1
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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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2
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Odensten C, Gunnarsson U, Johansson J, Näsvall P. Impact of parastomal hernia on colostomy costs at 1 year: Secondary analysis of a randomized clinical trial (STOMAMESH). Scand J Surg 2024; 113:33-39. [PMID: 37563916 DOI: 10.1177/14574969231188021] [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: 08/12/2023]
Abstract
BACKGROUND AND AIMS Parastomal hernia (PSH) is a common complication after the creation of a colostomy, with a prevalence of approximately 50%. Despite the high frequency, little is known how PSH affects the cost of colostomy care.The hypothesis in this study was that PSH increases the cost of colostomy care compared with not having a PSH. METHODS Two groups with (N = 61) and without (n = 147) PSH were compared regarding costs of stoma appliances and visits. The population from a large randomized trial comparing construction of colostomy with or without prophylactic mesh (STOMAMESH) was used and cross-matched with health economic data from the National Pharmaceutical Register, 1 year after initial surgery. RESULTS Patients with and without a PSH were similar in basic demographic data. No difference in cost of stoma appliances (with PSH 2668.3 EUR versus no PSH 2724.5 EUR, p = 0.938) or number of visits to a stoma therapist (p = 0.987) was seen, regardless of the presence or not of a PSH. CONCLUSIONS PSH appears not to affect costs due to colostomy appliances or the need to visit a stoma therapist, in the first year. The lesson to be learnt is that PSHs are not a driver for costs. Other factors may be determinants of the cost of a colostomy, including manufacturers' price and persuasion, means of procurement, and presence of guidelines.
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Affiliation(s)
- Christoffer Odensten
- Division of Surgery Sunderby Hospital Luleå 97180 Sweden Sunderby Research Unit Department of Surgical and Perioperative Sciences Medical Faculty Umeå University Umeå Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Medical Faculty, Umeå University, Umeå, Sweden
| | - Jeaneth Johansson
- Department of Business Administration and Industrial Engineering, Luleå University of Technology, Luleå, Sweden
| | - Pia Näsvall
- Sunderby Research Unit, Department of Surgical and Perioperative Sciences, Medical Faculty, Umeå University, Umeå, Sweden
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3
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Näverlo S, Strigård K, Gunnarsson U, Edin-Liljegren A. Patients' experiences of living with a stoma in rural areas in Northern Sweden. Int J Circumpolar Health 2023; 82:2221767. [PMID: 37300840 DOI: 10.1080/22423982.2023.2221767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
Introduction: Stoma complications are common and interfere with many aspects of everyday life. Stoma problems are usually managed by a specialised stoma nurse, a service not present in the rural areas of South Lapland in Sweden. The aim of this study was to describe how stoma patients in rural areas experience living with a stoma.Methods: A qualitative descriptive study with semi-structured interviews were conducted with 17 stoma patients living in rural municipalities and who received a part of their care at the local cottage hospital. Qualitative content analysis was employed.Results: Initially, the stoma was experienced as very depressing. Participants had difficulties in properly managing the dressing. Over time they learned how to properly care for their stoma, making their life easier. Both satisfaction and dissatisfaction with the healthcare were experienced. Those who were dissatisfied expressed a lack of competence in dealing with stoma-related problems.Conclusions: Living with a stoma in a rural area in northern Sweden is experienced as a learning process and acceptance of the stoma's existence is important. This study emphasises the need for increased knowledge of stoma-related problems in rural primary healthcare in order to help patients cope with everyday life.
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Affiliation(s)
- Simon Näverlo
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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4
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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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5
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Özlü NGÖ, Vural F. Stoma Perceptions of Adults with an Ostomy: A Metaphor Analysis in a Single Center. Adv Skin Wound Care 2023; 36:1-7. [PMID: 37603320 DOI: 10.1097/asw.0000000000000017] [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: 08/22/2023]
Abstract
OBJECTIVE To use metaphor to evaluate stoma perceptions among adults with ostomies to conceptualize and portray their lived experiences using a figurative approach. METHODS A qualitative research design was used. Participants were 27 adults with an ostomy who were followed up in the stoma therapy unit. Individuals were included in the study if they had had a temporary or permanent ostomy for at least 2 months and spoke Turkish. Participants were asked to complete the sentence: "Stoma is like…/similar to… because…." The researchers used content analysis to evaluate participants' responses. Interpretation of the metaphors developed by participants was carried out in five phases: coding, example metaphor compilation, theme development, ensuring trustworthiness, and transferring. RESULTS Participants expressed a total of 17 unique and 10 repeated metaphors for the concept of "stoma." These metaphors were grouped under three different themes: positive (lifesaving), negative (punishment/enemy), and neutral (temporary/necessity for life). The most commonly used metaphors were life, savior, comfort, difficulty, fear, punishment, and necessity. CONCLUSIONS Individuals with an ostomy mostly had negative metaphorical associations with stomas. The authors recommend that hospitals implement multifaceted interventions to bring positive metaphors to individuals with ostomies.
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Affiliation(s)
- Nazife Gamze Özer Özlü
- At Dokuz Eylül University, Faculty of Nursing, Department of Surgical Nursing, Izmir, Turkey, Nazife Gamze Özer Özlü, PhD, is Research Assistant; and Fatma Vural, PhD, is Associate Professor. Acknowledgments: The authors thank all of the people who participated in this study. They also thank the nurses and physicians at the clinic for their kind assistance. The authors have disclosed no financial relationships related to this article. Submitted August 11, 2022; accepted in revised form December 1, 2022
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6
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Haas S, Mikkelsen AH, Kronborg CJS, Oggesen BT, Møller PF, Fassov J, Frederiksen NA, Krogsgaard M, Graugaard-Jensen C, Ventzel L, Christensen P, Emmertsen KJ. Management of treatment-related sequelae following colorectal cancer. Colorectal Dis 2023; 25:458-488. [PMID: 35969031 DOI: 10.1111/codi.16299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 02/08/2023]
Abstract
AIM Colorectal cancer survivors are one of the most rapidly growing groups of patients living with and beyond cancer. In a national multidisciplinary setting, we have examined the extent of late treatment-related sequelae in colorectal cancer survivors and present the scientific evidence for management of these conditions in this patient category with the aim of facilitating identification and treatment. METHOD A systematic search for existing guidelines and relevant studies was performed across 16 and 4 databases, respectively, from inception to 2021. This yielded 13 guidelines and 886 abstracts, of which 188 were included in the finalized guideline (231 included for full text review). Secondarily, bibliographies were cross-referenced and 53 additional articles were included. RESULTS Symptoms have been divided into overall categories including psychosocial, bowel-related, urinary, sexual (male and female), pain/neuropathy and fatigue symptoms or complaints that are examined individually. Merging and grading of data resulted in 22 recommendations and 42 management strategies across categories. Recommendations are of a more general character, whereas management strategies provide more practical advice suited for initiation on site before referral to specialized units. CONCLUSION Treatment-related sequelae in colorectal cancer survivors are common and attention needs to be focused on identifying patients with unmet treatment needs and the development of evidence-based treatment algorithms.
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Affiliation(s)
- Susanne Haas
- Department of Surgery, Danish Cancer Society National Research Center for Survivorship and Late Adverse Effects Following Pelvic Organ Cancer, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
| | | | | | | | - Pia F Møller
- Department of Surgery, Vejle Hospital, Vejle, Denmark
| | - Janne Fassov
- Department of Surgery, Danish Cancer Society National Research Center for Survivorship and Late Adverse Effects Following Pelvic Organ Cancer, Aarhus University Hospital, Aarhus, Denmark
- Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Lise Ventzel
- Department of Oncology, University Hospital of Southern Denmark, Vejle, Denmark
| | - Peter Christensen
- Department of Surgery, Danish Cancer Society National Research Center for Survivorship and Late Adverse Effects Following Pelvic Organ Cancer, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Katrine Jøssing Emmertsen
- Department of Surgery, Danish Cancer Society National Research Center for Survivorship and Late Adverse Effects Following Pelvic Organ Cancer, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
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7
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Indrebø KL, Aasprang A, Olsen TE, Andersen JR. Factors associated with leakage in patients with an ostomy: A cross-sectional study. Nurs Open 2023; 10:3635-3645. [PMID: 36691880 PMCID: PMC10170928 DOI: 10.1002/nop2.1612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 11/01/2022] [Accepted: 12/16/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS To explore the associations between sociodemographic and clinical data, the patient's knowledge and skills, and relationship to healthcare professionals with leakage from an ostomy. DESIGN Cross-sectional. METHODS This study included 160 patients with a colostomy, ileostomy, or urostomy. Leakage was the dependent variable and was assessed by self-report. Sociodemographic and clinical data and the Ostomy Adjustment Scale subscores, 'knowledge and skills' and 'health care professionals' were independent variables. Spearman's rho and multivariate partial least squares regression analysis were used to estimate possible factors associated with leakage. RESULTS Of the participants, 13.8% had leakage weekly or more often, 16.3% more often than once a month and 37, 5% had leakage more seldom than once a month. The most important risk factors for leakage were (1) having an ostomy placement that does not meet international guidelines, (2) not having an optimal relationship with health professionals, (3) having a diagnosis other than cancer, (4) not having proper knowledge and skills in ostomy care, (5) not having a colostomy, (6) having a convex baseplate, (7) having an oval ostomy, and (8) being dependent on others for ostomy care. The independent variables in the PLS- model explained 31% of the variance in leakage. PATIENT OR PUBLIC CONTRIBUTION We thank the patients in the user panel for their help during the study.
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Affiliation(s)
- Kirsten Lerum Indrebø
- Department of Surgery, Førde Central Hospital, Førde, Norway.,Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Anny Aasprang
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Centre of Health Research, Førde Hospital Trust, Førde, Norway
| | - Torill Elin Olsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - John Roger Andersen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Centre of Health Research, Førde Hospital Trust, Førde, Norway
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8
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Borglit T, Krogsgaard M, Theisen SZ, Juel Rothmann M. Assessment of a support garment in parastomal bulging from a patient perspective: a qualitative study. Int J Qual Stud Health Well-being 2022; 17:2039428. [PMID: 35174778 PMCID: PMC8925919 DOI: 10.1080/17482631.2022.2039428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Trine Borglit
- Department of Surgery, Zealand University Hospital, Koege, Denmark
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9
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Krogsgaard M, Kristensen HØ, Furnée EJB, Verkuijl SJ, Rama NJ, Domingos H, Maciel J, Solis-Peña A, Espín-Basany E, Hidalgo-Pujol M, Biondo S, Sjövall A, Emmertsen KJ, Thyø A, Christensen P. Life with a stoma across five European countries-a cross-sectional study on long-term rectal cancer survivors. Support Care Cancer 2022; 30:8969-8979. [PMID: 35930059 DOI: 10.1007/s00520-022-07293-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Stoma-related problems are known to be important to patients and potentially affect everyday life. The prevalence of stoma-related problems in rectal cancer survivors remains undetermined. This study aimed to examine aspects of life with a long-term stoma, stoma management, and stoma-related problems and explore the impact of stoma-related problems on daily life. METHODS In total, 2262 patients from 5 European countries completed a multidimensional survey. Stoma-related problems were assessed using the Colostomy Impact score. Multivariable regression analysis, after adjusting for potential confounding factors, provided odds ratio (OR) and 95% confidence intervals (CI) for stoma-related problems' association with restrictions in daily life. RESULTS The 2262 rectal cancer survivors completed the questionnaire at a median of 5.4 years (interquartile range 3.8-7.6) after stoma formation. In the total sample, leakage (58%) and troublesome odour (55%) were most prevalent followed by skin problems (27%) and pain (21%). Stoma-related problems were more prevalent in patients with parastomal bulging. A total of 431 (19%) reported feeling restricted in daily activities in life with a stoma. Leakage, odour, skin problems, stool consistency, and frequent appliance changes were significantly associated with restrictions in daily life. The highest risk of experiencing restrictions was seen for patients having odour (OR 2.74 [95% CI: 1.99-3.78]) more than once a week and skin problems (OR 1.77 [95% CI: 1.38-2.27]). CONCLUSION In this large cohort with rectal cancer, stoma-related problems were highly prevalent and impacted daily life. Supportive care strategies should entail outreach to patients with a long-term stoma.
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Affiliation(s)
- Marianne Krogsgaard
- Department of Surgery, Center for Surgical Science, Zealand University Hospital, Lykkebækvej 1, 4600, Koege, Denmark.
| | - Helle Ø Kristensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Danish Cancer Society Centre for Research On Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus, Denmark
| | - Edgar J B Furnée
- Department of Surgery, Division of Abdominal Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sanne J Verkuijl
- Department of Surgery, Division of Abdominal Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nuno José Rama
- Surgery - Colorectal Unit, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Hugo Domingos
- Colorectal Surgery Unit, Champalimaud Foundation, Lisbon, Portugal
| | - João Maciel
- Colorectal Surgery Unit, Instituto Português de Oncologia, Lisbon, Portugal
| | - Alejandro Solis-Peña
- Colorectal Surgery Unit, General Surgery Department, Universitat Autonoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain
| | - Eloy Espín-Basany
- Colorectal Surgery Unit, General Surgery Department, Universitat Autonoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain
| | - Marta Hidalgo-Pujol
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain.,University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Coloproctology Unit, Bellvitge University Hospital, Barcelona, Spain.,University of Barcelona and IBIDELL (Bellvitge Biomedical Investigation Institute), Barcelona, Spain
| | - Annika Sjövall
- Division of Coloproctology, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Katrine J Emmertsen
- Danish Cancer Society Centre for Research On Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus, Denmark.,Department of Surgery, Regional Hospital Randers, Randers, Denmark
| | - Anne Thyø
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Danish Cancer Society Centre for Research On Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus, Denmark.,Department of Surgery, Regional Hospital Randers, Randers, Denmark
| | - Peter Christensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Danish Cancer Society Centre for Research On Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus, Denmark
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10
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Mini-invasive Surgery and Parastomal Hernia: Higher Frequency and No Prophylactic Mesh Effect. Surg Laparosc Endosc Percutan Tech 2021; 30:345-350. [PMID: 32398451 DOI: 10.1097/sle.0000000000000791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM Parastomal hernia (PSH) is very common. Recent reports suggest increased frequency after laparoscopic stoma formation compared with open surgery. A retrospective chart review was designed to appraise the outcomes regarding PSH in open and in laparoscopic procedures. MATERIALS AND METHODS All patients operated by rectal resection and planned end-colostomy in the period from 2004 to 2018 were reviewed. A total of 70 open and 101 laparoscopic operations were identified. A modified retromuscular mesh application through the trephine was used for the prevention of PSH in 42% of patients in the laparoscopic group. RESULTS The median follow-up was 58 (1 to 167) months in the open group and 43 (0 to 153) months in the laparoscopic group. Patient characteristics were evenly distributed between the groups, except for more male patients and higher American Society of Anesthesiologists Score as well as higher rates of patients with neoadjuvant treatment and mesh prophylaxis, in the laparoscopic group. Clinical PSH occurrences were 2 (3%) in the open group and 18 (18%) in the laparoscopic group (P=0.00). Propensity-weighted analysis estimates increased odds ratio (OR) for PSH in the laparoscopic group [OR=11.8; 95% confidence interval (CI): 1.4-96.6]. PSH repair rates were 0 in the open group and 6/18 (33%) in the laparoscopic group. Mesh prophylaxis in the laparoscopic group did not influence PSH outcome (OR=1.4; 95% CI: 0.5-4.0). Computed tomography scans were assessable in 48 and 66 patients, with median follow-up timepoints of 42 and 30 months in the open and laparoscopic groups, respectively, and 8 (18%) and 21 patients (32%) were diagnosed with PSH. Computed tomography assessment implied an increased risk for PSH in laparoscopy (OR=3.5; 95% CI: 1.1-11.9). Aggregate of chart and computed tomography occurrence of PSH showed an equivalent hazard (OR=3.2; 95% CI: 1.1-9.5). INTERPRETATIONS Laparoscopic operations with stoma formation seem to have an increased rate of PSH in comparison with open operations and the results support previous claims. Retromuscular keyhole mesh placement may not be the ideal method of PSH prevention in laparoscopic stoma formation.
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11
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Krogsgaard M, Andersen RM, Danielsen AK, Thomsen T, Klausen TW, Christensen BM, Gögenur I, Vinther A. Physical activity after colorectal cancer surgery-a cross sectional study of patients with a long-term stoma. Support Care Cancer 2021; 30:555-565. [PMID: 34342750 DOI: 10.1007/s00520-021-06374-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/19/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Physical activity is recommended to cancer survivors by the World Health Organisation (WHO) and is associated with improved survival after colorectal cancer. It remains unclear whether having a stoma is a barrier for an active lifestyle. We examined the level of physical activity and explored factors impacting physical activity in survivors with a stoma. METHODS A total of 1265 (65%) patients in the Danish Stoma Database completed a multidimensional survey. Physical activity of moderate- and vigorous-intensity was assessed using two validated questions. Based on WHO guidelines, physical activity was categorised into 'Meeting' or 'Not Meeting' recommendations. Multivariate regression analysis, adjusting for potential confounders, provided odds ratio (OR) and 95% confidence intervals (CI) for factors' association with'Not Meeting' guideline recommendations. RESULTS In total, 571 patients with colorectal cancer reported on physical activity at a median of 4.3 years (interquartile range 3.1-5.8) after stoma surgery. Two hundred ninety-three patients (51%) were 'Meeting recommendations' and 63% of them were 'Highly active'. Two hundred seventy-eight were 'Not meeting' recommendations (49%). Of the factors analysed, patients without support garment were more likely (OR 1.72 [95% CI 1.16; 2.54] not to meet guideline recommendations. We found no association between stoma type, surgical procedure, parastomal bulging and 'problematic stoma' and level of physical activity, respectively. CONCLUSION In this large sample of survivors with a stoma half of patients met or exceeded guideline recommendations. Of patients not meeting recommendations some could potentially meet the recommendations by modest increases in either moderate or vigorous activity.
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Affiliation(s)
- Marianne Krogsgaard
- Department of Surgery and Transplantation, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark. .,Department of Gastroenterology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark. .,Centre for Surgical Sciences, Department of Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Koege, Denmark.
| | - Rune Martens Andersen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200, Slagelse, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anne K Danielsen
- Department of Gastroenterology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thordis Thomsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Herlev Acute, Critical and Emergency Care Science Group, Department of Anaesthesiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | | | - Bo Marcel Christensen
- Department of Surgery and Transplantation, Clinic C, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ismail Gögenur
- Centre for Surgical Sciences, Department of Surgery, Zealand University Hospital, Lykkebækvej 1, 4600, Koege, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy and Hospital Secretariat and Communications, Research, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
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12
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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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13
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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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14
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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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15
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Odensten C, Strigård K, Dahlberg M, Gunnarsson U, Näsvall P. Parastomal Hernia Repair; Seldom Performed and Seldom Reported: Results From a Nationwide Survey. Scand J Surg 2018; 109:96-101. [DOI: 10.1177/1457496918818984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Parastomal hernia is common, but there are few population-based studies showing the frequency and outcome of parastomal hernia repair in routine surgical practice. The aim of this study was to identify patients undergoing surgery for parastomal hernia in Sweden and to define risk factors for complication and recurrence. Methods: A broad search of the Swedish National Patient Register 1998–2007 for all possible parastomal hernia repairs using surgical procedure codes. Records of all patients identified were reviewed and those with a definite parastomal hernia procedure were included and analyzed. Results: A total of 71 patients were identified after review of the records. The most common reason for surgery was cosmetic and the most frequent method was relocation of the stoma. Parastomal hernia recurrence rate was 18% during follow-up of a minimum 2 years. Overall, a surgical complication occurred in 32%. Possible risk factors were analyzed including emergency surgery versus planned, gender, age, indication for surgery, and method of surgery; none of which was significant. Conclusion: The frequency of parastomal hernia procedures was much lower than suggested by previous studies. The number of procedures per surgeon was even lower than expected. No specific risk factor could be identified. Parastomal hernia auditing in the form of a nationwide quality register should be mandatory. Centralization should be considered.
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Affiliation(s)
- C. Odensten
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
- Sunderby Research Unit, Umeå University, Umeå, Sweden
- Department of Surgery, Sunderby sjukhus, Luleå, Sweden
| | - K. Strigård
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - M. Dahlberg
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
- Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - U. Gunnarsson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - P. Näsvall
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
- Sunderby Research Unit, Umeå University, Umeå, Sweden
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16
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Prevention and treatment of parastomal hernia: a position statement on behalf of the Association of Coloproctology of Great Britain and Ireland. Colorectal Dis 2018; 20 Suppl 2:5-19. [PMID: 30176120 DOI: 10.1111/codi.14249] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/30/2018] [Indexed: 02/08/2023]
Abstract
AIM The Association of Coloproctology of Great Britain and Ireland (ACPGBI) Delphi process identified prevention and treatment of parastomal hernia (PSH) as the second highest priority non-cancer related colorectal pathology. This position statement aims to summarize the current evidence base. METHODS Four broad themes were identified (prevention, diagnosis/classification, management and operative repair). Guidelines are based on evidence from an extensive literature review using organized searches on the PubMed, MEDLINE, Embase and Cochrane databases. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adhered to for classifying the quality of evidence and reporting the strength of recommendations. RESULTS The suture repair of PSH other than for patients in extremis is not recommended. Synthetic non-absorbable mesh can be used safely in the short term in the construction of colostomies post rectal surgery, but longer-term follow-up is needed. Other broad recommendations are made around access to stoma care nurses, prevention classification and management. CONCLUSION There is a lack of high quality evidence for many domains in the prevention and treatment of PSH but the results of several studies are awaited. WHAT DOES THIS PAPER ADD TO THE LITERATURE?: Parastomal hernias are a common and debilitating condition following stoma formation. This position statement from ACPGBI details the current evidence base and ongoing research for the prevention, diagnosis and management of parastomal hernias.
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