Background.
Enteroatmospheric fistulas (EAF) that occur during the use of the “open abdomen” surgical tactics are a complex surgical pathology with a high mortality rate.
The aim.
To assess the ...effectiveness of treatment of various forms of enteroatmospheric fistulas in patients with postoperative peritonitis using vacuum aspiration technology.
Methods.
We assessed the results of the surgical treatment of 46 patients with EAF in the late course of postoperative peritonitis (PP). Three clinical and morphological groups were distinguished: group 1 (n = 24) – EAF in small wounds of the anterior abdominal wall; group 2 (n = 15) – EAF opening into limited cavities; group 3 (n = 7) – EAF opening into laparostoma wounds. In group 1, a fistula was formed using continuous aspiration devices or VAC systems. In group 2, we used continuous aspiration of intestinal contents from the cavity. In group 3, laparostoma was treated using vacuum devices with isolation of the intestinal fistula and simulation of a floating enterostoma.
Results.
Group 3 of patients with EAF was characterized by a high flow rate (1224.2 ± 210.3 ml), duration of treatment (87.3 ± 12.5 day), extensive laparostoma (335.4 ± 14.3 сm2), high mortality rate (57.1 %). The best results of treatment were obtained in groups 1 and 2. The flow rate was 675.8 ± 154.3 and 541.3 ± 114.1 ml, the duration of treatment was 2 or 3 times less (37.7 ± 6.1 and 26.4 ± 5.2 days), the mortality rate was 8.3 % and 6.7 % respectively.
Conclusion
. EAF that occur when using the “open abdomen” surgical tactics due to the impossibility of their isolation in extensive wounds of the anterior abdominal wall are complicated clinical and morphological forms. For their treatment, it is advisable to use VAC systems, aimed at the treatment of both the anterior abdominal wall wound itself and the intestinal fistula opening into it for its gradual extraterritorialization by modeling a floating enterostoma in a vacuum device.
Purpose
This study aims to provide an overview of all complications that may occur after construction of an ileostomy or colostomy (loop or end) in daily practice.
Methods
Between July 2007 and April ...2008, all adult patients who underwent any type of intestinal stoma formation were asked to participate in this prospective cohort study. All relevant patient characteristics were gathered. Patients were evaluated for complications eight times in a 1-year postoperative period. Enterostomal therapy nurses scored complications on specially designed forms.
Results
One hundred patients were included; two patients were lost before initial follow-up (FU). During FU, 21% of the patients deceased, and 15% were lost, physically unable to visit the outpatient clinic or withdrew from FU. In 37% of the patients, bowel continuity was restored. Only 26% of the patients were able to complete FU. Overall, 82% of all the patients had one or more stoma-related complications. Most common complications were skin irritation (55%), fixation problems (46%) and leakage (40%). Superficial necrosis, bleeding and retraction occurred in 20%, 14% and 9% of patients, respectively. More stoma related complications were found in stoma’s on inappropriate locations.
Conclusions
In this heterogenic patient population with formation of different stoma types, a high complication rate was detected.
Aim
To present the Danish Stoma Database Capital Region with clinical variables related to stoma creation including colostomy, ileostomy and urostomy.
Method
The stomatherapists in the Capital Region ...of Denmark developed a database covering patient identifiers, interventions, conditions, short‐term outcome, long‐term outcome and known major confounders. The completeness of data was validated against the Danish National Patient Register.
Results
In 2013, five hospitals included data from 1123 patients who were registered during the year. The types of stomas formed from 2007 to 2013 showed a variation reflecting the subspecialization and surgical techniques in the centres. Between 92 and 94% of patients agreed to participate in the standard programme aimed at handling of the stoma and more than 88% of patients having planned surgery had the stoma site marked pre‐operatively.
Conclusion
The database is fully operational with high data completeness and with data about patients with a stoma from before surgery up to 12 months after surgery. The database provides a solid basis for professional learning, clinical research and benchmarking.
A retrospective analysis of enteric stomas performed at Cook County Hospital was undertaken to evaluate stoma complications per stoma type and configuration and operating service. In addition, we ...attempted to identify factors predictive of increased enteric stoma complications.
From 1976 to 1995, data cards on 1,616 patients with stomas were compiled by Cook County Hospital enteric stomal therapists. Data card information included age, gender, weight, early and late stoma complications, emergency status, operating service, type and configuration of the stoma, and whether the patient was seen preoperatively by an enteric stomal therapist. Data were then analyzed using a logistic regression model to identify those variables that influenced the rate of complications.
There were 553 (34 percent) patients with complications. Among the total complications, 448 (28 percent) occurred early (<1 month postoperative), and 105 (6 percent) occurred late (>1 month). The most common early complications were skin irritation (12 percent), pain associated with poor stoma location (7 percent), and partial necrosis (5 percent). The most common late complications were skin irritation (6 percent), prolapse (2 percent), and stenosis (2 percent). The enteric stoma with the most complications was the loop ileostomy (75 percent). The enteric stoma with the least complications was the end transverse colostomy (6 percent). The general surgery service had the most complications (47 percent), followed by gynecology (44 percent), surgical oncology (37 percent), colorectal (32 percent), pediatric surgery (29 percent), and trauma (25 percent). Age, operating service, enteric stoma type and configuration, and preoperative enteric stomal therapist marking were found to be variables that influenced stoma complications.
Complications from enteric stoma construction are common. Preoperative enteric stoma site marking, especially in older patients, and avoiding the ileostomy, particularly in the loop configuration, can help minimize complications.
Zusammenfassung
Einleitung
Durch die zunehmenden Erfahrungen auf dem Gebiet der laparoskopisch-kolorektalen Eingriffe stellen auch offene Voroperationen und interenterische Adhäsionen, wie sie auch ...bei Patienten mit einer Hartmann-Situation zu finden sind, keine grundsätzlichen Kontraindikationen mehr dar. Das Ziel der Untersuchung ist die Klärung der Frage, ob die Laparoskopie für die Kontinuitätswiederherstellung bei vorhergehend zumeist notfallmäßiger Laparotomie ein geeignetes Verfahren darstellt und zur Reduktion der Morbidität und Letalität beitragen kann.
Methoden
In der prospektiven Datenbank „Laparoskopische kolorektale Chirurgie“ wurden alle Patienten mit laparoskopischer Kontinuitätswiederherstellung nach Hartmann-Situation, die im Beobachtungszeitraum von 01/2000 bis 12/2010 in der Klinik für Chirurgie der Universität Lübeck operativ versorgt wurden, erfasst. Die Daten wurden retrospektiv ausgewertet. Ein besonderer Fokus lag auf der Indikation zur Diskontinuitätsresektion, dem intraoperativen Befund, der Operationszeit, dem postoperativen Analgetikabedarf, der Zeit bis zum Wiedereinsetzen der Darmtätigkeit, der Verweildauer (VD) sowie der peri- und postoperativen Morbidität und Letalität.
Ergebnisse
Die wesentlichste Indikation zur Anlage einer Hartmann-Situation bestand bei perforierter Sigmadivertikulitis. Eine laparoskopische Kontinuitätswiederherstellung erfolgte bei 19 Patienten. Intraoperativ wurde bei 3 Patienten konvertiert (15,7%). Die mediane Operationszeit betrug 202 min (75–245), der postoperative kontinuierliche Analgetikabedarf lag im Median bei 7 Tagen (6–10), der Abschluss des Kostaufbaus war im Median nach 3 (2–16) Tagen abgeschlossen. Zum Wiedereinsetzen der Darmtätigkeit kam es im Median nach 3 (2–4) Tagen, die Verweildauer betrug 10 (8–13) Tage. Postoperativ wurden 3 (15,7%) Minorkomplikationen (2-mal Pneumonie, 1-mal protrahierte Darmatonie) und 4 (21%) Majorkomplikationen mit Notwendigkeit einer chirurgischen Intervention (2-mal Wundinfektion, 1-mal Adhäsionsileus, 1-mal Trokarhernie) beobachtet. Der mediane Follow-up betrug 8 Monate (1–20). Es gab keine peri- oder postoperative Letalität.
Schlussfolgerung
In der vorliegenden Untersuchung kann die grundsätzliche Machbarkeit der laparoskopischen Versorgung gezeigt werden. Allerdings setzt die laparoskopische Technik eine fortgeschrittene Expertise des Operateurs voraus und bedarf stets einer kritischen Nutzen-Risiko-Abwägung in der individuellen Situation.
Parastomal Hernia Cengiz, Y.; Israelsson, L.A.
European surgery,
February 2003, Letnik:
35, Številka:
1
Journal Article
Recenzirano
Background: Parastomal hernia is a common complication after the construction of enterostomas and is difficult to treat.
Methods: Proposals to avoid parastomal hernia are reviewed, analysing the ...current literature.
Results: The rate of parastomal hernia is probably more than 30 % in general surgical practice. Bringing out the enterostomy through a laparotomy wound has been disastrous in terms of infection, wound dehiscence and herniation. Bringing out the stoma through the rectus abdominis muscle has been associated with a lower rate of parastomal hernia. After repair of parastomal hernia, the lowest rates of recurrence have been achieved with methods using a prosthetic mesh. The sublay technique is then the theoretically most attractive method.
Conclusions: Parastomal hernia is a major surgical problem. The complication rate after the construction of enterostomas and the recurrence rate after repair of parastomal hernias are related to the choice of surgical technique.
Zusammenfassung: Grundlagen: Nach Anlegen einer perkutanen Enterostomie sind Parastomie‐Hernien eine häufige, schwierig zu behandelnde Komplikation.
Methodik: Vorschläge zur Vermeidung von Parastomie‐Hernien werden anhand einer Literaturübersicht dargestellt.
Ergebnisse: Parastomie‐Hernien werden in 30 % der Patienten beobachtet. Das Herausleiten einer Enterostomie durch die Laparotomie‐Wunde ist durch Infektionen, Wunddehiszenz und Herniation mit vielen Komplikationen verbunden. Wird das Stoma durch den M. rectus abdominis herausgeleitet, ist die Rate an Parastomie‐Hernien geringer. Zur Vermeidung von Rezidiven nach Verschluß von Parastomie‐Hernien hat sich die Verwendung eines Kunststoffnetzes in Sublay‐Technik besonders bewährt.
Schlußfolgerungen: Parastomie‐Hernien sind häufig ein chirurgisches Problem. Die Komplikations‐ und Rezidivrate nach Anliegen eines Enterostomas bzw. nach Korrektur einer Parastomie‐Hernie sind von der Wahl der chirurgischen Technik abhängig.
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