Late stomal complications

The Impact of Colostomy on Inpatient Outcomes Following Primary Total Knee Arthroplasty

Introduction The inpatient postoperative outcomes of patients with colostomies following primary total knee arthroplasty (TKA) have not been well studied in the literature. The purpose of this study was to analyze how colostomy impacts the immediate postoperative outcomes of TKA. Our null hypothesis is that after correcting for common variables, a colostomy does not predispose patients undergoing TKA to surgical site infections (SSIs) and periprosthetic infections. Methods The National Inpatient Sample database was used to retrieve information on colostomy patients and patients without a colostomy who had undergone primary TKA from 2016 to 2019. Patients with colostomies were matched to a cohort of non-colostomy control groups in a 1:1 propensity score algorithm by age, sex, race, and pertinent comorbidities. Patient demographic characteristics, comorbidities, length of hospital stay (LOS), total hospital charges, and inpatient complications were compared. Results Following propensity score matching, 399 patients with colostomies were compared to 385 patients without a colostomy (control). The colostomy group had a prolonged LOS (3.15 ± 2.67 vs 2.44 ± 3.15 days, p<0.001) compared to the control group. Also, the colostomy group had significantly higher incidences of acute kidney injury (AKI) (6.02% vs 1.56%, odds ratio (OR): 4.04, 95% confidence interval (CI): 1.63-10.00, p<0.001), blood loss anemia (20.55% vs 13.25%, OR: 1.69, 95% CI: 1.16-2.48, p=0.008), and blood transfusions (4.01% vs 0.26%, OR: 16.04, 95% CI: 2.12-121.56, p<0.001). There was no difference in periprosthetic infection, superficial SSI, or deep SSI. Conclusion Patients with colostomies face a notably higher risk of experiencing AKI, blood loss anemia, and blood transfusion requirements during the immediate postoperative period following primary TKA. Despite the perceived risk of postoperative infection in colostomy patients, this patient population is not at an increased risk of developing periprosthetic infection, superficial SSI, or deep SSI following TKA.

End-colostomy parastomal hernia repair: a systematic review on laparoscopic and robotic approaches

INTRODUCTION

Parastomal hernia (PSH) is the most common and challenging complication after stoma creation, with an estimated 50% incidence 2 years after the index surgery. Mesh repair is the treatment of choice. Laparoscopic and/or robotic approaches allow acceptable outcomes.

MATERIALS AND METHODS

A systematic literature review from January 2012 to November 2023 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Embase, PubMed, and Scopus search were performed to select articles dealing with minimally invasive surgical treatment for PSH after end colostomy.

RESULTS

603 studies were found, and 24 were chosen. When compared to open surgery, laparoscopy showed decreased postoperative complications and recurrence. The main laparoscopic approaches are the keyhole (KH), the Sugarbaker (SB), and the sandwich technique. Continuous improvement in surgery, mesh technology, and surgeons' expertise led to an amelioration of surgical outcome and recurrence rate after repair. Recent studies showed comparable outcomes for SB and KH techniques, while novel surgical approaches have been proposed in an attempt to further increase the operative and long-term results. Reports on PSH robotic repairs are scarce and describe small series results, suggesting a role of the initial learning curve as a risk factor for complications.

CONCLUSION

End-colostomy PSH surgical repair still represents a challenge for surgeons. Recent evidence has not shown a significant advantage in postoperative complications and recurrence with a specific repair among SB, KH, and sandwich technique. The paucity of data on robotic surgery does not allow to draw definitive conclusion. Further primary, multicentric, and larger cohort studies are needed.

Management of the Difficult Stoma

Fecal ostomy creation is a commonly performed procedure with many indications. Better outcomes occur when preoperative patient education and stoma site marking are provided. Despite a seemingly simple operation, ostomy creation is often difficult and complications are common. Certain risk factors, particularly obesity, are strongly associated with stoma-related complications. The ability to optimize the ostomy and stoma in the operating room and to troubleshoot frequently encountered post-operative stoma-related issues are critical skills for surgeons and ostomy nurses alike.

Risk factors for stoma prolapse after laparoscopic loop colostomy

BACKGROUND

Stoma prolapse (SP) is a common stoma-related complication, particularly in loop colostomies. This study aimed to investigate potential risk factors for SP development after laparoscopic loop colostomy.

METHODS

In total, data from 140 patients who underwent laparoscopic loop colostomy were analyzed between September 2016 and March 2022. Risk factors for SP were investigated retrospectively.

RESULTS

The median follow-up duration after colostomy was 12.5 months, and SP occurred in 33 (23.6%) patients. Multivariate analysis showed that being overweight (body mass index ≥ 25; odds ratio [OR], 8.69; 95% confidential interval [CI], 1.61-46.72; p = 0.012) and having a thin rectus abdominis penetration of the stoma (< 8.9 mm; OR, 8.22; 95% CI, 2.50-27.05; p < 0.001) were independent risk factors for SP. Other patient characteristics and surgical factors associated with stoma construction were unrelated to SP development.

CONCLUSIONS

Being overweight and the route penetrating the thinner rectus abdominis during stoma construction was associated with a significantly higher incidence of SP after laparoscopic loop colostomy. Selecting a construction site that penetrates the thicker rectus abdominis muscle may be crucial for preventing SP.

Gastrointestinal Ostomies in Children: A Primer for the Pediatrician

Despite the advancement of medical therapies in the care of the preterm neonate, in the management of short bowel syndrome and the control of pediatric inflammatory bowel disease, the need to create fecal ostomies remains a common, advantageous treatment option for many medically complex children.

Lived Experience of Parastomal Bulging: A Mixed Methods Study

Aim

This United Kingdom study aimed to explore people's experiences of living with, and self-managing parastomal bulging.

Methods

Seventeen people were interviewed and 61 people completed an online survey.

Results

Parastomal bulging has a detrimental impact on quality of life including a negative impact on stoma function, daily activities, body image, physical intimacy, and socialising; access to specialist information and support for addressing the problem of bulging was inequitable; support garments were the most common self-management intervention; there was confusion about what exercise would be beneficial or how being active would help in terms of parastomal bulging self-management; peer support is no substitute for high quality specialist support.

Conclusion

People need equitable access to information and support to self-manage and treat parastomal bulging. Research about other types of self-management interventions, for example, exercise is required so that people do not have to rely solely on support garments to self-manage parastomal bulging.

Clinical Outcomes of Ileostomy Closure during versus after Adjuvant Chemotherapy in Patients with Rectal Cancer

Background

Protective ileostomy can effectively prevent severe anastomotic leakage after rectal cancer surgery; however, the optimal timing for ileostomy closure during adjuvant chemotherapy remains unclear. This study aimed to explore the safety and long-term outcomes of early ileostomy closure during adjuvant chemotherapy.

Method

Patients who underwent laparoscopic rectal cancer surgery combined with protective ileostomy and adjuvant chemotherapy between April 2017 and April 2021 were retrospectively evaluated. Patients were divided into an early closure group during chemotherapy (group A) and a late closure group after chemotherapy (group B).

Results

A total of 215 patients were included in this study, with 115 in group A and 100 in group B. There were no significant differences in demographic and clinical characteristics between the two groups. In group A, durations of stoma status (p < 0.001) and low anterior resection syndrome (LARS) (p < 0.001) were shorter, and rectal stenosis (p=0.036) and stoma-related complications (p=0.007), especially stoma stenosis (p=0.041), were less common. However, compliance with chemotherapy was worse (p=0.009). There were no significant differences in operative time, postoperative hospital stay, postoperative complications, incidence and severity of LARS, disease-free survival, or overall survival between groups.

Conclusion

Early ileostomy closure can effectively reduce the duration of stoma status, duration of LARS, rectal stenosis, and stoma-related complications while not affecting surgical complications and oncological outcomes. Ileostomy closure should not be delayed because of adjuvant chemotherapy. However, follow-up should be strengthened to increase compliance and integrity with chemotherapy.

Outcomes of Emergency Parastomal Hernia Repair in Older Adults: A Retrospective Analysis

INTRODUCTION

Parastomal hernias are common and many are never repaired. Emergency parastomal hernia repair (PHR) is a feared complication following ostomy creation, yet the incidence and long-term outcomes of emergency PHR are unknown.

MATERIALS AND METHODS

We performed a retrospective analysis of 100% Medicare claims data (2007-2015) to evaluate complications, readmissions, reoperations, hospitalizations, and mortality after emergency PHR. We used logistic regression and Cox proportional hazard models to determine the association of surgical approach, including repair with ostomy reversal, resiting, mesh, minimally invasive approach, or a myofascial flap. Analysis took place between June 2022 and February 2023.

RESULTS

A total of 6658 patients underwent emergency PHR (mean [standard deviation] age, 75.9 [9.8] y; 4031 female individuals [60.5%]). Overall, 3433 (51.2%) patients underwent primary PHR, 1626 (24.4%) underwent PHR with ostomy resiting, and 1599 (24.0%) underwent PHR with ostomy reversal. In the 30 d after surgery, 4151 (62.3%) patients had complications and 55 (0.83%) underwent reoperation. Compared to local repair, the 30-d odds of complications were lower for patients who underwent ostomy resiting (odds ratio 0.82 [95% confidence interval 0.72-0.93]). Five y after surgery, the cumulative incidence of reoperation was 12.0% and was lowest for patients who underwent PHR with ostomy reversal (hazard ratio 0.15 [95% confidence interval 0.11-0.21]) when compared to local repair.

CONCLUSIONS

Emergency PHR is associated with significant morbidity. However, technique selection may influence outcomes. Understanding the prognosis of emergency PHR may improve decision-making and patient counseling for patients living with this common disease.

Hernia Active Living Trial (HALT): an exercise intervention in people with a parastomal hernia or bulge

BACKGROUND

Parastomal hernias are a common consequence of stoma surgery and can occur in up to 50% of patients. They are mangaged either conservatively, through support hosiery, or surgically. A patient feasibility study called the Hernia Active Living Trial (HALT) was designed to examine if a clinical pilates-based exercise programme offers an alternative approach to managing a parastomal hernia or bulge.

METHOD

Adults with an ileostomy or colostomy who perceived they had a bulge around their stoma were included in the study. The intervention included up to 12 online sessions of an exercise booklet and videos with an exercise specialist. Interviews were conducted to explore participants' experiences of the intervention. The interview data were analysed systematically and thematically. Participants were also asked to complete patient diaries every week.

RESULTS

Twelve of the 13 participants who completed the intervention agreed to be interviewed. Following analysis, three main themes emerged including managing a hernia/bulge, benefits and barriers. Participants talked about the benefits of this programme including: reduction of the size of their hernia, increased abdominal control, body confidence and posture, as well as increased physical activity levels. The barriers described were generally overcome allowing participants to engage in what was perceived to be a positive and potentially life-changing experience.

CONCLUSIONS

A clinical pilates-based exercise programme for people with a parastomal hernia can bring both direct and indirect improvements to a patient's hernia management, sense of wellbeing and day-to-day life. Individuals with a hernia should be informed about the need for, and value of, exercise to strengthen core muscles, as part of their non-surgical options for self-management.

Repair of stoma prolapse with the "peristomal cerclage" method using vessel tape

Stoma prolapse is one of the most common late complications following stoma construction. Although prolapses can be managed conservatively, they often require surgical revision. This study aimed to describe a revision method called peristomal cerclage applied with local anesthesia to treat stoma prolapse. A 66-year-old male patient with advanced rectal cancer underwent sigmoid loop colostomy one year ago due to a distal occlusive tumor. A revision of the colostomy prolapse that developed postoperatively was planned. After the reduction of the 12 cm prolapse into the abdomen under local anesthesia, a repair was performed in the form of peristomal wrapping of a vessel tape; except for short-term abdominal distension, no complications developed in the patient. He is currently in the postoperative 26th month and terminal period, and his colostomy is working normally. The present report aimed to describe the peristomal cerclage method, a minimally invasive revision procedure applied to patients with stoma prolapse, and to deliver its long-term results. It is important to report the results obtained with the more widespread use of this method.

Efficacy of laparoscopic surgery for loop colostomy: a propensity-score-matched analysis

PURPOSE

Colostomy is a common procedure for fecal diversion, but the optimal colostomy approach is unclear in terms of surgical outcomes and stoma-related complications. The purpose of this study was to examine the efficacy and feasibility of laparoscopic loop colostomy.

METHODS

This retrospective cohort study included patients who underwent loop colostomy at Shizuoka Cancer Center in Japan between April 2010 and March 2022. Patients were divided into two groups based on surgical approach: the laparoscopic (LAP) and open (OPEN) groups. Surgical outcomes and the incidences of stoma-related complications such as stomal prolapse (SP), parastomal hernia (PSH), and skin disorders (SD) were compared with and without propensity score matching.

RESULTS

Of the 388 eligible patients, 180 (46%) were in the LAP group and 208 (54%) were in the OPEN group. The male-to-female ratio was 5.5:4.5 in the Lap group and was 5.3:4.7 in the OPEN group, respectively. The median age was 68 years (range, 31-88 years) in the LAP group and 65 years (range, 23-93 years) in the OPEN group, respectively. The LAP group, compared with the OPEN group, had a shorter operative time and lower incidences of surgical site infection (3.9% versus 16.3%, respectively; p < 0.01) and SD (11.7% versus 24.5%, respectively; p < 0.01). There was no significant difference between the LAP and OPEN groups in the incidence of SP (17.3% versus 17.3%, respectively) or PSH (8.9% versus 6.7%, respectively). After propensity score matching, the incidences of surgical site infection and SD were significantly lower in the LAP group than in the OPEN group, while there were no significant differences in the operative time or the incidences of SP and PSH.

CONCLUSION

Our results suggest that laparoscopic surgery could be beneficial and feasible in loop colostomy.

Outcomes of Total Joint Arthroplasty Subsequent to Ostomy: A Case Series

Background

Ostomy surgery is associated with a high rate of postoperative complications and poses several theoretical concerns for subsequent total joint arthroplasty (TJA). There is concern that ostomy may negatively impact nutrition or increase risk of known gastrointestinal (GI) complications such as obstruction, constipation, or diarrhea, particularly with the use of postoperative opioids. There is also concern that the open nature of the ostomy may increase the risk of infection. This case series reports outcomes and assesses the risk associated with TJA in patients with previous surgical history of intestinal ostomy.

Methods

This is an institutional review board-approved retrospective case series of patients with surgical history of ostomy who underwent total hip or total knee arthroplasty. Cohort consisted of 14 cases in 10 patients and was examined to report individual TJA and ostomy procedural details and outcomes.

Results

Of the 14 cases, none required GI clearance or prophylaxis outside of standard perioperative antibiotics prior to TJA surgeries, and all TJAs resulted in good outcomes. Four cases (29%) had a complication, although only 2 of these were GI complications and none were life-threatening or required further surgery. The first of the 2 experienced increased ostomy output, and symptoms were resolved promptly with rehydration. The second experienced decreased ostomy output, and symptoms were resolved promptly with changes in prn pain medications. Other complications were postoperative urinary tract infection and syncopal episode.

Conclusions

TJA can be performed safely in the setting of ostomy with major consideration being risk of diarrhea or constipation during postoperative period.

Stomal Prolapse Due to Sidedness of Transverse Loop Colostomy: A Retrospective Cohort Study

Objectives

Stomal prolapse (SP) is one of the most common complications of loop colostomy and can impair a patient's quality of life. Herein, we evaluated the risk factors for SP to prevent its occurrence after a transverse loop colostomy.

Methods

This retrospective study included 84 patients who underwent loop transverse colostomy between January 2016 and December 2020. We evaluated the incidence of SP and examined the relationship between perioperative factors and SP using univariate and multivariate logistic regressions.

Results

SP occurred in 11 (13.0%) patients. Median time to SP was 99 postoperative days. In the univariate analysis, a right side abdominal wall stoma site, perioperative chemotherapy, and anti-VEGF antibody therapy were associated with a significantly higher incidence of SP. Multivariate analysis identified that construction of a temporary loop colostomy in the right transverse colon during rectal cancer surgery (odds ratio, 5.07; 95% confidence interval, 1.12-22.86) is an independent risk factor.

Conclusions

In this study, multivariate analysis showed that the right side of the transverse colon was a risk factor for SP. Therefore, when constructing a transverse colon loop stoma, the stoma should be constructed in the left transverse colon to prevent SP.

Surgical management of ostomy complications: a MISSTO-WSES mapping review

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.

Rethinking recovery: rehabilitation and intra-abdominal pressure management to reduce the risk of parastomal hernia

Julie Mills, RN, Global Ostomy Nurse Engagement Manager, Convatec, writes that parastomal hernia is a common and consequential complication of stoma surgery, but the risk can be reduced with a structured rehabilitation programme based on appropriate core abdominal exercises, supported by the full multidisciplinary team.

Investigation of Effects of Preoperative Readiness on Symptom Management in Patients with Intestinal Stoma: A Systematic Review and Meta-Analysis Study

OBJECTIVE

This study aims to examine the effect of preoperative readiness on postoperative symptom management in patients with intestinal stoma through systematic review and meta-analysis.

METHODS

"Intestinal stoma", "complications" and other related terms were searched regardless of the language of publication in the publications published in the databases until December 29, 2021.

RESULT

As a result, 30 studies were found. Two independent reviewers reviewed the studies, and the methodological quality of the included studies was assessed using the Health Evidence™ Quality Assessment Tool. The Comprehensive Meta-Analysis 3 was used to analyze the data. Publication bias, funnel plot, and the effect size were calculated using Cohen's kappa. Preparation for intestinal stoma surgery consisted of two main themes, and postoperative complications/problems consisted of nine sub-themes. The meta-analysis results showed that preoperative readiness had a moderate effect size on postoperative complications (d=0.498, d=0.457).

CONCLUSION

It was thus concluded that preoperative practices were significant and effective in postoperative symptom management.

Endoscopic transstomal stent insertion: a novel approach for a stenosed stoma in a challenging patient

Transstomal stent deployment to maintain the patency of stoma in a challenging patient who developed stoma stenosis, is a minimal invasive, novel technique. This is a new and alternative approach in management of stoma stenosis in a difficult case using a biodegradable stent for end colostomy.

Hernia Active Living Trial (HALT): a feasibility study of a physical activity intervention for people with a bowel stoma who have a parastomal hernia/bulge

BACKGROUND

Parastomal bulging/hernia is a common complication associated with a stoma. Strengthening of the abdominal muscles via exercise may be a useful self-management strategy. The aim of this feasibility work was to address uncertainties around testing a Pilates-based exercise intervention for people with parastomal bulging.

METHODS

An exercise intervention was developed and tested in a single-arm trial (n = 17 recruited via social media) followed by a feasibility randomised controlled trial RCT (n = 19 recruited from hospitals). Adults with an ileostomy or colostomy with a bulge or diagnosed hernia around their stoma were eligible. The intervention involved a booklet, videos, and up to 12 online sessions with an exercise specialist. Feasibility outcomes included intervention acceptability, fidelity, adherence, and retention. Acceptability of self-report measures for quality of life, self-efficacy, and physical activity were assessed based on missing data within surveys pre- and post-intervention. Interviews (n = 12) explored participants' qualitative experiences of the intervention.

RESULTS

Nineteen of 28 participants referred to the intervention completed the programme (67%) and received an average of 8 sessions, lasting a mean of 48 min. Sixteen participants completed follow-up measures (44% retention), with low levels of missing data across the different measures, apart from body image and work/social function quality of life subscales (50% and 56% missing, respectively). Themes from qualitative interviews related to the benefits of being involved, including behavioural and physical changes in addition to improved mental health. Identified barriers included time constraints and health issues.

CONCLUSIONS

The exercise intervention was feasible to deliver, acceptable to participants, and potentially helpful. Qualitative data suggests physical and psycholosical benefits. Strategies to improve retention need to be included in a future study.

TRIAL REGISTRATION

ISRCTN, ISRCTN15207595 . Registered on 11 July 2019.

Intestinal Stomas-Current Practice and Challenges: An Institutional Review

Introduction

A stoma is an artificial anastomosis of the gastrointestinal tract to the abdominal skin wall to reroute the stream of feces. Fecal diversion, bowel decompression, and anastomosis protection are common indications for stomas. Relative to other surgical operations, stomas have a high morbidity rate, with rates averaging 40% and ranging 14-79%. The most common early complication was peristomal skin irritation. In contrast, parastomal hernias were the most common late complication.

Methods

This research was performed at King Hamad University Hospital (KHUH) in the Kingdom of Bahrain. Our study included patients who had undergone ileostomies and colostomies. The inclusion criteria included adult patients who are 15 years and older, both emergency and elective cases, and with ASA score of 1-4. The excluded patients were those who had had their stomas performed outside of KHUH and those who were not following up in the hyperbaric department of our hospital. This study was performed using a retrospective study design. The sample size was 98 which included patients with stomas that were following up with the hyperbaric team between January 2018 and February 2021.

Results

We have broken down the indications for stoma formation. The breakdown of all our documented complications are illustrated in the given figure.

Conclusion

Within our institutional study, 63.3% of stoma complications consisted of skin problems. This formed the majority of complications. Establishing a stoma care unit would offer continuous support and care to patients and help them in returning to an optimal quality of life. Additionally, this goal can be met through preoperative and postoperative education regarding surgery and stoma formation. This includes preoperative stoma marking and siting, as well as improved recovery through instruction from knowledgeable stoma care specialists regarding hands-on stoma care.Finally, patients can be assisted through specialized stoma clinics.

How to cite this article

Qassim T, Saeed MF, Qassim A, et al. Intestinal Stomas-Current Practice and Challenges: An Institutional Review. Euroasian J Hepato-Gastroenterol 2023;13(2):115-119.

Peristomal Skin Complications in Ileostomy and Colostomy Patients: What We Need to Know from a Public Health Perspective

BACKGROUND

Peristomal skin complications (PSCs) are the most common skin problems seen after ostomy surgery. They have a considerable impact on a patient's quality of life and contribute to a higher cost of care.

METHODS

A systematic review was conducted, querying three databases. The analysis was performed on international studies focused on the clinical-epidemiological burden of PSCs in adult patients with ileostomy/colostomy.

RESULTS

Overall, 23 studies were considered. The main diseases associated with ostomy surgery were rectal, colon and gynecological cancers, inflammatory bowel diseases, diverticulitis, bowel obstruction and intestinal perforation. Erythema, papules, skin erosions, ulcers and vesicles were the most common PSCs for patients with an ostomy (or stoma). A PSCs incidence ranging from 36.3% to 73.4% was described. Skin complications increased length of stay (LOS) and rates of readmission within 120 days of surgery.

CONCLUSIONS

PSCs data are still limited. A knowledge of their burden is essential to support health personnel and decision-makers in identifying the most appropriate responses to patients' needs. Proper management of these complications plays a fundamental role in improving the patient's quality of life. A multidisciplinary approach, as well as increased patient education and their empowerment, are priority measures to be implemented to foster a value-based healthcare.

Two undesirable complications of a blowhole colostomy in left-sided colonic obstruction

Two patients with an acute left-sided colonic obstruction had a successful decompression after construction of a blowhole transverse colostomy as a bridge to surgery. However, they presented with two rather unknown stoma-related complications during this bridging period. Patient A had a stomal prolapse with additional skin problems.Patient B complained of abdominal discomfort during follow-up. The blowhole colostomy appeared to be stenotic. Stoma dilation and irrigation was initiated to prevent complete closure.Definite resection of the left-sided obstruction and reversal of both blowhole colostomies was successful, and the patients recovered without further complications.We hypothesise that incision size may be related to prolapse and stenosis rates and that eversion of the mucosa of the blowhole may reduce the risk of stomal stenosis.

A Consensus on Stomal, Parastomal, and Peristomal Complications

OBJECTIVE

To establish a consensus on terminology used to define stomal, parastomal, and peristomal complications in Australia.

METHODS

A list of stomal, parastomal, and peristomal complications was generated through group dialogue, which was informed by clinical and academic knowledge of the researchers. An extensive literature review was undertaken to identify any additional terms and to create a database of definitions/descriptions. A library of images related to the identified conditions was generated. An online Delphi process was conducted among a representative, purposive sample of Australia expert wound, ostomy, and continence nurses and colorectal surgeons. Ten terms were presented to the panel with descriptive photographs of each complication. Up to three Delphi rounds and, if necessary, a priority voting round were conducted.

RESULTS

Seven of the 10 terms reached agreement in the first round. One term ( allergic dermatitis ) was refined ( allergic contact dermatitis ) and reached agreement in the second round. Two terms ( mucocutaneous granuloma and mucosal granuloma ) were considered by the panel to be the same condition in different anatomical locations and were combined as one term ( granuloma ). Two terms ( skin stripping and tension blisters ) were combined as one term ( medical adhesive-related skin injury ) and reached agreement in round 2.

CONCLUSIONS

A consensus in terminology used to describe stomal or parastomal/peristomal complications will enhance communication among patients and health professionals and advance opportunities for education and benchmarking of stomal, parastomal, and peristomal complications nationally.

Stoma-Related Complications: A Single-Center Experience and Literature Review

Introduction: The creation of an abdominal stoma is a common procedure performed by surgeons as a part of the treatment for benign and malignant conditions in general surgery. Stoma formation is simple, but sometimes the associated postoperative complications have an impact on the patients’ physical and psychological state. The majority of complications do not require reoperation, but when it is indicated, we have to assess the most appropriate option for the patient.

Material and Methods: We conducted a retrospective study in a single surgical center, the Department of Surgery, Mureș County Hospital, Târgu Mureș, Romania, using data from patients who have been admitted under elective conditions for stoma-related complications between 2005 and 2019.

Results: A total number of 877 ostomies (653 colostomies and 224 ileostomies) were performed, and 157 patients (17.9%) developed some type of stoma complication and required surgical intervention. The mean age was 64.5 ± 2.1 years, with a male-female ratio of 1.3 to 1. The leading comorbidities included cardiovascular disease (52.2% of cases), obesity (22.2%), and diabetes (18.4%). Parastomal hernia was the most frequent complication (47.5% of cases), followed by stoma prolapse (23.4%), parastomal stenosis (20.3%), and parastomal infection (8.2%). There was an association between age and the type of complication: parastomal hernia, stoma prolapse, and stenosis were more frequent in the elderly; parastomal infection was more prevalent in young patients. A longer hospital stay was observed in case of parastomal hernia.

Conclusions: Stoma formation is associated with significant morbidity. Typically, the complications appear in the elderly. Conservative treatment is essential, but some of the late complications, such as parastomal hernia, stoma stenosis, stoma prolapse, and parastomal infection, require a surgical solution. Parastomal hernias are the most common complications, frequently associated with comorbidities and prolonged hospitalization.

Design of New Concept of Knitted Hernia Implant

A knitted implant, unilaterally modified with plasma-assisted chemical-vapor deposition (PACVD), and with a nano-layer of fluorine derivative supplementation, for reducing the risk of complications related to adhesions, and the formation of a thick postoperative scar was prepared. The biological evaluation of designed or modified medical devices is the main aspect of preclinical research. If such studies use a medical device with prolonged contact with connective tissue (more than 30 days), biocompatibility studies require a safety assessment in terms of toxicity in vitro and in vivo, allergenicity, irritation, and cancerogenicity, reproductive and developmental toxicity. The ultimate aspect of biological evaluation is biofunctionality, and evaluation of the local tissue response after implantation, resulting in the determination of all aspects of local biocompatibility with the implemented synthetic material. The implantation of PACVD-modified materials in muscle allows us to estimate the local irritation effect on the connective tissue, determining the risk of scar formation, whereas implantation of the above-mentioned knitted fabric into the abdominal wall, assists with evaluating the risk of fistula formation-the main post-surgical complications. The research aimed to evaluate the local reaction of the soft tissues after the implantation of the knitted implants modified with PACVD of the fluoropolymer in the nanostuctural form. The local effect that occurred during the implantation of the designed implants was quantitatively and qualitatively evaluated when PACVD unmodified (reference), and modified medical devices were implanted in the abdominal cavity (intra-abdominal position) for 12 or into the muscles for 56 weeks. The comparative semi-quantitative histological assessment included the severity of inflammatory cells (multinucleated cells, lymphocytes, plasma cells, macrophages, giant cells) and the tissue response (necrosis, neovascularization, fibrosis, and fat infiltration) on a five-point scale. The knitted implants modified by PACVD did not indicate cumulative tissue response when they were implanted in the muscle and intra-abdominally with direct contact with the viscera. They reduced local tissue reaction (score -2.71 after 56 weeks of the implantation) and internal organ adhesion (irritation score -2.01 and adhesion susceptibility -0.3 after 12 weeks of the implantation) compared with the reference (unmodified by PACVD) knitted implant, which had an identical structure and was made of the same source.

Comparing Sugarbaker versus keyhole mesh technique for open retromuscular parastomal hernia repair: study protocol for a registry-based randomized controlled trial

Background

Parastomal hernia, common after stoma creation, negatively impacts patient quality of life. For patients with a permanent stoma, durable parastomal hernia repair remains a challenge, with few high-quality studies for guidance. An alternative to open retromuscular parastomal hernia repair with retromuscular “keyhole” mesh is the recent Sugarbaker modification. We aim to compare these two techniques in a head-to-head prospective study.

Methods

This is a registry-based randomized controlled trial designed to investigate whether the retromuscular Sugarbaker technique is superior to the retromuscular keyhole technique for parastomal hernia repair. The primary study endpoint is parastomal hernia recurrence at 2 years. Secondary endpoints include hospital length-of-stay, readmission, wound morbidity, mesh-related complications, re-operation, all 30-day morbidity, and patient-reported outcomes, including hernia-related quality of life, stoma-specific quality of life, pain, and decision regret.

Discussion

Based on the post hoc analysis of a recent randomized controlled trial, we hypothesize that the retromuscular Sugarbaker technique will reduce parastomal hernia recurrence by 20% at 2 years compared to the retromuscular keyhole mesh technique. The results of this study may provide evidence-based guidance for surgeons repairing parastomal hernias.

Trial registration

ClinicalTrials.gov NCT03972553. Registered on 3 June 2019

A Comparative Study between Scanning Devices for 3D Printing of Personalized Ostomy Patches

This papers presents a comparative study of three different 3D scanning modalities to acquire 3D meshes of stoma barrier rings from ostomized patients. Computerized Tomography and Structured light scanning methods were the digitization technologies studied in this research. Among the Structured Light systems, the Go!Scan 20 and the Structure Sensor were chosen as the handheld 3D scanners. Nineteen ostomized patients took part in this study, starting from the 3D scans acquisition until the printed ostomy patches validation. 3D mesh processing, mesh generation and 3D mesh comparison was carried out using commercial softwares. The results of the presented study show that the Structure Sensor, which is the low cost structured light 3D sensor, has a great potential for such applications. This study also discusses the benefits and reliability of low-cost structured light systems.

Antegrade Colonic Enema Channels in Pediatric Patients Using Appendix or Cecal Flap: A Comparative Robotic versus Open series

Introduction We present perioperative outcomes of a single center experience with robotic assisted ACE channel creation for the treatment of chronic constipation refractory to medical therapy and compare it to the traditional open surgical approach. We also demonstrate a step-by-step video presentation of the robotic approach for cecal flap ACE performed as part of a dual continence procedure in patients with short length of appendix. Methods A retrospective chart review of pediatric patients who underwent ACE channel creation between 2008-2020 was performed. We compared demographics, intraoperative, and postoperative variables of the open versus robotic approach. Results Among 28 patients, 15 were open and 13 robotic. In order to construct the ACE channel, a cecal flap was utilized in 36%, split appendix in 50%, full length appendix in 11%, and sigmoid colon in 3% of patients. Both approaches showed equivalent estimated blood loss (50 ml [IQR=20-100]), median length of hospital stay (7 vs. 8 days, p=0.7) and median time to return to regular diet (4 vs. 5 days, p=0.5) (table 1). Patients in the open group were more likely to have a history of prior abdominal surgeries than those in the robotic group (80% vs. 38.5%, p=0.02). The risk of Clavien-Dindo grade 3 or more complications (40% vs. 23.1%, p=0.04) and the rate of ACE channel stenosis (46.7% vs. 7.7%, p=0.02) were significantly higher in the open approach. Channel stenosis was significantly higher in patients with an appendix ACE channel (87.5% vs. 12.5%, p<0.05) compared to those with cecal flap ACE. Conclusions Robotic assisted ACE channel creation is a safe and acceptable alternative with a significantly lower rate of channel stenosis and other Clavien grade 3 complications compared to the traditional open approach. Cecal flaps are also at a lower risk of stomal stenosis than appendix.

Evaluation of the Outcome of Local Surgery for Stomal Prolapse

We reviewed the results of local surgical treatment of stoma prolapse, a long-term complication of stoma construction. Fifteen patients treated for stomal prolapse between 2009 and 2020 at the authors' and affiliated hospitals were included in this study. The treatment comprised local laparotomic stomal reconstruction (LLSR) in nine patients and stapling repair (SR) in six. We compared and evaluated the clinical and surgical information and postoperative complications. Operation time was significantly shorter in the SR group than in the LLSR group: 20 and 53 min, respectively (p = 0.036). The duration of postoperative hospitalization was shorter in the SR group than in the LLSR group: 5.5 and 8 days, respectively; the difference was not significant (p = 0.088). No short-term complications were found in either group. Regarding long-term, postoperative complications, parastomal hernias developed after 2.5 years in one patient in the LLSR group and after 6 months in one patient in the SR group; both patients had histories of parastomal hernia surgery and had relatively high body mass indices. Local surgery for stomal prolapse was minimally invasive and performed safely. In patients with a history of surgery for parastomal hernia, attention must be paid to the potential of parastomal hernia developing as a postoperative complication.

Parastomal Hernia Repair Using a Silo Biologic Mesh

BACKGROUND

A parastomal hernia (PSH) is an enlargement of the stoma's original opening through the abdominal wall's musculature around a colostomy, ileostomy, or urostomy. Its incidence can be up to 48%. The described methods for its repair have high recurrence rate.This article presents a 3-dimensional silo technique for PSH repair (PSH-R). The aims of this technique are to enhance the structural strength of the tunnel wall, to reinforce both the sidewalls and the fascia above and below the muscular opening, and to maintain a stable stoma opening.

METHODS

All consecutive patients undergoing PSH-R with the silo technique between January 2009 and May 2018 by 2 plastic surgeons were included. The outcome parameters of interest were hernia recurrence and wound-related complications.

RESULTS

This study reports 22 patients (9 male, 13 female) with a mean age of 66.7 years and an average body mass index of 29.2. The variety of ostomy types included 10 colostomies, 7 ileostomies, and 5 urostomies. Postoperatively, there were 3 surgical site infections, 1 seroma, and 2 wound healing delays. Six patients were readmitted, 3 of those because of small bowel obstruction. These 3 cases all required reoperation, in addition to 1 operative revision for stoma retraction. During our average follow-up of 19.9 months, 3 cases of PSH recurrence were diagnosed for a recurrence rate of 13.6%.

CONCLUSIONS

This silo technique is associated with favorable complication and low recurrence rates compared with the available techniques in surgical literature. In our practice, it has established itself as a new and safe technique for complex or recurrent PSHs and should be considered in a surgeon's armamentarium. This technique has become our standard for treatment of recurrent PSHs.

Transverse Colostomy Differs in Outcomes Compared to Sigmoid Colostomy: A Cohort Analysis

PURPOSE

Our aim was to identify any differences in outcomes following transverse versus sigmoid colostomy creation for management of cancer.

METHODS

Transverse and sigmoid colostomies are used to manage cancer-related complications including obstruction, perforation, and fistulation. The decision to use either colostomy is largely based on the surgeon's preference and the location of the cancer complication. All patients treated for cancer complications with the use of a sigmoid or transverse colostomy at National University Hospital between January 2011 and December 2016 were included. Patient characteristics and distribution frequencies were reported based on the operation performed. Post procedure morbidity and mortality was compared. Univariate and subgroup analysis were performed.

RESULTS

This was a single-center, retrospective cohort study of 93 patients who underwent a colostomy creation over a 5-year duration. Of the 93 patients included, 56 underwent a transverse colostomy (median age 59, 26 male, 30 female) and 37 a sigmoid colostomy (median age 64, 20 male, 17 female). According to univariate analysis, higher rates of stoma prolapse were seen patients with transverse colostomies. There were no differences in complications between a laparoscopic or open approach. There were no differences in the rate of other postoperative complications.

CONCLUSION

Sigmoid colostomies were associated with a lower prolapse rate compared to transverse colostomies for cancer management. The manner of surgical approach did not affect rate of postoperative complications.

A rare case of intussusception through a prolapsed end colostomy

Intussusception through a prolapsed end colostomy is amongst the rarest of stoma complications. In this case report, we discuss the therapeutic approach to this complication and provide an update of the existing literature. A 66-year-old male presented with a prolapsed colostomy that was ischaemic in appearance. Intraoperatively, a small bowel intussusception within the prolapsed colon was identified. A subtotal colectomy was subsequently performed to prevent further volvulus formation. When patients present with a prolapsing oedematous enterostomy that cannot be reduced, careful clinical examination is required. If there is vascular compromise, exploratory laparotomy is mandatory.

The Use of a Stoma Rod/Bridge to Prevent Retraction: A Systematic Review

PURPOSE

We evaluated evidence related to the use of a rod (bridge) to prevent stoma retraction during loop ostomy construction.

METHODS

We completed a systematic review of the literature. We searched MEDLINE, EMBASE, and COCHRANE databases up to December 4, 2019. We posed the following question based on a PICO format. Do adult patients undergoing ostomy surgery experience less stomal retraction when compared to patients managed without placement of a stoma rod?

FINDINGS

Our initial search returned 182 articles; after reading studies in full, 5 articles were identified that collectively enrolled 1058 participants. Four studies were randomized controlled trials and one was a prospective cohort study. Meta-analysis could not be performed because of the small number of studies and the heterogeneity of outcomes measurements. The incidence of stoma retraction ranged between 0%-8% in patients managed with a rod and 0.78%-8.2% in patients with no rod. The number of reported adverse events was low. Placement of a stoma rod was associated with more adverse outcomes than in patients managed without a rod. Adverse events included local edema, stoma necrosis, skin necrosis, peristomal moisture-associated skin damage (irritant dermatitis), peristomal abscess, bleeding, and mucocutaneous separation.

CONCLUSIONS

Stoma rod does not seem to reduce the risk of stoma retraction and might result in other adverse events.

IMPLICATIONS

We recommend avoidance of stoma rod/bridge placement during ostomy surgery.

Prophylactic retromuscular mesh placement for parastomal hernia prevention: a retrospective cohort study of permanent colostomies and ileostomies

PURPOSE

Parastomal hernia (PSH) is the most common complication of stoma formation. The safety and efficiency of prophylactically placing mesh to prevent PSH remain controversial. To address this question, we examined the incidence of clinical and radiological PSH when using parastomal prophylactic mesh (PPM).

METHODS

We performed a retrospective, single-center, cohort study that included all patients with permanent stoma creation between 2015 and 2018. Patients were divided into two groups according to the utilization of PPM or not.

RESULTS

During the study period, 185 patients had a permanent stoma created, 144 with colostomy and 41 with ileostomy. PPM was placed in 79 patients. There was no difference in the need for early surgical reintervention (p = 0.652) or rehospitalization (p = 0.314) for stoma-related complications in patients with mesh as compared with patients without. Similarly, there was no difference in operative time (p = 0.782) or in length of hospital stay (p = 0.806). No patients experienced infection of the mesh or required prosthesis removal. There was a lower incidence rate of PSH with PPM placement in patients with permanent colostomy [adjusted hazard ratio (HR) 0.50 (95% confidence interval 0.28-0.89); p = 0.018]. In contrast, a higher incidence rate of PSH was observed in patients with ileostomy and PPM [adjusted HR 5.92 (95% confidence interval 1.07-32.65); p = 0.041].

CONCLUSION

Parastomal prophylactic mesh placement to prevent PSH is a safe and efficient approach to reduce the incidence of PSH in patients requiring a permanent colostomy. However, mesh may increase the rate of PSH after permanent ileostomy.

The role of radiological classification of parastomal hernia as a predictor of the need for surgical hernia repair: a retrospective cohort study

PURPOSE

Parastomal hernia (PSH) is a frequent complication of stoma creation during colorectal surgery. Radiological classification systems have been proposed for PSH but are primarily used for research. Our objective was to determine if PSH radiological classification at diagnosis could predict the need for surgical repair during follow-up.

METHODS

In this retrospective cohort study, we reviewed 705 postoperative CT scans from 154 patients with permanent stoma creation from 2015 to 2018. Patients were included for analysis if a primary PSH was diagnosed on any exam. PSH were classified according to the European Hernia Society (EHS) and Moreno-Matias (MM) classification systems.

RESULTS

The incidence of radiological PSH was 41% (63/154) after a median radiological follow-up of 19.2 months (interquartile range, 10.9-32.9). Surgical repair was required in 17 of 62 patients with a primary PSH. There was no significant correlation between PSH classification and surgical hernia repair for either the EHS (p = 0.56) or MM classification systems (p = 0.35) in a univariate analysis. However, in a multivariate analysis, the type of PSH according to the EHS classification was significantly correlated with PSH repair during follow-up (p = 0.02). Type III PSH were associated with a lower incidence of surgical hernia repair as compared with type I, with a hazard ratio (HR) of 0.01 (95% CI, <0.00-0.20). A similar correlation was not seen using the MM classification (p = 0.10).

CONCLUSION

EHS classification of PSH was significant correlated with the need for surgical repair during short-term follow-up. Prospective studies are required to establish a potential role in patient care.

Italian Guidelines for the Nursing Management of Enteral and Urinary Stomas in Adults: An Executive Summary

PURPOSE

This article is an executive summary of Italian guidelines for nursing management of enteral and urinary ostomies in adults.

METHODS

Scoping review and generation of evidence and consensus-based clinical guidelines.

SEARCH STRATEGY

The Multidisciplinary Italian Study group for STOmas (MISSTO) was founded in 2018. This group created guidelines for management of enteral and urinary ostomies in adults based on a scoping review of the literature. The research included previous guidelines, systematic reviews, meta-analyses, randomized clinical trials, cohort studies, and case reports. Five main topics were identified: "stoma preparation," "stoma creation," "stoma complications," "stoma care," and "stoma reversal" (for enteral stomas)." All the studies were evaluated according to the GRADE system and AGREE II tool. Recommendations were elaborated in the form of statements, with an established grade of recommendation for each statement. For low levels of scientific evidence statements, a consensus conference composed of expert members of the major Italian scientific societies in the field of stoma management and care discussed, corrected, validated, or eliminated the statements. A final version of the guidelines with definitive recommendations was elaborated and prepared for publication.

FINDINGS/CONCLUSIONS

This document represents the first Italian guidelines on enteral and urinary stoma management to assist nurses caring for persons with an enteral or urinary ostomy.

The Role of Mesh Implants in Surgical Treatment of Parastomal Hernia

A parastomal hernia is a common complication following stoma surgery. Due to the large number of hernial relapses and other complications, such as infections, adhesion to the intestines, or the formation of adhesions, the treatment of hernias is still a surgical challenge. The current standard for the preventive and causal treatment of parastomal hernias is to perform a procedure with the use of a mesh implant. Researchers are currently focusing on the analysis of many relevant options, including the type of mesh (synthetic, composite, or biological), the available surgical techniques (Sugarbaker’s, “keyhole”, or “sandwich”), the surgical approach used (open or laparoscopic), and the implant position (onlay, sublay, or intraperitoneal onlay mesh). Current surface modification methods and combinations of different materials are actively explored areas for the creation of biocompatible mesh implants with different properties on the visceral and parietal peritoneal side. It has been shown that placing the implant in the sublay and intraperitoneal onlay mesh positions and the use of a specially developed implant with a 3D structure are associated with a lower frequency of recurrences. It has been shown that the prophylactic use of a mesh during stoma formation significantly reduces the incidence of parastomal hernias and is becoming a standard method in medical practice.

Robotic Sugarbaker parastomal hernia repair: technique and outcomes

PURPOSE

To present a novel technique for the repair of parastomal hernias.

METHODS

A total of 15 patients underwent parastomal hernia repair. A robotic Sugarbaker technique was utilized for repair. The fascial defect was closed prior to robotic intraperitoneal placement of the mesh. Baseline demographics of the patients were obtained, and intra-operative and post-operative outcomes were tracked.

RESULTS

The etiology of the ostomies was oncologic in all but three patients. Five of the stomas were urostomies (33.3%). Patient characteristics were as follows: age 64.9.1 ± 9.3 years, BMI 30.1 ± 4.7 kg/m², smoking history 60.0%, and diabetes 6.7%. The mean size of the hernia defect was 46.0 ± 40.1 cm² with a mesh size of 372.0 ± 101.2 cm². The mean operative time was 182.0 ± 51.9 min. In seven patients, an inferolateral preperitoneal flap was created for mesh placement. Intraoperatively, only one enterotomy was made during dissection, which was repaired without complication. The mean length of stay was 4.2 ± 1.9 days. There was only one hernia recurrence (6.7%). There were no wound complications, surgical site infections, or mesh infections. A mean follow-up time of 14.2 ± 9.4 months was achieved.

CONCLUSIONS

Robotic Sugarbaker parastomal hernia repair is a safe and effective technique. The results demonstrate the feasibility of fascial closure with this technique and a low recurrence rate. The authors propose this technique should be widely considered for parastomal hernia repair.

Evaluation of short-term loop colostomy in dogs using conventional and supporting subcutaneous silicone drain techniques

Objective:

This study aimed at evaluating the supporting and non-supporting loop colostomy techniques in dogs.

Materials and Methods:

In this study, 12 adult healthy mongrel dogs were used to carry out a short-term (21 days) temporary flank loop colostomy. The dogs were divided into two groups (n = 6). In the first group (Con group), conventional stoma fixation was operated without loop support. In the second group [subcutaneous silicone drain (SSD) group], an SSD was used as a supporting bridge. The stoma was fixed by a modified, interrupted seromuscular vertical mattress suture pattern. Both peristomal and stomal complications were recorded.

Results:

Results showed that a total of seven dogs (58%) suffered complications. There was a significant tendency toward less peristomal (p = 0.012) and stomal complications (p = 0.001) in the SSD group. The intensity of pain was significantly (p < 0.05) different between the two groups in the first week post surgery. Comfort with stoma care was significantly (p = 0.015) better in the SSD group, experiencing the best results.

Conclusion:

It is concluded that an appropriate stoma location, using a soft supporting bridge, stoma fixation using modified interrupted neuromuscular vertical mattress sutures, and proper appliance fixation by adhesive tapes and a tight T-shirt may overcome the complications of short-term loop colostomy in dogs and introduce a satisfaction for stoma care.

HALT (Hernia Active Living Trial): protocol for a feasibility study of a randomised controlled trial of a physical activity intervention to improve quality of life in people with bowel stoma with a bulge/parastomal hernia

BACKGROUND

Parastomal hernia (PSH) can be repaired surgically, but results to date have been disappointing, with reported recurrence rates of 30 to 76%. Other types of intervention are therefore needed to improve the quality of life of people with PSH. One potential intervention is physical activity. We hypothesise that the intervention will increase core activation and control across the abdominal wall at a site of potential weakness and thus reduce the risk of PSH progression. Increases in physical activity will improve body image and quality of life (QoL).

METHODS

Subjects and sampleThere were approximately 20 adults with a bowel stoma and PSH. People with previous PSH repair will be excluded as well as people who already do core training.Study designThis is a feasibility study of a randomised controlled trial with 2 months follow-up, in 2 sites using mixed methods. Stage 1 involves intervention development and in stage 2, intervention and trial parameters will be assessed.InterventionA theoretically informed physical activity intervention was done, targeting people with PSH.Main outcome of feasibility studyThe main outcome is the decision by an independent Study Steering Committee whether to proceed to a full randomised controlled trial of the intervention.Other outcomesWe will evaluate 4 intervention parameters-fidelity, adherence, acceptability and safety and 3 trial parameters (eligible patients' consent rate, acceptability of study design and data availability rates for following endpoints): I.Diagnosis and classification of PSHII.Muscle activationIII.Body composition (BMI, waist circumference)IV.Patient reported outcomes: QoL, body image and physical functioningV.Physical activity;VI.Psychological determinants of physical activityOther dataIncluded are other data such as interviews with all participants about the intervention and trial procedures.Data analysis and statistical powerAs this is a feasibility study, the quantitative data will be analysed using descriptive statistics. Audio-recorded qualitative data from interviews will be transcribed verbatim and analysed thematically.

DISCUSSION

The feasibility and acceptability of key intervention and trial parameters will be used to decide whether to proceed to a full trial of the intervention, which aims to improve body image, quality of life and PSH progression.

TRIAL REGISTRATION

ISRCTN15207595.

The Lived Experiences of Persons With Ostomies Attending a Support Group: A Qualitative Study

PURPOSE

The purpose of this study was to describe the lived experiences of patients with ostomies participating in a support group.

DESIGN

Qualitative, descriptive, phenomenological study.

SUBJECT AND SETTING

Fifteen adults with different types of ostomies were recruited from support groups in the state of Georgia.

METHODS

Semistructured interviews were digitally audio-recorded and transcribed verbatim. Analyses of data were performed using Parse's 5-step thematic analysis.

RESULTS

Four major themes and 10 subthemes emerged from the interviews: (1) theme 1-support group gives hope and changes lives, with 2 subthemes of increased knowledge and provided new knowledge and allows open communication; (2) theme 2-changes in body image had 2 subthemes, some things are different and everyone is the same; (3) theme 3-I am not alone resulted in 4 subthemes of feeling of belonging, willingness to be helped, being supported, and developing lifelong relationships; and (4) theme 4-being independent manifested 2 subthemes including confidence in rejoining society, and building confidence and decreased shame.

CONCLUSION

We found that participation in an ostomy support group allowed individuals with ostomies to function at more advanced levels than they were before participating in the support group. The lived experiences were characterized by hope, willingness to live fully again, participating in different activities, and making new friends. Participants shared their positive experiences with others who were experiencing the same problems they once experienced. These findings add to and support the body of knowledge related to the interactions between nurses and individuals with ostomies as well as the care needed to ensure a safe discharge from the acute care facility. New knowledge gained may help in the improvement of the education provided during hospitalization. Providing this information will equip patients and families with a better understanding of and methods to care for their new ostomies and develop an acceptance of their new health status.

Outcomes of stapler repair with anastomosis for stoma prolapse

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.

An Innovative Approach to Clinical Practice Guideline Adaptation in the Nursing Profession in a Developing Country

INTRODUCTION

Healthcare professionals should seek the necessary resources to improve the quality of care. Given the cultural, social, and economic differences, in every health care system, there are increasing needs for the adapted versions of clinical practice guidelines (CPGs). This study aimed to introduce an innovative CPG adaptation approach for nurses working in a developing country.

METHODS

This study is comprised of three sections: a. An extensive systematic search of the literature, b. The adaptation process, c. Interviews, which were held with stakeholders, users and/or the target population. We applied all of the stages of guideline adaptation process according to Adaptation Resource Toolkit, with the integration of the findings of a systematic literature search and a qualitative content analysis in an "adolopted" new CPG.

RESULTS

In this study, we applied a mix of three methods namely adoption, adaptation and development (adolopment) of recommendations to save time, cost, and manpower efficiently. Moreover, we integrated the utilized qualitative research method and literature review with the adolopment approach to develop the recommendations.

CONCLUSION

Given there is a paucity of nursing clinical practice guidelines (NCPGs) in the nursing management of cancer therapy-induced mucositis and to save time and costs, the findings emerging from the adoption, adaptation, and de novo guideline development by a panel of experts and qualitative content analysis (QCA) method were integrated to achieve a more comprehensive nursing practice guideline.

A Rare Case of Prolapsed Sigmoid End Colostomy Complicated by Small Bowel Incarceration Treated with Manual Reduction and Emergency Surgery

Patient: Male, 74-year-old

Final Diagnosis: Prolapsed colostomy with small bowel incarceration

Symptoms: Small bowel obstruction

Medication:—

Clinical Procedure: Emergency laparotomy

Specialty: Surgery