•What is currently known about this topic?•Stoma stapling may be successful for treating stoma prolapse and retraction in adults, but there are no information about the technique in children.•What ...new information is contained in this article?•Stoma stapling has low success rate, but has few complications and is easy to perform.
Stoma prolapse and retraction are common stoma complications, and there are many available techniques for correction. Results of stoma stapling to treat prolapse/-retraction in children has not yet been reported. The aim of this study was, therefore, to present results with this technique.
Retrospective study with review of medical records of patients treated with stoma stapling during 2001-2022.
19 patients were identified; 12 boys (63%). Most common underlying diagnoses were Hirschsprung's disease and anorectal malformation. There were ten colostomies and nine ileostomies. Stapling was performed under general anesthesia. The enterostomy was stapled longitudinally along the whole length of the extra-abdominal part of the stoma at three places, usually with 1200 between each stapler row. A knifeless GIA stapler was used. A total of 32 stapling procedures were performed, median 1 (1-5) per patient. Median operating time was 16 (4-51) minutes, 22% of patients needed opiates the first 24 hours postoperatively, and median postoperative stay was 1 (1-4) day. There were no complications related to the stapling procedures. Success was defined as no prolapse or retraction after maximum two stapling procedures. Five (26%) patients had successful outcome. Underlying diagnosis, type of stoma (colostomy/ileostomy) or age at stoma formation did not influence the success rate.
Stoma stapling to treat stoma prolapse/retraction was only successful in 1/4 of patients. Although the success rate was rather low, we suggest that stoma stapling may be attempted once because it is a mini-invasive procedure.
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.
This review aimed to highlight the etiology, diagnosis, treatment, and prevention of obstructive and secretory complications associated with diverting ileostomy (DI). Obstructive complications at the ...stoma site are termed stoma outlet obstruction (SOO) or stoma-related obstruction (SRO). The incidence of SOO/SRO is 5.4%-27.3%, and the risk factors are multifactorial; however, the configuration of the stoma limb and the thickness of the rectus abdominis muscle (RAM) may be of particular concern. Trans-stomal tube decompression is initially attempted with a success rate of 33%-86%. A thick RAM may carry the risk of recurrence. Surgical refinement, including a wider incision of the anterior sheath and adequate stoma limb length, avoids tension and immobility and may decrease SOO/SRO. Secretory complications of DI are termed high output stoma (HOS). Persistent HOS lead to water and sodium depletion, and secondary hyperaldosteronism, resulting in electrolyte imbalances, such as hypomagnesemia. The incidence of HOS is 14%-24%, with an output of 1000-2000 mL/d lasting up to three days. Treatment of HOS is commenced after excluding postoperative complications or enteritis and includes fluid intake restriction, antimotility and antisecretory drug therapies, and magnesium supplementation. Intensive monitoring and surveillance programs have been successful in decreasing readmissions for dehydration.
Purpose: Stoma site marking is an important factor in reducing stoma-related complications, thereby influencing the long-term quality of life in the elective setting. The impact of preoperative stoma ...site marking in emergency stoma creation is largely unknown. We aimed to determine whether preoperative stoma site marking in emergency stoma creation reduces stoma-related complications.Methods: Patients who underwent emergency stoma creation at our hospital between 2009 and 2022 were examined by reviewing our prospective database and retrospective chart review. Subjects were classified into the “marking (+)” or “marking (-)” group according to stoma site marking (194 and 151 patients, respectively). The changes in the frequency of stoma marking over time and the effects of stoma marking on stoma-related complications were analyzed.Results: The overall frequency of grade 2 or higher stoma-related complications was lower in the marking (+) group than in the marking (-) group (24% vs 36%, p=0.010). Stoma site marking was associated with fewer soma site bleeding (2%vs 10%, p<0.001), and the frequency of peristomal dermatitis was also lower (10%) in the marking (+) group (vs 18%, p=0.042). Moreover, the lack of stoma site marking was an independent risk factor for overall stoma-related complications (adjusted odds ratio: 1.69, p=0.034).Conclusion: Preoperative stoma site marking was associated with stoma-related complications in emergency surgery. The clinical significance of our attempt is worth validating with prospective studies.
Objection
This study was conducted to examine the effect of self-efficacy levels on stoma adaptation in patients with intestinal stoma.
Methods
The study was planned as descriptive and analytical and ...was carried out in the university adult hospital general surgery stoma and wound care unit. Sixty-two patients with intestinal stoma who met the admission criteria were included in the study. Ethics committee approval, institutional permission and patient consent were obtained for the study. Data were collected from June to September 2021 using the Descriptive Feature Information Form, the Self Efficacy Scale for Individuals with Ostomy, and the Ostomy Adjustment Inventory (OAI-23). Data were analyzed by number, percentage, mean, standard deviation, Mann Whitney U, t test, ANOVA, Pearson’s correlation, and linear regression analysis tests.
Results
The mean age of the patients with intestinal stoma who participated in our study was 53.12 ± 12.30 years; 71% of them were women, 83.9% were married, and 32.2% were primary and secondary school graduates. The duration of stoma was 8.45 ± 4.69 months, 80.6% of them were opened due to cancer, and 54.8% of them had temporary colostomy. There was a weak and significant correlation between the duration of stoma of the patients and their self-efficacy and stoma adaptation, and as their self-efficacy levels increased, their stoma adaptation increased (
p
< .05).
Conclusions
Self-efficacy is one of the important factors affecting patients’ adaptation with the stoma. For this reason, it is recommended to plan trainings to support the self-efficacy levels of patients and to conduct interventional studies in this direction.
Purpose
The published data on the outcomes of an operative repair for stoma prolapse are limited. This study aimed to clarify the long-term outcomes of stapler repair with anastomosis for stoma ...prolapse.
Methods
Twenty-four patients (15 men, median age 64 years, range 33–88 years) undergoing 25 stapler repairs with anastomosis were prospectively registered, and their medical records were retrospectively reviewed.
Results
The median length of prolapse was 10 cm (range 5–22). Stoma prolapse repair was performed by means of 16 loop colostomies, four end colostomies, three loop ileostomies, and one end ileostomy. A stapler was used 4.6 times on average (range 4–8). The average operative time and bleeding were 40.8 (range 15–75) min and 40 (range 0–214) mL, respectively. No mortality and morbidity were observed after surgery. A recurrence of stoma prolapse was reported in only one of 25 repairs (4%) at the proximal limb of loop ileostomy during a median follow-up period of 1 year (range 1–120 months). However, a new stoma prolapsed in one untreated limb of loop stoma.
Conclusions
Stapler repair with anastomosis is a safe and minimally invasive treatment option for stoma prolapse with a low recurrence. However, the effectiveness of reparing stoma prolapse on the proximal limb of loop ileostomy might be limited.
Intestinal stoma site selection is one of the key elements in preoperative planning and nursing care of patients with intestinal diseases. It is a medical procedure that should be performed prior to ...any scheduled surgery potentially resulting in a stoma. In emergency surgeries this could be difficult, but an attempt should always be made. Preoperative stoma site selection allows the optimal creation and location of the stoma. The priority is that the stoma should be easily accessible and visible to the patient. A correctly located stoma reduces postoperative complications and improves patients’ quality of life. This work discusses the process and principles of selecting the intestinal stoma site in adult patients prior to scheduled or emergency surgeries. It includes a review of the current literature on this subject. The analysis involved scientific publications from the period between 1 January 2000 and 31 August 2021. Literature searches were conducted in the PubMed and Google Scholar databases, using a mixed combination of the following English and Polish terms: “ostomies”, “intestinal stoma”, “education”, “stoma site selection”, “stoma site marking”, “stoma siting”, “stoma complications”, “peristomal skin complications”, “stomia jelitowa”, “model opieki”, “edukacja”, “wyznaczanie miejsca stomii”, and “powikłania stomijne”. Sixty scientific publications were used to analyse the subject matter of this work.
Background and objective:
Stoma site marking is an important factor in reducing stoma-related complications, thereby influencing the long-term quality of life in the elective setting. The impact of ...preoperative stoma site marking in emergency stoma creation is largely unknown. We aimed to determine whether preoperative stoma site marking in emergency stoma creation reduces stoma-related complications.
Methods:
Patients who underwent emergency stoma creation at our hospital between 2009 and 2022 were examined by reviewing our prospective database and retrospective chart review. Subjects were classified into the “marking (+)” or “marking (−)” group according to stoma site marking (194 and 151 patients, respectively). The changes in the frequency of stoma marking over time and the effects of stoma marking on stoma-related complications were analyzed.
Results:
The overall frequency of grade 2 or higher stoma-related complications was lower in the marking (+) group than in the marking (−) group (24% versus 36%, p = 0.010). Stoma site marking was associated with fewer soma site bleeding (2% versus 10%, p < 0.001), and the frequency of peristomal dermatitis was also lower (10%) in the marking (+) group (versus 18%, p = 0.042). Moreover, the lack of stoma site marking was an independent risk factor for overall stoma-related complications (adjusted odds ratio: 1.69, p = 0.034).
Conclusions:
Preoperative stoma site marking was associated with stoma-related complications in emergency surgery. The clinical significance of our attempt is worth validating with prospective studies.
Aim
Fashioning a defunctioning stoma is common when performing an anterior resection for rectal cancer in order to avoid and mitigate the consequences of an anastomotic leakage. We investigated the ...permanent stoma prevalence, factors influencing stoma outcome and complication rates following stoma reversal surgery.
Method
Patients who had undergone an anterior resection for rectal cancer between 2007 and 2013 in the northern healthcare region were identified using the Swedish Colorectal Cancer Registry and were followed until the end of 2014 regarding stoma outcome. Data were retrieved by a review of medical records. Multiple logistic regression was used to evaluate predefined risk factors for stoma permanence. Risk factors for non‐reversal of a defunctioning stoma were also analysed, using Cox proportional‐hazards regression.
Results
A total of 316 patients who underwent anterior resection were included, of whom 274 (87%) were defunctioned primarily. At the end of the follow‐up period 24% had a permanent stoma, and 9% of patients who underwent reversal of a stoma experienced major complications requiring a return to theatre, need for intensive care or mortality. Anastomotic leakage and tumour Stage IV were significant risk factors for stoma permanence. In this series, partial mesorectal excision correlated with a stoma‐free outcome. Non‐reversal was considerably more prevalent among patients with leakage and Stage IV; Stage III patients at first had a decreased reversal rate, which increased after the initial year of surgery.
Conclusion
Stoma permanence is common after anterior resection, while anastomotic leakage and advanced tumour stage decrease the chances of a stoma‐free outcome. Stoma reversal surgery entails a significant risk of major complications.
Evidence indicates that a common problem for the person with an ostomy is pouch leakage and the development of peristomal skin irritation, which can negatively affect quality of life. While it is ...clear that the pouching system seal leakage can cause profound problems for the person with an ostomy, little information is available on interventions that focus on leakage. To address this gap, an international group of ostomy nurse experts was convened to develop consensus-based practice guidelines to assist ostomy nurses in determining the best pouching system for the patient. The outcomes of these guidelines for the person with a stoma are to decrease leakage and increase security and confidence leading to an increased quality of life. A large-scale Modified Delphi Consensus-Building Process was used to identify key factors in assessing body and stoma profiles to determine the best pouching system. The resulting consensus provides practice guidelines on how to assess body and stoma profiles, engage and educate patients, and when to follow up with patients after hospital discharge or product change.
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