Eight of 13 (62%) vedolizumab exposed patients had a postoperative complication, including mucocutaneous separation at the stoma (3), readmission for pain/dehydration (2), bowel obstruction at the ostomy, and intraoperative colonic perforation. In comparison, four of 16 (25%) vedolizumab naive patients had a postoperative complication, including readmission for ileus and for high stoma output with mucocutaneous separation. p=0.07. CONCLUSIONS At our institution, patients treated with vedolizumab prior to surgery have a high prevalence of postoperative complications, notably mucocutaneous separation of the stoma. A prospective, multicenter study is needed to determine if these observed complications are attributable to vedolizumab. LEVEL OF EVIDENCE Level III.
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