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Awouters M, Vanuytsel T, Huysentruyt K, De Bruyne P, Van Hoeve K, Hoffman I. Nutritional management of high-output ileostomies in paediatric patients is vital and more evidence-based guidelines are needed. Acta Paediatr 2024; 113:861-870. [PMID: 38389122 DOI: 10.1111/apa.17163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
AIM Paediatric patients with high-output ileostomies (HOI) face an elevated risk of complications. This study aimed to comprehensively review the existing literature and offer nutritional management recommendations for paediatric patients with an HOI. METHODS PubMed and Embase were searched for relevant English or French language papers up to 31 June 2022. The emphasis was placed on studies involving paediatric ileostomy patients, but insights were obtained from adult literature and other intestinal failure pathologies when these were lacking. RESULTS We identified 16 papers that addressed nutritional issues in paediatric ileostomy patients. Currently, no evidence supports a safe paediatric HOI threshold exceeding 20 mL/kg/day on two consecutive days. Paediatric HOI patients were at risk of dehydration, electrolyte disturbances, micronutrient deficiencies and growth failure. The primary dietary choice for neonates is bolus feeding with breastmilk. In older children, an enteral fluid restriction should be installed favouring isotonic or slightly hypotonic glucose-electrolyte solutions. A diet that is high in calories, complex carbohydrates and proteins, low in insoluble fibre and simple carbohydrates, and moderate in fat is recommended. CONCLUSION Adequate nutritional management is crucial to prevent complications in children with an HOI. Further research is needed to establish more evidence-based guidelines.
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Affiliation(s)
- Marijke Awouters
- Department of Paediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Huysentruyt
- Department of Paediatric Gastroenterology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Pauline De Bruyne
- Department of Paediatric Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | - Karen Van Hoeve
- Department of Paediatric Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Ilse Hoffman
- Department of Paediatric Gastroenterology, University Hospitals Leuven, Leuven, Belgium
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2
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Mullin K, Rentea RM, Appleby M, Reeves PT. Gastrointestinal Ostomies in Children: A Primer for the Pediatrician. Pediatr Rev 2024; 45:210-224. [PMID: 38556505 DOI: 10.1542/pir.2023-006195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
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.
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Affiliation(s)
- Kaitlyn Mullin
- Pediatric Colorectal Center, Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital-Kansas City, Kansas City, MO
- University of Missouri-Kansas City, Kansas City, MO
| | | | - Patrick T Reeves
- Pediatric Colorectal Center, Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
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3
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Maksimkin AI, Bagatelia ZA, Kulushev VM, Gordienko EN, Lebedko MS, Anikina SS, Shin EP. [Morphological predictors of water-electrolyte disorders in patients with preventive ileostomy after rectal resection for cancer]. Khirurgiia (Mosk) 2024:16-28. [PMID: 38634580 DOI: 10.17116/hirurgia202404116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To analyze morphological changes in wall of functioning and non-functioning small intestine in patients with preventive ileostomy and to determine histological predictors of water-electrolyte disorders. MATERIAL AND METHODS We prospectively analyzed 57 patients >18 years old who underwent rectal resection with preventive ileostomy between January 2022 and November 2023. Anthropometric data included gender, age, body mass index, ECOG and ASA classes. Complications associated with large losses through ileostomy were water-electrolyte disorders, dehydration and acute renal failure with repeated hospitalization. Morphological analysis implied intraoperative full-layer biopsy of small intestine on anterior abdominal wall (ileostomy). Intraoperative biopsy of efferent and afferent loops was also carried out. Tissue samples were examined by light microscopy. We analyzed mean height of mucous membrane villi and depth of crypts, as well as their ratio. Fibrosis and swelling of submucosa were evaluated too. The results were analyzed in the SPSS Statistics 20 software. RESULTS Mean height of intestinal villi <465 microns (p=0.028), ratio of their height to crypt depth <4.38 (p=0.034) and submucosal fibrosis (p=0.031) significantly affected malabsorption and readmission of patients. The risk of readmission was 11.5 and 5.5 times higher in univariate analysis. Multivariate analysis revealed in-hospital dehydration with resumption of infusion therapy as a predictor of readmission (p=0.046). CONCLUSION Ileostomy is a certain stress for the patient's body. Not every patient is able for adaptation. One of the adaptation mechanisms is hypertrophy of mucous membrane villi involved in digestion. This mechanism is less pronounced in patients with repeated hospitalizations. Preoperative morphological examination of ileum mucosa may be an additional objective predictor of possible complications of preventive ileostomy.
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Affiliation(s)
- A I Maksimkin
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
| | - Z A Bagatelia
- Russian Medical Academy of Continuing Professional Education, Moscow, Russia
- Botkin Moscow City Clinical Hospital, Moscow, Russia
| | - V M Kulushev
- Botkin Moscow City Clinical Hospital, Moscow, Russia
| | - E N Gordienko
- Botkin Moscow City Clinical Hospital, Moscow, Russia
| | - M S Lebedko
- Botkin Moscow City Clinical Hospital, Moscow, Russia
| | - S S Anikina
- Botkin Moscow City Clinical Hospital, Moscow, Russia
| | - E P Shin
- Russian University of Medicine, Moscow, Russia
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4
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Zhang Q, Sun J, Wang D, Wang Q, Hu H. Knowledge, attitudes, practices and associated factors regarding high output stoma of ileostomy among colorectal surgical nurses: a multicentre cross-sectional study. Support Care Cancer 2023; 32:12. [PMID: 38060050 DOI: 10.1007/s00520-023-08228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE High output stoma(HOS) is one of the most common complications after ileostomy, leading to fluid and electrolyte disturbances and renal dysfunction, and increasing the risk of readmission. Routine health education for HOS should be provided, and nurses, as the primary educators, should have adequate knowledge and skills in this area. However, there is a paucity of research on the knowledge and practice of HOS management. This study used the Knowledge, Attitude and Behavioural Practice Model to assess the management of HOS by colorectal surgery nurses and to explore the factors that influence it. METHOD Using a multi-centre, cross-sectional study design, 398 colorectal surgery nurses from 6 hospitals in 6 cities in 6 provinces were surveyed using a structured electronic questionnaire to assess general information and knowledge, attitudes and management practices and training needs related to HOS of ileostomy. RESULTS Colorectal surgery nurses' knowledge and practice of HOS was low. The presence or absence of training is an important factor influencing nurses' knowledge, attitudes and practice, with most nurses having no training and stoma specialist nurses scoring relatively high on knowledge and practice. CONCLUSIONS Nurses play a very important role in the management of HOS, but this study shows that the current level of knowledge and practice of HOS among colorectal surgery nurses is concerning, and whether or not they have received training is the most critical influencing factor; therefore, training related to HOS is urgently needed.
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Affiliation(s)
- Qing Zhang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Jianan Sun
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Dongxue Wang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Quan Wang
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China
| | - Haiyan Hu
- Department of Gastrocolorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, Jilin, China.
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Kenneally H, Brown N, Schmitt D. Outcomes of Total Joint Arthroplasty Subsequent to Ostomy: A Case Series. Arthroplast Today 2023; 24:101220. [PMID: 37867924 PMCID: PMC10585621 DOI: 10.1016/j.artd.2023.101220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/02/2023] [Accepted: 09/09/2023] [Indexed: 10/24/2023] Open
Abstract
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.
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Affiliation(s)
- Hannah Kenneally
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Nicholas Brown
- Department of Orthopedic Surgery, Loyola University Chicago Health Sciences Division, Maywood, IL, USA
| | - Daniel Schmitt
- Department of Orthopedic Surgery, Loyola University Chicago Health Sciences Division, Maywood, IL, USA
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6
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Mithany RH, Shahid MH, Shahid R, Hannan A, Gill MU, Aslam S. Ileostomy 101: Understanding the Basics for Optimal Patient Care. Cureus 2023; 15:e46822. [PMID: 37829655 PMCID: PMC10565359 DOI: 10.7759/cureus.46822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 10/14/2023] Open
Abstract
This comprehensive literature review explores the foundational aspects of ileostomy, encompassing surgical techniques, postoperative care, complications, and advancements. Ileostomy, a surgical procedure redirecting the ileal lumen through an abdominal opening, is a critical intervention for various gastrointestinal conditions. The review delves into surgical techniques, emphasizing the importance of stoma location and type selection, whether temporary or permanent. Complications associated with ileostomy are discussed, highlighting the significance of vigilant postoperative care, including stoma care and addressing potential complications. The profound impact of ileostomy on patients' quality of life is elucidated, underlining the necessity for a holistic approach to patient care. Additionally, advancements in the field, such as biodegradable stoma bags, smart stoma appliances, and telemedicine, are explored for their potential to enhance patient outcomes. The review emphasizes the need for individualized approaches and ongoing research to maximize the benefits of these advancements for ileostomy patients and improve their overall experience.
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Affiliation(s)
- Reda H Mithany
- Laparoscopic Colorectal Surgery, Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, GBR
| | | | - Ra'ana Shahid
- General Surgery, Lahore General Hospital, Lahore, PAK
| | - Abdul Hannan
- Surgery, Glangwili General Hospital, Carmarthen, GBR
| | - Muhammad Umar Gill
- Accident and Emergency Medicine, Kings College Hospital NHS Foundation Trust, London, GBR
| | - Samana Aslam
- Obstetrics and Gynaecology, Lahore General Hospital, Lahore, PAK
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7
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McCann C, Gilpin V, Scott C, Pourshahidi LK, Gill CIR, Davis J. Moving towards in pouch diagnostics for ostomy patients: exploiting the versatility of laser induced graphene sensors. JOURNAL OF MATERIALS SCIENCE 2023; 58:14207-14219. [PMID: 37745186 PMCID: PMC10511578 DOI: 10.1007/s10853-023-08881-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023]
Abstract
The development of a 3D printed sensor for direct incorporation within stoma pouches is described. Laser induced graphene scribed on either side of polyimide film served as the basis of a 2 electrode configuration that could be integrated within a disposable pouch sensor for the periodic monitoring of ileostomy fluid pH. The graphene sensors were characterised using electron microscopy, Raman spectroscopy, DekTak profilometry with the electrochemical properties investigated using both cyclic and square wave voltammetry. Adsorbed riboflavin was employed as a biocompatible redox probe for the voltammetric measurement of pH. The variation in peak position with pH was found to be linear over pH 3-8 with a sub Nernstian response (43 mV/pH). The adsorbed probe was found to be reversible and exhibited minimal leaching through repeated scanning. The performance of the system was assessed in a heterogeneous bacterial fermentation mixture simulating ileostomy fluid with the pH recorded before and after 96 h incubation. The peak profile in the bacterial medium provided an unambiguous signal free from interference with the calculated pH before and after incubation (pH 5.3 to 3.66) in good agreement with that obtained with commercial pH probes. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s10853-023-08881-x.
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Affiliation(s)
- Conor McCann
- School of Engineering, Ulster University, Belfast, Northern Ireland
| | - Victoria Gilpin
- School of Engineering, Ulster University, Belfast, Northern Ireland
| | - Cameron Scott
- School of Engineering, Ulster University, Belfast, Northern Ireland
| | | | - Chris. I. R. Gill
- School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland
| | - James Davis
- School of Engineering, Ulster University, Belfast, Northern Ireland
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8
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Carlsson E, Forsmark A, Sternhufvud C, Scheffel G, Andersen FB, Persson EI. Short- and long-term direct and indirect costs of illness after ostomy creation - a Swedish nationwide registry study. BMC Health Serv Res 2023; 23:837. [PMID: 37553576 PMCID: PMC10408161 DOI: 10.1186/s12913-023-09850-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 07/26/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Despite advance in care of people with an ostomy, related complications remain prevalent. The objective of this study was to examine short- and long-term healthcare resource utilization and associated costs after ostomy creation. METHODS This observational study was based on retrospectively collected data from national and regional Swedish registries. The population consisted of people living in Sweden, who had an ostomy created. The earliest index date was 1 January 2006, and people were followed for ten years, until death, reversal of temporary ostomy, termination of purchases of ostomy products, or end of study, which was 31 December 2019. Each person with an ostomy was matched with two controls from the general population based on age, gender, and region. RESULTS In total, 40,988 persons were included: 19,645 with colostomy, 16,408 with ileostomy, and 4,935 with urostomy. The underlying diseases for colostomy and ileostomy creations were primarily bowel cancer, 50.0% and 55.8% respectively, and additionally inflammatory bowel disease for 20.6% of ileostomies. The underlying cause for urostomy creation was mainly bladder cancer (85.0%). In the first year after ostomy creation (excl. index admission), the total mean healthcare cost was 329,200 SEK per person with colostomy, 330,800 SEK for ileostomy, and 254,100 SEK for urostomy (100 SEK was equivalent to 9.58 EUR). Although the annual mean healthcare cost decreased over time, it remained significantly elevated compared to controls, even after 10 years, with hospitalization being the main cost driver. The artificial opening was responsible for 19.3-22.8% of 30-day readmissions after ostomy creation and for 19.7-21.4% of hospitalizations during the entire study period. For the ileostomy group, dehydration was responsible for 13.0% of 30-day readmissions and 4.5% of hospitalization during the study period. CONCLUSIONS This study reported a high disease burden for persons with an ostomy. This had a substantial impact on the healthcare cost for at least ten years after ostomy creation. Working ability seemed to be negatively impacted, indicated by increased cost of sickness absence and early retirement. This calls for improved management and support of ostomy care for the benefit of the affected persons and for the cost of society.
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Affiliation(s)
- Eva Carlsson
- Department of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | | | - Eva I Persson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
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9
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Nair A, Prasad A, Parikh S, Chaudhri M, Nookala V, Cheriyath P. A Case Report of Cardiac Failure in a Patient on Teduglutide for High-Output Ileostomy Stoma. Cureus 2023; 15:e37518. [PMID: 37197113 PMCID: PMC10184872 DOI: 10.7759/cureus.37518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/19/2023] Open
Abstract
A high volume of ileostomy output in patients with extensive bowel resection can be hard to manage. This leads to extensive loss of fluids and electrolytes along with malabsorption. Medications have traditionally controlled it by delaying intestinal transit and decreasing intestinal and gastric secretion using opiates, loperamide, diphenoxylate, omeprazole, somatostatin, and octreotide. However, many patients depend on parenteral nutrition and fluid and electrolyte infusions, even with optimal drug therapy. Despite the best possible care, they may develop renal failure. Teduglutide is a glucagon-like peptide-2 (GLP-2) analog given as a daily subcutaneous injection, and it has been promising in managing short bowel syndrome. It has been effective in decreasing the dependence on parenteral nutrition. However, improving fluid and electrolyte balance can precipitate cardiac failure in some patients, especially those with borderline cardiac functions, hypertension, and thyroid disorders. This usually presents in the first few months of the initiation of teduglutide therapy and may require stopping the medication. We present the case report of an elderly female with a high-output stoma on parenteral nutrition on teduglutide. There was a significant decrease in stoma output, and parenteral nutritional support could be stopped. However, she presented with worsening dyspnea and was diagnosed with cardiac failure with an ejection fraction of 16%-20%. The baseline ejection fraction was 45%, done six months before this. Coronary angiography showed no stenosis in any vessels, and the decline in left ventricular ejection fraction and fluid overload was attributed to teduglutide therapy.
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Affiliation(s)
- Ambica Nair
- Internal Medicine, Ocean University Medical Center, Hackensack Meridian Health, Brick, USA
| | - Ankita Prasad
- Internal Medicine, Ocean University Medical Center, Hackensack Meridian Health, Brick, USA
| | - Shrujal Parikh
- Internal Medicine, Ocean University Medical Center, Hackensack Meridian Health, Brick, USA
| | - Moiuz Chaudhri
- Internal Medicine, Ocean University Medical Center, Hackensack Meridian Health, Brick, USA
| | - Vinod Nookala
- Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Pramil Cheriyath
- Internal Medicine, Ocean University Medical Center, Hackensack Meridian Health, Brick, USA
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10
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Impact of gastric and bowel surgery on gastrointestinal drug delivery. Drug Deliv Transl Res 2023; 13:37-53. [PMID: 35585472 PMCID: PMC9726802 DOI: 10.1007/s13346-022-01179-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 01/01/2023]
Abstract
General surgical procedures on the gastrointestinal tract are commonly performed worldwide. Surgical resections of the stomach, small intestine, or large intestine can have a significant impact on the anatomy and physiological environment of the gastrointestinal tract. These physiological changes can affect the effectiveness of orally administered formulations and drug absorption and, therefore, should be considered in rational drug formulation design for specific pathological conditions that are commonly associated with surgical intervention. For optimal drug delivery, it is important to understand how different surgical procedures affect the short-term and long-term functionality of the gastrointestinal tract. The significance of the surgical intervention is dependent on factors such as the specific region of resection, the degree of the resection, the adaptive and absorptive capacity of the remaining tissue, and the nature of the underlying disease. This review will focus on the common pathological conditions affecting the gastric and bowel regions that may require surgical intervention and the physiological impact of the surgery on gastrointestinal drug delivery. The pharmaceutical considerations for conventional and novel oral drug delivery approaches that may be impacted by general surgical procedures of the gastrointestinal tract will also be addressed.
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11
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Ma H, Li X, Yang H, Qiu Y, Xiao W. The Pathology and Physiology of Ileostomy. Front Nutr 2022; 9:842198. [PMID: 35529469 PMCID: PMC9072868 DOI: 10.3389/fnut.2022.842198] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/30/2022] [Indexed: 12/02/2022] Open
Abstract
An ileostomy is a surgery that is commonly performed to protect low pelvic anastomoses or prevent high-risk anastomotic leakages. However, various postoperative complications remain of major concern. After an ileostomy, the distal intestinal segment is left open for an extended period and is in a non-functional state. Consequently, the intestinal mucosa, smooth muscle, and microbiota undergo significant changes that are closely related to postoperative recovery and complications. A systematic description of these changes is necessary to understand the relationship among them and take more effective measures for postoperative intervention.
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Affiliation(s)
- Haitao Ma
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xiaolong Li
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Hua Yang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yuan Qiu
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Weidong Xiao
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
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12
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Portela R, Vahibe A, Badaoui JN, Hassan OU, Mckenzie TJ, Kellogg TA, Ghanem OM. Bariatric Surgery in Patients with Existing Ostomy: A Preliminary Feasibility Study. Bariatr Surg Pract Patient Care 2022; 17:127-130. [PMID: 35765305 PMCID: PMC9233518 DOI: 10.1089/bari.2021.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ray Portela
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmet Vahibe
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Todd A. Kellogg
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar M. Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Affiliation(s)
| | - Julia Hall
- Northumbria Healthcare Trust, Cramlington, UK
| | | | - Kate Carney
- Northumbria Healthcare Trust, Cramlington, UK
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14
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Burka AT, Benge CD. Impaired Absorption of Extended-Release Potassium Chloride in a Patient With a High-Output Ileostomy. J Wound Ostomy Continence Nurs 2021; 48:431-433. [PMID: 34495934 DOI: 10.1097/won.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Best practices in the management of ileostomies include use of immediate release (IR) medications and elimination of enteric coated and prokinetic agents. Extended-release (ER) potassium chloride is designed for postpyloric release rather than colonic absorption and is postulated to be an appropriate option for potassium repletion in this patient subset. CASE We present a patient with an ileostomy who received intravenous ER and IR oral potassium chloride supplementation following diverting loop ileostomy. Clinical responsiveness to ER potassium chloride was poor; 15 to 40 mEq was required to replace 0.1 mEq/L of potassium. However, upon transition to IR potassium chloride, only 6.67 mEq was required to replace 0.1 mEq/L of potassium. CONCLUSIONS Our experience in this case suggests that patients with surgical alterations to their gastrointestinal tracts who fail to have expected rises in serum potassium levels may benefit from early conversion to IR potassium chloride.
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Affiliation(s)
- Abigail T Burka
- Abigail T. Burka, PharmD, BCPS, BCCCP, Lipscomb University College of Pharmacy and Health Sciences, Nashville, Tennessee
- Cassandra D. Benge, PharmD, BCPS, AACC, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Cassandra D Benge
- Abigail T. Burka, PharmD, BCPS, BCCCP, Lipscomb University College of Pharmacy and Health Sciences, Nashville, Tennessee
- Cassandra D. Benge, PharmD, BCPS, AACC, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
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15
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Mitchell A, England C, Atkinson C. Provision of dietary advice for people with an ileostomy: a survey in the UK and Ireland. Colorectal Dis 2020; 22:2222-2231. [PMID: 32668070 DOI: 10.1111/codi.15268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/30/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim was to explore whether people with an ileostomy in the UK and Ireland receive the dietary advice they require. METHOD An online survey with multiple-choice questions asked people with an ileostomy about the dietary advice they received and would have preferred to receive. Participants were recruited via websites of the Ileostomy and Internal Pouch Association and Crohn's and Colitis UK and via social media. People with a current ileostomy, age 16 years or over, and living in the UK or Ireland were eligible for inclusion. Responses were analysed using descriptive statistics. RESULTS In all, 291 eligible responses were received and included in the analysis; 201 (69%) received advice on diet for their ileostomy from a healthcare professional or the internet. Of the 90 who did not receive dietary advice, 82 (91%) would have liked advice. Stoma nurses were the most common source of dietary advice (55%), but many other sources were frequently reported. Most (62%) felt that at least some dietary advice they received was conflicting. Over half (55%) felt anxious about managing their diet with a new ileostomy, 39% were confused, and 31% frustrated. Of 291 respondents, 29% received advice from a dietitian compared to 60% who would have preferred advice from a dietitian. CONCLUSION Many people undergoing ileostomy surgery do not receive the dietary advice and support they require. Healthcare professionals working with people with an ileostomy should be mindful they are often anxious about their diet and require clear and consistent dietary advice and support.
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Affiliation(s)
- A Mitchell
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - C England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
| | - C Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, UK
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