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Smith C, Cook N. Ostomy Care Nurses' Knowledge and Practice Related to Prevention and Management of Parastomal Hernias in Adults: A Nationwide Survey of UK Stoma Care Nurses. J Wound Ostomy Continence Nurs 2024; 51:289-296. [PMID: 39037161 DOI: 10.1097/won.0000000000001091] [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: 07/23/2024]
Abstract
PURPOSE The purpose of this study was to describe the knowledge and practices of ostomy care nurses related to the United Kingdom's Association of Stoma Care Nurses (ASCN) 2016 guidelines for prevention and management of parastomal hernia (PSH) in adults. DESIGN Cross-sectional descriptive study. SUBJECTS AND SETTING The target population was approximately 300 stoma care nurses; 120 useable responses to the survey were received, reflecting a response rate of approximately 40%. METHODS A 31-item questionnaire was developed for the purposes of this study, consisting of multiple choice and short answer questions grouped into 2 sections; demographics, and knowledge and practices. The questionnaire was distributed to members of the ASCN who work with adults via an online survey platform with the aim of reaching as many respondents as possible. The Chi-square test was used to determine relationships between the nominal demographic data and the nominal knowledge and practices data. RESULTS Almost two-thirds of respondents (65%, n = 78) rated their knowledge relating to prevention and management of PSH as good or excellent. Nevertheless, 79.8% (n = 95) indicated they needed additional education to improve their knowledge and practice related to prevention of PSH. Those who rated their knowledge as excellent or good were significantly more likely to be aware of the guidelines compared to those who ranked their knowledge as average or poor. CONCLUSIONS Study findings suggest variability in knowledge among UK stoma care nurses, along with a desire for additional education in this area of care.
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Affiliation(s)
- Clare Smith
- Clare Smith, MSc, Colorectal/Stoma Care Nurses, Colorectal/Stoma Care Nurses, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
- Neal Cook, PhD, Professor of Nursing, School of Nursing, Ulster University, Londonderry, Northern Ireland
| | - Neal Cook
- Clare Smith, MSc, Colorectal/Stoma Care Nurses, Colorectal/Stoma Care Nurses, Barnsley Hospital NHS Foundation Trust, Barnsley, UK
- Neal Cook, PhD, Professor of Nursing, School of Nursing, Ulster University, Londonderry, Northern Ireland
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MacDonald S, Wong LS, Ng HJ, Hastings C, Ross I, Quasim T, Moug S. Postoperative outcomes and identification of risk factors for complications after emergency intestinal stoma surgery - a multicentre retrospective study. Colorectal Dis 2024; 26:994-1003. [PMID: 38499914 DOI: 10.1111/codi.16947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/29/2023] [Accepted: 02/20/2024] [Indexed: 03/20/2024]
Abstract
AIM Approximately 4000 patients in the UK have an emergency intestinal stoma formed each year. Stoma-related complications (SRCs) are heterogeneous but have previously been subcategorized into early or late SRCs, with early SRCs generally occurring within 30 days postoperatively. Early SRCs include skin excoriation, stoma necrosis and high output, while late SRCs include parastomal hernia, retraction and prolapse. There is a paucity of research on specific risk factors within the emergency cohort for development of SRCs. This paper aims to describe the incidence of SRCs after emergency intestinal surgery and to identify potential risk factors for SRCs within this cohort. METHOD Consecutive patients undergoing emergency formation of an intestinal stoma (colostomy, ileostomy or jejunostomy) were identified prospectively from across three acute hospital sites over a 3-year period from the ELLSA (Emergency Laparotomy and Laparoscopic Scottish Audit) database. All patients were followed up for a minimum of 1 year. A multivariate logistic regression model was used to identify risk factors for early and late SRCs. RESULTS A total of 455 patients were included (median follow-up 19 months, median age 64 years, male:female 0.52, 56.7% ileostomies). Early SRCs were experienced by 54.1% of patients, while 51% experienced late SRCs. A total of 219 patients (48.1%) had their stoma sited preoperatively. Risk factors for early SRCs included end ileostomy formation [OR 3.51 (2.24-5.49), p < 0.001], while preoperative stoma siting was found to be protective [OR 0.53 (0.35-0.83), p = 0.005]. Patient obesity [OR 3.11 (1.92-5.03), p < 0.001] and reoperation for complications following elective surgery [OR 4.18 (2.01-8.69), p < 0.001] were risk factors for late SRCs. CONCLUSION Stoma-related complications after emergency surgery are common. Preoperative stoma siting is the only truly modifiable risk factor to reduce SRCs, and further research should be aimed at methods of improving the frequency and accuracy of this in the emergency setting.
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Affiliation(s)
- Scott MacDonald
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Li-Siang Wong
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Hwei Jene Ng
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Claire Hastings
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Immogen Ross
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Tara Quasim
- Department of Anaesthesia, Pain and Critical Care, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Susan Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
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Krogsgaard M, Dreyer P, Thomsen T. Understanding patients' perspectives when unprepared for the emergence of a parastomal bulge-a qualitative study. Colorectal Dis 2023; 25:2198-2205. [PMID: 37814485 DOI: 10.1111/codi.16750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/14/2023] [Accepted: 08/03/2023] [Indexed: 10/11/2023]
Abstract
AIM The aim was to investigate patients' experiences of being prepared for the development of a parastomal bulge in relation to a stoma. METHODS The paper draws on a qualitative interview study conducted with 20 Danish patients participating in five focus groups. Analysis was performed using a phenomenological-hermeneutic approach. RESULTS We identified three themes. The first theme is 'The unforeseen bulge gives rise to increasing concern and a search for an explanation'. Patients searched for explanations in their own life and suspected that their behaviour or previous illness induced the bulge. The second theme is 'Missing or confusing information leads to counterproductive behaviour'. Patients lacked information on the prevention and treatment of parastomal bulging which led to disappointment with healthcare professionals. The third theme is 'Weighing the pros and cons of life with the bulge against the gamble of surgical repair'. Some patients came to terms with their situation, but for others a deadlocked situation arose when surgical repair was not an option. CONCLUSION Healthcare communication directly impacts on patients' experiences and outcomes. When unprepared for the emergence of a parastomal bulge, patients' emotional and psychological well-being are affected and likewise patients' possibility of using their own health beliefs as a preventive strategy. To preserve patient autonomy, satisfaction and well-being, surgeons and stoma nurses should provide patients with tailored information bearing in mind the current lack of clear evidence on the prevention and treatment of parastomal bulging.
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Affiliation(s)
- Marianne Krogsgaard
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Koege, Denmark
| | - Pia Dreyer
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark
| | - Thordis Thomsen
- Department of Anaesthesiology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Satora M, Żak K, Frankowska K, Misiek M, Tarkowski R, Bobiński M. Perioperative Factors Affecting the Healing of Rectovaginal Fistula. J Clin Med 2023; 12:6421. [PMID: 37835064 PMCID: PMC10573987 DOI: 10.3390/jcm12196421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/01/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023] Open
Abstract
Rectovaginal fistula is rare, but a severe complication in gynecology, which despite the effort of clinicians is still not treated successfully in many cases. According to statistics, the healing rates of surgery in patients with RVF range from 20 to 100%. The treatment effectiveness depends on the etiology of fistula, the age of the patients, the presence of comorbidities, the type of surgery and many other factors. Considering the low efficiency of treatment and the high risk of recurrence, the question of possible methods to improve the results occurs. In our review, we analyzed both modifiable and non-modifiable factors which may influence the treatment, healing rate and future fate of the patients. Taking into account all analyzed risk factors, including age, comorbidities, smoking status, microbiology, medications, stoma and stool features, we are aware that rectovaginal fistula's treatment must be individualized and holistic. In cases of poorly healing RVF, the drainage of feces, the use of antibiotic prophylaxis or the implementation of estrogen therapy may be useful. Moreover, microbiome research in women with RVF and towards estrogen therapy should be performed in order to create treatment algorithms in women with fistulae. Those interventions, in our opinion, may significantly improve the outcome of the patients.
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Affiliation(s)
- Małgorzata Satora
- I Chair and Department of Oncological Gynaecology and Gynaecology, Student Scientific Association, Medical University of Lublin, 20-081 Lublin, Poland; (M.S.); (K.Ż.); (K.F.)
| | - Klaudia Żak
- I Chair and Department of Oncological Gynaecology and Gynaecology, Student Scientific Association, Medical University of Lublin, 20-081 Lublin, Poland; (M.S.); (K.Ż.); (K.F.)
| | - Karolina Frankowska
- I Chair and Department of Oncological Gynaecology and Gynaecology, Student Scientific Association, Medical University of Lublin, 20-081 Lublin, Poland; (M.S.); (K.Ż.); (K.F.)
| | - Marcin Misiek
- Department of Gynecology, Holy Cross Cancer Center, 25-734 Kielce, Poland;
| | - Rafał Tarkowski
- I Chair and Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, 20-081 Lublin, Poland;
| | - Marcin Bobiński
- I Chair and Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, 20-081 Lublin, Poland;
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Manole TE, Daniel I, Alexandra B, Dan PN, Andronic O. Risk Factors for the Development of Parastomal Hernia: A Narrative Review. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2023; 11:187-192. [PMID: 37533654 PMCID: PMC10393091 DOI: 10.4103/sjmms.sjmms_235_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 03/13/2023] [Accepted: 06/07/2023] [Indexed: 08/04/2023]
Abstract
Parastomal hernia is one of the most common late complications after stoma formation, significantly decreasing patient's quality of life and negatively impacting body image and physical functioning. Progress has been made regarding the surgical technique of stoma creation in different categories of patients, but a better understanding of the risk factors is crucial in reducing the likeliness of parastomal hernia formation and in helping develop risk stratification strategies for pre-and post-operation management. However, currently there is limited consensus on the associated risk factors. Accordingly, for this narrative review, the authors conducted a literature review through three databases (PubMed, Web of Science, and Scopus) and categorized the identified risk factors into the following three categories: patient-, surgery-, and disease-related. Within these categories, the following 10 risk factors were identified and discussed: age, gender, waist circumference, type of ostomy, laparoscopic approach, aperture size >3 cm, stoma not passing through the middle of rectus abdominis muscle, BMI >25 kg/m2, altered collagen metabolism, and diabetes.
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Affiliation(s)
- Teodora Elena Manole
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ion Daniel
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- IIIrd Department of General Surgery, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Bolocan Alexandra
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- IIIrd Department of General Surgery, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Păduraru N. Dan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- IIIrd Department of General Surgery, University Emergency Hospital of Bucharest, Bucharest, Romania
| | - Octavian Andronic
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- IIIrd Department of General Surgery, University Emergency Hospital of Bucharest, Bucharest, Romania
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Ambe PC, Kugler CM, Breuing J, Grohmann E, Friedel J, Hess S, Pieper D. The effect of preoperative stoma site marking on risk of stoma-related complications in patients with intestinal ostomy - A systematic review and meta-analysis. Colorectal Dis 2022; 24:904-917. [PMID: 35297146 DOI: 10.1111/codi.16118] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/15/2022] [Accepted: 03/08/2022] [Indexed: 12/12/2022]
Abstract
AIM This systematic review and meta-analysis aimed to investigate the effect of preoperative stoma site marking on stoma-related complications in patients with intestinal ostomy. METHODS MEDLINE, Embase, CENTRAL, CINHAL, and Google Scholar were searched up to August 2021 for randomised controlled trials (RCTs) and nonrandomised studies of interventions (NRSI) that involved patients with intestinal ostomies comparing preoperative stoma site marking to no marking and which reported at least one patient-relevant outcome. Outcomes were prioritised by stakeholder involvement. Random-effects meta-analyses produced odds ratios (ORs) or standardised mean differences (SMD) and 95% confidence intervals (CIs). The ROBINS-I tool and the GRADE approach were used to assess the risk of bias and certainty of evidence, respectively. RESULTS This review included two RCTs and 25 NRSI. The risk of bias was high in RCTs and serious to critical in NRSI. Although preoperative site marking reduced stoma-related complications (OR: 0.45, 95% CI: [0.31-0.65]), dependence on professional or unprofessional care (narrative synthesis), and increased health-related quality of life (SMD: 1.13 [0.38-1.88]), the evidence is very uncertain. Preoperative site marking may probably reduce leakage (OR: 0.14 [0.06-0.37]) and may decrease dermatological complications (OR: 0.38 [0.29-0.50]) and surgical revision (OR: 0.09 [0.02-0.49]). The confidence in the cumulative evidence was moderate to very low. CONCLUSION Despite low quality evidence, preoperative stoma site marking can prevent stoma-related complications and should be performed in patients undergoing gastrointestinal surgery given that this intervention poses no harm to patients.
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Affiliation(s)
- Peter C Ambe
- GFO Kliniken Rhein-Berg, Vinzenz Pallotti Hospital, Bergisch Gladbach, Germany.,Department of Health, Witten/Herdecke University, Witten, Germany
| | | | - Jessica Breuing
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | | | - Julia Friedel
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany.,University of Cologne, Cologne, Germany
| | - Simone Hess
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Witten, Germany
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Dellafiore F, Caruso R, Bonavina L, Udugampolage NS, Villa G, Russo S, Vangone I, BaronI I, Di Pasquale C, Nania T, Manara DF, Arrigoni C. Risk factors and pooled incidence of intestinal stoma complications: systematic review and Meta-analysis. Curr Med Res Opin 2022; 38:1103-1113. [PMID: 35608158 DOI: 10.1080/03007995.2022.2081455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The present systematic review aimed to identify, critically assess and summarize which risk factors might determine the onset of ostomy complications, describing a pooled incidence and stratified incidences by each identified risk factor. METHODS A systematic literature review with a meta-analysis of observational studies was performed by following the PRISMA statement and flow chart. The quality assessment of the included articles was performed through the Newcastle-Ottawa Scale (NOS). RESULTS Sixteen articles published between 1990 and 2018 focused on the risk factors related to intestinal stomal complications, and the performed analysis led to identifying influenceable and non-influenceable risk factors. The median of the NOS evaluation was 6 (IQR = 5.75-6). Among 10,520 included patients, the pooled incidence of stomal complications was 35%, ranging from 9% to 63%, regardless of the nature of the complications. Analysis of the sub-groups highlighted obesity and ostomy surgery performed via laparoscopy or emergency conditions have significant incidences, respectively, of 66% and 68%. CONCLUSIONS The pooled incidence of stomal complications requires greater attention for its relevant epidemiology. From the clinical point of view, patients with obesity and chronic conditions require more attention to prevent complications, possibly employing accurate educational interventions to enhance proper stoma management.
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Affiliation(s)
- Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Division of General Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Giulia Villa
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Sara Russo
- ItalyVascular Surgery Unit, IRCCS Policlinic San Matteo Foundation, Nursing degree course, University of Pavia, section Istituti Clinici di Pavia e Vigevano S.p.A., Pavia, Italy
| | - Ida Vangone
- Department of Oncology and Hematology-Oncology, Istituto Europeo Oncologia, Milan, Italy
| | - Irene BaronI
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Tiziana Nania
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Duilio F Manara
- Center for Nursing Research and Innovation, Vita-Salute San Raffaele University, Milan, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
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Maglio A, Malvone AP, Scaduto V, Brambilla D, Denti FC. The frequency of early stomal, peristomal and skin complications. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:1272-1276. [PMID: 34889670 DOI: 10.12968/bjon.2021.30.22.1272] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The incidence of early complications after stoma formation (within 30 days of surgery) is difficult to determine and has been reported to be in a range of 3%-82%. AIM The aim of this study was to analyse the onset of stomal, peristomal and skin complications one month (30 days) after ostomy creation. METHOD This review analysed enteral stoma therapy nurse reports on patients who had an ostomy created between January 2016 and December 2020. FINDINGS Complications were analysed according to ostomy type: colostomy, ileostomy and urostomy. There were 1292 incidences of complications: skin complications were the most common (26%), and abscess the least common (0%). CONCLUSION A majority (63%) of patients experienced at least one or more complications within 30 days of surgery. Haemorrhage was reported as a complication (2%) but the authors found no data on its incidence in the literature. In addition to early complications, late complications were detected.
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Affiliation(s)
- Andrea Maglio
- Enteral Stoma Nurse, General and Emergency Surgery, and Gastroenterological Surgery Departments, San Raffaele Hospital, Milan, Italy
| | - Alessandro Pasquale Malvone
- Nurse, General and Emergency Surgery, and Gastroenterological Surgery Departments, San Raffaele Hospital, Milan, Italy
| | - Vitalba Scaduto
- Nurse, General and Emergency Surgery, and Gastroenterological Surgery Departments, San Raffaele Hospital, Milan, Italy
| | - Davide Brambilla
- Multi-specialist Ambulatory Nurse, San Raffaele Hospital, Milan, Italy
| | - Francesco Carlo Denti
- Enteral Stoma Nurse, General and Emergency Surgery, and Gastroenterological Surgery Departments, San Raffaele Hospital, Milan, Italy
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Zelga P, Kluska P, Zelga M, Piasecka-Zelga J, Dziki A. Patient-Related Factors Associated With Stoma and Peristomal Complications Following Fecal Ostomy Surgery: A Scoping Review. J Wound Ostomy Continence Nurs 2021; 48:415-430. [PMID: 34495932 DOI: 10.1097/won.0000000000000796] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Ostomy creation is often an integral part of the surgical management of various diseases including colorectal malignancies and inflammatory bowel disease. Stoma and peristomal complications may occur in up to 70% of patients following ostomy surgery. The aim of this scoping literature review was to synthesize evidence on the risk factors for developing complications following creation of a fecal ostomy. DESIGN Scoping literature review. SEARCH STRATEGY Two independent researchers completed a search of the online bibliographic databases PubMed, MEDLINE, Cochrane, Google Scholar, and EMBASE for all articles published between January 1980 and December 2018. The search comprised multiple elements including systematic literature reviews with meta-analysis of pooled findings, randomized controlled trials, cohort studies, observational studies, other types of review articles, and multiple case reports. We screened 307 unique titles and abstracts; 68 articles met our eligibility criteria for inclusion. The methodological rigor of study quality included in our scoping review was variable. FINDINGS/CONCLUSIONS We identified 6 risk factors associated with an increased likelihood of stoma or peristomal complications (1) age more than 65 years; (2) female sex; (3) body mass index more than 25; (4) diabetes mellitus as a comorbid condition; (5) abdominal malignancy as the underlying reason for ostomy surgery; and (6) lack of preoperative stoma site marking and WOC/ostomy nurse specialist care prior to stoma surgery. We also found evidence that persons with a colostomy are at a higher risk for prolapse and parastomal hernia. IMPLICATIONS Health care professionals should consider these risk factors when caring for patients undergoing fecal ostomy surgery and manage modifiable factors whenever possible. For example, preoperative stoma site marking by an ostomy nurse or surgeon familiar with this task, along with careful perioperative ostomy care and education of the patient by an ostomy nurse specialist, are essential to reduce the risk of modifiable risk factors related to creation of a fecal ostomy.
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Affiliation(s)
- Piotr Zelga
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Piotr Kluska
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Marta Zelga
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Joanna Piasecka-Zelga
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Adam Dziki
- Piotr Zelga, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Piotr Kluska, MD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
- Marta Zelga, MD, Department of Pediatric Surgery, Urology and Transplantology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
- Joanna Piasecka-Zelga, PhD, Research Laboratory for Medicine and Veterinary Products in the GMP Quality System, Nofer Institute of Occupational Medicine, Lodz, Poland
- Adam Dziki, MD, PhD, Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
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Scientific and Clinical Abstracts From WOCNext® 2021: An Online Event ♦ June 24-26, 2021. J Wound Ostomy Continence Nurs 2021; 48:S1-S49. [PMID: 37632236 DOI: 10.1097/won.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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11
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Longitudinal associations of sociodemographic, lifestyle, and clinical factors with alcohol consumption in colorectal cancer survivors up to 2 years post-diagnosis. Support Care Cancer 2021; 29:5935-5943. [PMID: 33761003 PMCID: PMC8410706 DOI: 10.1007/s00520-021-06104-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/23/2021] [Indexed: 02/06/2023]
Abstract
Purpose Alcohol consumption can lead to worse prognosis and mortality among colorectal cancer (CRC) patients. We investigated alcohol consumption of CRC survivors up to 2 years post-diagnosis, and how sociodemographic, lifestyle, and clinical factors were associated longitudinally with these habits. Methods We pooled longitudinal data of 910 CRC survivors from the ongoing PROCORE and EnCoRe studies with data collected at diagnosis (baseline) and 3, 6, 12, and 24 months post-diagnosis. Both studies assessed alcohol consumption, including beer, wine, and liquor. Generalized estimated equation models were used to examine changes over time in alcohol consumption and multivariable longitudinal associations of sociodemographic, lifestyle, and clinical factors with alcohol consumption. Results At baseline, participants were on average 67 years old, 332 (37%) were female, and alcohol was consumed by 79%. Most survivors (68–71%) drank less at all follow-ups. Beer, wine, and liquor were consumed by 51%, 58%, and 25% at baseline, respectively, and these declined over time. Males consumed more alcohol, and higher education, more physical activity, and not having a (permanent) stoma were associated with consuming more alcohol. Conclusion CRC survivors decreased their alcohol consumption in the 2 years post-diagnosis. Future studies should take the significant factors that were associated with alcohol post-diagnosis consumption into account, when they investigate CRC health outcomes or for identifying subgroups for interventions. Males with higher education, more physical activity, and no stoma should be reminded after diagnosis for reducing their alcohol consumption. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06104-0.
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Krogsgaard M, Gögenur I, Helgstrand F, Andersen RM, Danielsen AK, Vinther A, Klausen TW, Hillingsø J, Christensen BM, Thomsen T. Surgical repair of parastomal bulging: a retrospective register-based study on prospectively collected data. Colorectal Dis 2020; 22:1704-1713. [PMID: 32548884 DOI: 10.1111/codi.15197] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/13/2020] [Indexed: 12/16/2022]
Abstract
AIM The aim of this work was to examine (1) the incidence of primary repair, (2) the incidence of recurrent repair and (3) the types of repair performed in patients with parastomal bulging. METHOD Prospectively collected data on parastomal bulging from the Danish Stoma Database were linked to surgical data on repair of parastomal bulging from the Danish National Patient Register. Survival statistics provided cumulative incidences and time until primary and recurrent repair. RESULTS In the study sample of 1016 patients with a permanent stoma and a parastomal bulge, 180 (18%) underwent surgical repair. The cumulative incidence of a primary repair was 9% [95% CI (8%; 11%)] within 1 year and 19% [95% CI (17%; 22%)] within 5 years after the occurrence of a parastomal bulge. We found a similar probability of undergoing primary repair in patients with ileostomy and colostomy. For recurrent repair, the 5-year cumulative incidence was 5% [95% CI (3%; 7%)]. In patients undergoing repair, the probability was 33% [95% CI (21%; 46%)] of having a recurrence requiring repair within 5 years. The main primary repair was open or laparoscopic repair with mesh (43%) followed by stoma revision (39%). Stoma revision and repair with mesh could precede or follow one another as primary and recurrent repair. Stoma reversal was performed in 17% of patients. CONCLUSION Five years after the occurrence of a parastomal bulge the estimated probability of undergoing a repair was 19%. Having undergone a primary repair, the probability of recurrent repair was high. Stoma reversal was more common than expected.
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Affiliation(s)
- M Krogsgaard
- Department of Surgical Gastroenterology, Clinic C Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - I Gögenur
- Department of Surgery, Centre for Surgical Sciences, Zealand University Hospital, Koege, Denmark
| | - F Helgstrand
- Department of Surgery, Centre for Surgical Sciences, Zealand University Hospital, Koege, Denmark
| | - R M Andersen
- Department of Surgical Gastroenterology, Clinic C Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A K Danielsen
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital in Herlev and Gentofte, Copenhagen, Denmark.,QD-Research Unit, Copenhagen University Hospital in Herlev and Gentofte, Denmark
| | - T W Klausen
- Department of Haematology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - J Hillingsø
- Department of Surgical Gastroenterology, Clinic C Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - B M Christensen
- Department of Surgical Gastroenterology, Clinic C Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - T Thomsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Herlev Acute, Critical and Emergency Care Science Group, Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Andersen RM, Thomsen T, Danielsen AK, Gögenur I, Alkjær T, Nordentoft T, Possfelt-Møller E, Vinther A. Evaluation of abdominal exercises after stoma surgery: a descriptive study. Disabil Rehabil 2020; 44:710-719. [PMID: 32510238 DOI: 10.1080/09638288.2020.1771620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To evaluate the feasibility of exercises for the abdominal muscles in patients after colostomy or ileostomy formation on the following parameters: muscle activity, pain, discomfort, and difficulty of performing the exercises.Materials and methods: Patients with a new stoma were divided into groups based on time after surgery: Early group, 0-2 weeks (n = 12); Intermediate group, 2-6 weeks (n = 15); and Late group, 6-12 weeks (n = 10). During a single individual test session, participants in each group performed a different set of 10-11 abdominal coordination and strengthening exercises for the abdominal muscles. Activity of the abdominal muscles was measured with electromyography. Pain, discomfort, and difficulty were rated for each exercise.Results: For the Early group, muscle activity reaching a predetermined threshold was measured for half of the participants in a few exercises. In both the Intermediate group and the Late group, muscle activity reaching the onset criteria was measured for all muscles for a high percentage of participants in several exercises. Both strengthening and coordinating exercises were feasible based on low ratings of pain, discomfort, and difficulty.Conclusions: This study identified feasible exercises that activated the abdominal muscles at different time points after stoma formation. The observations can be used as guidance for the choice of exercises in clinical practice and future research.Implications for rehabilitationThe findings of this study can be used in clinical practice as guidance for choice of exercise at different time points after surgery.This study identified useful exercises for activating the abdominal muscles in rehabilitation after stoma surgery from two weeks on.In the first two postoperative weeks, there was limited involvement of the abdominal muscles with the evaluated exercises.Most of the evaluated abdominal exercises were feasible after stoma surgery based on pain, discomfort, and difficulty.
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Affiliation(s)
- Rune Martens Andersen
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Gastroenterology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thordis Thomsen
- Department of Anesthesiology, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Ismail Gögenur
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Surgery, Center for Surgical Sciences, Zealand University Hospital, Køge, Denmark
| | - Tine Alkjær
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tyge Nordentoft
- Department of Gastroenterology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emma Possfelt-Møller
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark.,QD-Research Unit, Copenhagen University Hospital, Herlev and Gentofte, Copenhagen, Denmark
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Post surgical rectovaginal fistula: who really benefits from stoma diversion? Updates Surg 2020; 73:165-171. [PMID: 32449033 DOI: 10.1007/s13304-020-00810-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/18/2020] [Indexed: 12/13/2022]
Abstract
To analyze the role of stoma diversion and timing of stoma maintenance in the healing of post-surgical Recto Vaginal Fistulae (psRVF). A retrospective analysis of a prospectively maintained registry. All patients with a psRVF diagnosed at IRCCS Sacro Cuore-Don Calabria Hospital of Negrar di Valpolicella from January 2002 to December 2016 were analyzed. The baseline treatment was a fecal diversion. Patients were divided into two groups according to healing time: < 6 months (Group 1) or > 6 months (Group 2). 2043 women underwent rectal resections in the study period. We recorded 37 patients with psRVF (1.8%). Nineteen women (51.3%) healed (Group 1) within 6 months. The median time of psRVF recovery in group 1 was 99.7 days. Concomitant local treatment of the fistula did not influence the healing rate (p 0.8). Colostomies were significantly higher in group 1 (p 0.003). The size of the psRVF influenced the success rate of fistula healing with loop stoma (p 0.07). A multivariate analysis the presence of fever and pelvic abscess (pelvis sepsis) were significantly associated with diversion failure (p 0.035). A step-up approach with the maintenance of loop stoma at least for six months for all patients with psRVF could be changed. Patients with larger fistula and pelvic sepsis at index procedure should be addressed earlier to a specific second-level treatment.
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Impact of a Parastomal Bulge on Quality of Life - A Cross-sectional Study of Patients From the Danish Stoma Database. Ann Surg 2019; 274:e1085-e1092. [PMID: 31850997 DOI: 10.1097/sla.0000000000003743] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate stoma specific and generic HRQoL in patients with and without a parastomal bulge. BACKGROUND Most patients have to live with their stoma complicated by a parastomal bulge. How this affects quality of life remains unclear. METHODS Patients in the Danish Stoma Database completed the Short-form 36 health survey and the stoma-QOL questionnaire. Linear regression analysis, adjusted for potential confounding factors, provided mean and mean score differences and 95% confidence intervals for each HRQoL scale and item. Cohens d provided estimates of effect size. RESULTS A total of 1265 patients (65%) completed the questionnaire 4.4 (interquartile range 3.1-6.0) years after stoma surgery. Of these, 693 (55%) patients with a parastomal bulge had significantly impaired (P < 0.01) HRQoL across all stoma specific and generic health domains compared to patients without a parastomal bulge. In patients with a benign diagnosis or an ileostomy, a parastomal bulge impacted significantly on Social Functioning and Mental Health resulting in a worse Mental Component Summary. A large bulge >10 cm impaired HRQoL (P < 0.01) across all stoma specific and generic domains. The impact on HRQoL was independent of time with the bulge. CONCLUSIONS A novel finding in this large, unselected sample from high-quality regional registries was that parastomal bulging was associated with substantial and sustained impairment of HRQoL.
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Parastomal hernias causing symptoms or requiring surgical repair after colorectal cancer surgery-a national population-based cohort study. Int J Colorectal Dis 2019; 34:1267-1272. [PMID: 31147771 DOI: 10.1007/s00384-019-03292-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Parastomal hernia is a complication with high morbidity that affects the patient's quality of life. The aim of this study was to assess the cumulative incidence of parastomal hernia in patients who have undergone colorectal cancer surgery and to identify potential risk factors that could predispose to the development of this type of hernia in a large population-based cohort over a long follow-up period. METHODS The Swedish Colorectal Cancer Registry and the National Patient Register were used to collect study cohort data between January 2007 and September 2013. All patients undergoing colorectal cancer surgery including a permanent stoma were included in the study group. RESULTS A total of 39,984 patients were registered during the study period. Of these, 7649 received a permanent stoma. Multivariate proportional hazard analysis, based on 6329 patients for whom all covariates could be retrieved, showed that the only independent risk factor for developing a parastomal hernia was BMI ≥ 30 (HR 1.49; 95% CI 1.02-2.17; p < 0.037). A slightly elevated hazard ratio was found for preoperative radiotherapy (HR 1.36; 95% CI 0.96-1.91; p < 0.070). The cumulative incidence of patients diagnosed or surgically treated for parastomal hernia over a follow-up period of 5 years was 7.7% (95% CI 6.1-9.2%). CONCLUSIONS The cumulative incidence of parastomal hernia causing symptoms or requiring surgery after 5 years was at least 7.7%. Obesity increases the risk of developing parastomal hernia.
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Ileostomy versus fecal diversion device to protect anastomosis after rectal surgery: a randomized clinical trial. Int J Colorectal Dis 2019; 34:811-819. [PMID: 30740632 DOI: 10.1007/s00384-019-03255-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Patients with rectal anastomosis commonly experience various ileostomy-related complications. This study aimed to elucidate the usefulness of a fecal diversion device (FDD) as an alternative to ileostomy for protecting rectal anastomosis. METHODS Patients with rectal anastomosis were randomly assigned to the ileostomy and FDD groups except in cases of emergency surgery. The primary endpoint was the clinical safety and effectiveness of FDD. The mean operation time, delay of diet advancement, length of hospital stay, FDD and stoma durations, and anastomotic leakage (AL) management methods were compared. RESULTS A total of 54 patients were enrolled in this study. No cases of mortality occurred. Overall morbidity was similar between groups (P = 0.551). Six patients (22.2%) in the FDD group and nine (29.0%) in the stoma group (P = 0.555) had AL. The mean total hospital stay was 16.4 ± 6.7 and 23.4 ± 8.7 days in the FDD and stoma groups, respectively (P = 0.002). The mean total hospital cost was 12,726.8 ± 3422.8 USD and 17,954.9 ± 9040.3 USD in the FDD and stoma groups, respectively (P = 0.008). The mean FDD and stoma durations were 21.6 ± 6.1 days and 114.9 ± 41.3 days, respectively (P < 0.0001). CONCLUSIONS This study demonstrated FDD safety and effectiveness. We identified the possibility of FDD as an alternative technique to conventional stoma procedures.
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