Stoma care: an update
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Each year an estimated 13 500 stoma surgeries are carried out in the UK ( Kettle, 2019 ). Stoma surgery may involve the formation of a colostomy or an ileostomy. The person with a stoma may require help and support from the community nurse. This article aims to update readers on the indications for colostomy and ileostomy surgery and to enable them to support ostomates to reduce the risks of complications.Keywords:
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We have analysed the activities of a hospital-based stomatherapy service between 1980 and 1983. The average numbers of patients seen per annum included 395 out-patients, 307 in-patients and 116 home visits. Of the 276 in-patients with colostomies, 72% had underlying malignant disease; 17% were performed as emergencies and 51% were temporary stomas. Hospital mortality for patients with a temporary stoma was 19% and only 59% had their temporary stoma reversed. Only 45% of colostomy patients received preoperative counselling and 11% had no regular follow-up. Complications were recorded at some stage after colostomy in 25% but only 10% required surgical refashioning. Of the 184 in-patients with ileostomies, 52% had ulcerative colitis and 41% had Crohn's disease. Only 13% of ileostomies were performed as emergencies, and only 11% were temporary. In contrast to colostomy, 83% of ileostomy patients received preoperative counselling and adequate follow-up was provided for 98% of patients. Complications were recorded in 57% of patients after ileostomy but surgical reconstruction was needed in only 18%.
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Aim: To study indications, types and different uses of stoma. To study causes of complications, management to them; and time interval between stoma creation and closure. Method : From July 2010 to October 2012,266 patients of intestinal stoma including colostomy, ileostomy, urostomy were studied in 28 months in all age group. Results and conclusion : Out of 266 cases of stoma studied 188 cases (70.6%) were of colostomy, 78 cases (29.3%) were of ileostomy. Stoma construction is more common in age group >12yrs (61.3%) with male preponderance (76.3%). Most of the stomas were done on emergency (60.1%) basis by junior doctors without preoperative bowel preparation. Most of stomas were temporary (77.5%) and closure was done after 6 wks interval. Complications are more with ileostomy (53.8%) than colostomy. Complications can be minimized by preoperative bowel preparation, availability of stoma therapist, surgery in elective hours and by senior doctor .
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Abstract Patients undergoing colorectal surgery who required a defunctioning stoma were randomly allocated to receive either a loop ileostomy (n = 23) or transverse loop colostomy (n = 24). Assessment was made during construction, immediately postoperatively, during the period of outpatient supervision and before and after stoma closure. The ileostomy was associated with significantly less odour than the colostomy (P<0.01) and required significantly less appliance changes (P<0.05). Furthermore eleven patients (58 per cent) with a colostomy experienced three or more problems with stoma management compared with only three patients (18 per cent) with an ileostomy (P<0.05). Wound infection was also significantly more common after closure of the colostomy compared with the ileostomy. Both types of stoma were demonstrated objectively to defunction the distal bowel almost completely. These results indicate that a loop ileostomy is the procedure of first choice when a stoma is needed to defunction the distal colorectum.
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Can a person with an intestinal stoma lead a normal life? Most patients can. But they must be rehabilitated quickly. If patients undergoing colostomy are instructed before and after surgery about irrigating the stoma, most can stop using an appliance in days or weeks. Patients with ileostomies present more of a problem, but they too can return to a useful life.
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Each year an estimated 13 500 stoma surgeries are carried out in the UK ( Kettle, 2019 ). Stoma surgery may involve the formation of a colostomy or an ileostomy. The person with a stoma may require help and support from the community nurse. This article aims to update readers on the indications for colostomy and ileostomy surgery and to enable them to support ostomates to reduce the risks of complications.
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The major cutaneous problems formerly associated with ileostomy have been virtually eliminated by appliances that can be held in place by adhesives. Advances in surgical procedures for initial establishment, subsequent care, and occasionally necessary revision of the stoma have rendered possible the complete rehabilitation of most ileostomy patients. Improved surgical methods have similarly been found to prevent or correct complications of colostomy, e. g., necrosis, retraction, or stenosis of the stoma. The colostomy patient can usually attain control of feces by regular irrigations without the need of wearing a bag and thereafter rarely has psychological or social problems.
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Pre-operative preparation and postoperative education are both essential elements for the recovery and successful discharge into the community of patients with a stoma. The ultimate goal of any stoma care nurse is to provide patients with the necessary practical skills and knowledge to return to a lifestyle they enjoyed before surgery (Abrahams, 1984). The basic pre- and postoperative planning that is required for patients who have had bowel surgery under elective conditions with a confirmed colorectal pathology, for example, rectal cancer or inflammatory bowel disease, is described below. Stomas include colostomy, ileostomy, jejunostomy and urostomy. They can either be end stomas (one segment of bowel is exteriorised), or loop stomas (two segments of bowel are exteriorised), and they may be permanent or temporary.
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The closure of a temporary stoma, whether a colostomy or ileostomy, may be eagerly awaited by the stoma patient and encouraged by the surgeon. However, the procedure is not without risk, complications of stoma reversal may include disruptive bowel changes, wound infection, sepsis and death. The decision to restore intestinal continuity is often underestimated, and the reversal of a colostomy after a Hartmann's procedure implies a high mortality and low percentage of restoration of intestinal continuity. In this article, Pat Black assesses the effects of colostomy and ileostomy reversal on patient outcome.
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Introduction: Stomas provide fecal diversion in emergent and elective settings. There are several factors that should be considered when selecting which type of stoma should be created for a particular patient and condition. These include the indication for the stoma (fecal diversion, intestinal decompression), the site of intestinal pathology, available stoma sites, ease of caring for the stoma, and difficulty of subsequent stoma reversal. The aim of this study is to evaluate our clinical experience with stomas. Methods: The medical charts and computer-based data of all patients with stomas operated in our clinic between January 2008 and May 2016 were documented retrospectively. Demographics, indications for stoma placement, the type of stomas, stoma related complications, and the timing of stoma closure were recorded. Overall morbidities and the survival of patients were also evaluated. The mean follow-up period was 60 months (range 2-96). Results: A total of 204 patients (123 male and 81 female) were operated and the mean age was 54 (range, 18–92). Type of stomas created were jejunostomy (n= 14, 6.8 %), ileostomy (n=105, 51.4 %;), colostomy (n=81, 39.7 %), and ileostomy+colostomy (n=4, 1.9 %). The number of emergent conditions (n=119, 58.3 %) pulled ahead of the elective cases (n=85, 41.6%). The primary reason of ostomy placement was malignancies (n=140, 68.6%). While mostly preferred type of stoma for cancer surgery was colostomy and loop/end ileostomy (n=60, 74 %, n=90, 85.7 %, respectively); jejunostomy was seen to be obligatory for mesenteric ischemia (n=12, 85.7 %), exposing these patients to short bowel syndrome (n=10, 83 %). Overall complication rate was 14.7 % (n=30). Parastomal hernia, stenosis and necrosis were equally seen complications (n=9, 4.4 % each, respectively). Prolapsus was seen in only 3 patients (1.4 %). The average time for closure was 280 days (range 14-1436). In over 1/3 of patients (n=79, 38.7%); the ostomies could not be closed due to ongoing chemo/radiotherapy (n=32, 40 %), Miles operation (n=24, 30 %), failed intestinal function due to short bowel syndrome (n=9, 11 %), early mortality (n=8, 10 %), and other reasons (n=6, 7 %). The mortality was seen mostly in jejunostomy-created patients (n=7, 50 %). Conclusion: Colorectal carcinomas and short bowel syndrome are the main reasons for permanent stomas. Even in attentive surgical approach in creation of stomas, complication rates and morbidity are relatively high. References: 1. Strong SA. The Difficult Stoma: Challenges and Strategies. Clin Colon Rectal Surg. 2016;29:152–9. 2. Öistämö E, Hjern F, Blomqvist L, Falkén Y, Pekkari K, Abraham-Nordling M. Emergency management with resection versus proximal stoma or stent treatment and planned resection in malignant left-sided colon obstruction. World J Surg Oncol. 2016;14(1):232.
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