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Steen CJ, Wei MYK, Vadakkenchery Varghese E, Asghari-Jafarabadi M, Sansom W, Balakrishnan V, An V, Chandra R. Quality of life amongst patients with diverting umbilical stomas in rectal surgery: a single centre prospective randomized controlled pilot study. ANZ J Surg 2024; 94:187-192. [PMID: 37749845 DOI: 10.1111/ans.18709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/08/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The umbilical stoma (umbistoma) has been proposed as a viable alternative site for a temporary defunctioning stoma. Suggested advantages of the umbistoma include decreased number of surgical incisions required, improved cosmesis and ease of reversal surgery. This study aimed to assess the patient experience of umbilical loop ileostomies in rectal surgery, with the primary outcome being patient reported quality of life (QoL). METHODS A total of 20 patients undergoing laparoscopic rectal cancer surgery were randomly allocated to have a defunctioning ileostomy at a conventional site (right iliac fossa) or at the umbilicus. Patient-reported QoL was assessed at 6 weeks using the Stoma-QoL questionnaire. Secondary outcomes were number of stomas reversed, length of time awaiting stoma reversal surgery, duration of operative time for stoma reversal, length of hospital stay following stoma reversal and rate of parastomal or post reversal incisional hernias. RESULTS Patients who had an umbilical stoma scored significantly lower on the Stoma-QoL questionnaire compared to the conventional group, particularly on questions regarding feelings of tiredness, body insecurity and anxiety. No significant differences were observed between the two groups in relation to secondary outcomes. CONCLUSION There may be potential disadvantages to the umbilical stoma with negative impacts on body image and subsequent increased social anxiety. Patient selection and adequate counselling will be important when considering an umbilical stoma. Further larger scale prospective studies are required to further validate the feasibility and longer-term safety of umbilical stomas in both clinical outcomes as well as patient QoL.
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Affiliation(s)
- Christopher J Steen
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Cabrini Research, Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Matthew Y K Wei
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | | | - Mohammad Asghari-Jafarabadi
- Cabrini Research, Cabrini Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Wendy Sansom
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Vikram Balakrishnan
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Vinna An
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Raaj Chandra
- Department of Colorectal Surgery, Eastern Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Coletta D, De Padua C, Iannone I, Puzzovio A, Greco PA, Patriti A, La Torre F. Defunctioning Ileostomy to Prevent the Anastomotic Leakage in Colorectal Surgery. The State of the Art of the Different Available Types. Front Surg 2022; 9:866191. [PMID: 35495739 PMCID: PMC9043457 DOI: 10.3389/fsurg.2022.866191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/08/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Diego Coletta
- Department of Surgical Sciences, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
- *Correspondence: Diego Coletta ; orcid.org/0000-0002-9116-0733
| | - Cristina De Padua
- Department of General Surgery, Emergency Department, Emergency and Trauma Surgery Unit, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Immacolata Iannone
- Department of General Surgery, Emergency Department, Emergency and Trauma Surgery Unit, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Antonella Puzzovio
- Department of General Surgery, Emergency Department, Emergency and Trauma Surgery Unit, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Alberto Patriti
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Filippo La Torre
- Department of Surgical Sciences, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
- Department of General Surgery, Emergency Department, Emergency and Trauma Surgery Unit, Policlinico Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
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Vigna C, Arndt K, Dressler J, Loehner D, Messaris E. Single Center Experience with Umbilical Stomas Following Colorectal Surgery. J Laparoendosc Adv Surg Tech A 2022; 32:432-437. [PMID: 35119309 DOI: 10.1089/lap.2021.0809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The umbilicus is commonly used as an access site to perform minimally invasive colorectal surgery. Umbilical stomas are becoming an attractive option as an alternative site for temporary stomas since they reduce the need for additional abdominal incisions. Methods: We retrospectively evaluated patients who underwent umbilical stoma creation after colorectal resection for diagnosis of rectal cancer, diverticulitis, or ulcerative colitis between January 2020 and July 2021. Surgical technique, clinical and perioperative outcomes, complications, and cosmetic end results were described. Results: A total of 11 patients underwent umbilical stoma creation. There were no major surgical complications. Peristomal skin irritation was secondary to difficulties with the management of the pouching system. One patient presented with ostomy prolapse. Three patients experienced incisional hernia after stoma reversal. There were no wound infections. Conclusion: Umbilical stomas appear to be a safe alternative to conventional stomas and provide superior cosmetic outcomes.
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Affiliation(s)
- Carolina Vigna
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kevin Arndt
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jeremy Dressler
- Division of Colorectal Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Donna Loehner
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Sujka J, Alemayehu H, Benedict LA, Sobrino JA, St. Peter SD, Fraser JD. Outcomes of Ostomy Location in Children: Placement of the Ostomy at the Umbilicus. J Laparoendosc Adv Surg Tech A 2019; 29:243-247. [DOI: 10.1089/lap.2018.0185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joseph Sujka
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Hanna Alemayehu
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Justin A. Sobrino
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Jason D. Fraser
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
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Lam D, Lauritz B, Chandra R, Mushaya C, Sansom W, Sammour T, Keck J. Midline Stoma via the Umbilicus Versus Traditional Diverting Loop Ileostomy: a Retrospective Comparative Study. Indian J Surg 2018. [DOI: 10.1007/s12262-017-1674-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Hada M, Hayashi K, Sawada K, Oshima M, Kato Y, Oyama K, Kotake M, Hara T. Anticipation of umbistoma in laparoscopic anterior rectal resection: Ileostomy and ostomy closure. JOURNAL OF THE ANUS RECTUM AND COLON 2018; 2:77-82. [PMID: 31559347 PMCID: PMC6752148 DOI: 10.23922/jarc.2017-037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/31/2018] [Indexed: 11/30/2022]
Abstract
Objective: The use of laparoscopic surgery for rectal disease is expected to provide good cosmetic benefits for patients postoperatively. However, this expectation is significantly reduced when a diverting ileostomy is created. We present a new technique that reduces the size of the skin wound by constructing a diverting ileostomy in the umbilicus. This procedure, diverting umbilical ileostomy (umbistoma) does not require special tools for its construction and closure. Methods: Twenty-nine patients underwent treatment with umbilical diverting stoma, including five women and 24 men, with a mean age of 70 years (range: 40-88 years). At the time of ostomy closure, a new umbilicus was formed by subcutaneously suturing the wound to the fascia. In addition, we did not close the new umbilical upper and lower spaces, so as to allow open drainage of the healing wound. Results: All procedures were completed successfully without any perioperative complications. Conclusions: Our findings suggest that the umbilical diverting stoma could provide improved safety and cosmetic advantages in laparoscopic rectal resection.
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Affiliation(s)
- Masahiro Hada
- Department of Surgery, Koseiren Takaoka Hospital, Toyama, Japan
| | - Kengo Hayashi
- Department of Surgery, Koseiren Takaoka Hospital, Toyama, Japan
| | - Koichiro Sawada
- Department of Surgery, Koseiren Takaoka Hospital, Toyama, Japan
| | - Masahiro Oshima
- Department of Surgery, Koseiren Takaoka Hospital, Toyama, Japan
| | - Yosuke Kato
- Department of Surgery, Koseiren Takaoka Hospital, Toyama, Japan
| | - Kaeko Oyama
- Department of Surgery, Koseiren Takaoka Hospital, Toyama, Japan
| | - Masanori Kotake
- Department of Surgery, Koseiren Takaoka Hospital, Toyama, Japan
| | - Takuo Hara
- Department of Surgery, Koseiren Takaoka Hospital, Toyama, Japan
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Miyo M, Takemasa I, Hata T, Mizushima T, Doki Y, Mori M. Safety and Feasibility of Umbilical Diverting Loop Ileostomy for Patients with Rectal Tumor. World J Surg 2018; 41:3205-3211. [PMID: 28748422 DOI: 10.1007/s00268-017-4128-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Fashioning an ileostomy in the umbilicus and combining the trauma from extraction of colorectum with that from ileostomy should be less invasive and lead to improved cosmetic outcomes. However, there are only a few reports regarding umbilical ileostomy. METHODS We retrospectively collected data for 121 consecutive patients with rectal tumor who underwent elective laparoscopic rectal resection with diverting loop ileostomy between 2010 and 2015 at Osaka University Hospital, Japan. The safety and feasibility of umbilical diverting loop ileostomy and its influence on stoma care were investigated. RESULTS A total of 83 patients were included in this study; of these, 30 underwent umbilical diverting loop ileostomy and 53 underwent conventional diverting loop ileostomy, which was created in the right lower quadrant of the abdomen. The umbilical and conventional groups showed similar rates of postoperative and stoma-related complications (26.7 vs. 32.1%, p = 0.804 and 3.3 vs. 3.8%, p = 1.000, respectively). Level of parastomal dermatitis was evaluated by DET score at three time points (stoma self-management establishment, first outpatient review post-discharge, and just before stoma closure). DET scores at any time points did not differ significantly between the two groups. CONCLUSIONS Umbilical diverting loop ileostomy is comparable to conventional ileostomy with regard to safety and feasibility. Our methods for umbilical ileostomy using the umbilical skin flap were less invasive and did not have a negative impact on stoma care and parastomal dermatitis. Umbilical ileostomy may be a promising alternative to conventional ileostomy in selected cases.
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Affiliation(s)
- Masaaki Miyo
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ichiro Takemasa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan. .,Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S-1, W-17, Chuo-ku, Sapporo, Hokkaido, 060-8556, Japan.
| | - Taishi Hata
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsunekazu Mizushima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Ishiguro S, Komatsu S, Ando K, Osawa T, Yasui K, Arikawa T, Ohashi N, Miyachi M, Sano T. Feasibility of umbilical loop ileostomy in overweight and obese patients with rectal cancer during laparoscopic surgery: Preliminary results. Asian J Endosc Surg 2017; 10:79-82. [PMID: 28045234 DOI: 10.1111/ases.12316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/26/2016] [Accepted: 06/23/2016] [Indexed: 12/29/2022]
Abstract
We examined the feasibility of umbilical diverting ileostomy for overweight and obese patients with rectal cancer undergoing laparoscopic surgery. Four patients who were overweight or obese (BMI > 27 kg/m2 ) were initially scheduled for the creation of a conventional loop ileostomy. Intraoperatively, however, this was considered too complicated because of thick subcutaneous fat, bulky mesentery, or both. Instead, patients received a diverting ileostomy with the placement of an umbilical stoma. All patients had protruding umbilical ileostomies. No severe stoma-related complications were encountered. One patient had minor skin dehiscence, and another had paralytic ileus but resumed oral intake after a short time. Performing a temporary loop ileostomy at the umbilicus was safe and feasible in this small group of overweight and obese patients. This stoma placement may avoid the problems inherent to conventional loop ileostomy in obese subjects.
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Affiliation(s)
- Seiji Ishiguro
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Shunichiro Komatsu
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Keiichi Ando
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Takaaki Osawa
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Kohei Yasui
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Takashi Arikawa
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Norifumi Ohashi
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Masahiko Miyachi
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
| | - Tsuyoshi Sano
- Division of Gastroenterological Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan
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