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Concept: Colostomy

152

Intestinal loop stoma is a common surgical procedure performed for various benign and malignant abdominal problems, but it rarely undergoes spontaneous closure, without surgical intervention. Two male patients presented to our emergency surgical department with acute abdominal pain. One of them was diagnosed as having rectosigmoid perforation and underwent diversion sigmoid loop colostomy after primary closure of the perforation. The other was a known case of carcinoma of the rectum who had already undergone low anterior resection with covering loop ileostomy; the patient underwent second loop ileostomy, this time for complicated intestinal obstruction. To our surprise, both the loop colostomy and ileostomy closed spontaneously at 8 weeks and 6 weeks, respectively, without any consequences. Spontaneous stoma closure is a rare and interesting event. The exact etiology for spontaneous closure remains unknown, but it may be hypothesized to result from slow retraction of the stoma, added to the concept of a tendency towards spontaneous closure of enterocutaneous fistula.

Concepts: Surgery, Colorectal cancer, Ulcerative colitis, Abdominal pain, Gastroenterology, Stoma, Ileostomy, Colostomy

33

The aim of this study was to determine whether parastomal hernia (PSH) rate can be reduced by using synthetic mesh in the sublay position when constructing permanent end colostomy. The secondary aim was to investigate possible side-effects of the mesh.

Concepts: Colostomy

28

PURPOSE: This study evaluated the risk factors influencing permanent stoma after curative resection of rectal cancer and compared the long-term survival of patients according to the stoma state. METHODS: From January 2004 to December 2010, 895 consecutive rectal cancer patients with histological-confirmed adenocarcinoma who received low anterior resection with curative intent at the Department of Colon and Rectal Surgery, Chonnam National University Hwasun Hospital, were evaluated retrospectively. Patient demographics, times of stoma reversal, and number/reason of permanent stoma were evaluated. RESULTS: Three hundred fifteen patients (35.2 %) had a diverting stoma of temporary intent among 895 rectal adenocarcinoma patients. Loop ileostomy was performed in 271 patients (86.0 %). A total of 256 (81.3 %) of 315 stoma patients received stoma closure. The mean period between primary surgery and stoma closure was 5.6 months (range, 1-44 months). Seventy-three patients (23.2 %) were confirmed with permanent stoma. Multivariate analysis showed stage IV (hazard ratio (HR), 3.380; 95 % confidence interval (CI), 1.192-18.023; p = 0.027), anastomosis-related complication (HR, 3.299; 95 % CI, 1.397-7.787; p = 0.006), colostomy type (HR, 7.276, 95 % CI, 2.454-21.574; p = 0.000), systemic metastasis (HR, 2.698; 95 % CI, 1.1.288-5.653; p = 0.009), and local recurrence (HR, 4.231; 95 % CI, 1.724-10.383; p = 0.002) were independent risk factors for permanent stoma. CONCLUSIONS: On postoperative follow-up, in patients with anastomotic complication, tumor progression with local recurrences and systemic metastasis may cause permanent stoma.

Concepts: Cancer, Oncology, Risk, Surgery, Colorectal cancer, Ileostomy, Colostomy, Ostomy pouching system

28

Colonic perforation with fecal peritonitis is a life-threatening clinical condition. For these patients, a two-stage operation of fecal diversion and a postponed colostomy closure is generally recommended. Accordingly, a simple and feasible primary repair technique was explored.

Concepts: Escherichia coli, Peritonitis, Diverticulitis, Gastrointestinal perforation, Colostomy

25

The body image perceptions of persons with a stoma and their partners are rarely examined and have yet to be evaluated in a Turkish sample. Using convenience sampling methods, a descriptive, cross-sectional study was conducted among individuals receiving treatment at the authors' stomatherapy unit between March 1, 2012 and May 31, 2012 to assess the effect of the stoma on self-image and partner perception. Eligible participants had to be >18 years of age, married, and with an abdominal stoma (colostomy, urostomy, or ileostomy) for at least 2 months. Data were obtained through separate (patient or partner), face-to-face, 30-minute to 45-minute interviews using the appropriate questionnaire. Questionnaire items assessed demographic variables and patient/partner feelings toward the ostomate’s body using the Body Cathexis Scale (BCS) and author-developed questionnaires comprising statements eliciting individual responses (agree, disagree, undecided) regarding their feelings toward the stoma. Data were tabulated and analyzed using percentile distributions, and Mann Whitney U and Kruskal Wallis H tests were performed (Bonferroni correction was applied). Sixty (60) patients (25 women, 35 men, mean age 56.01 ± 10.1 years; 25 with an ileostomy, 30 with a colostomy, 5 with an ileostomy) participated, along with their 60 heterosexual partners (mean age 54.56 ± 10.25 years) married a mean of 33.06 ± 11.03 years. Mean patient BCS score was 133.15 ± 20.58 (range 40 - low perception - to 200 - high perception). Mean BCS score of patients whose partner helped in stoma care was significantly higher (136.04) than those whose partners did not (120.27) (P = 0.033). Patients who consulted their partners' opinions on stoma creation and participation in care had significantly higher BCS scores (P <0.05), and BCS scores of patients whose partners thought the stoma had a negative effect on their relationship were significantly lower (P = 0.040); patients' perceptions toward their bodies were parallel to their partners'. Mean BCS score of patients experiencing physical and psychosocial problems was significantly lower than those of patients who did not experience such problems. The results of this study show a number of factors, including involving patient partners before surgery, affect body perception of persons following stoma surgery.

Concepts: Psychology, Surgery, Perception, Mind, Stoma, Ileostomy, Colostomy, Ostomy pouching system

25

Marking the optimal location for a stoma preoperatively enhances the likelihood of a patient’s independence in stoma care, predictable pouching system wear times, and resumption of normal activities. Colon and rectal surgeons and certified ostomy nurses are the optimal clinicians to select and mark stoma sites, as this skill is a part of their education, practice, and training. However, these providers are not always available, particularly in emergency situations. The purpose of this position statement, developed by the Wound, Ostomy and Continence Nurses Society in collaboration with the American Society of Colon and Rectal Surgeons and the American Urological Association, is to provide a guideline to assist clinicians (especially those who are not surgeons or WOC nurses) in selecting an effective stoma site.

Concepts: Hospital, Surgery, Physician, Gastroenterology, Stoma, Ileostomy, Colostomy, Ostomy pouching system

3

Traditionally, perforated diverticulitis with purulent peritonitis was treated with resection and colostomy (Hartmann’s procedure), with inherent complications and risk of a permanent stoma. The DILALA (DIverticulitis - LAparoscopic LAvage versus resection (Hartmann’s procedure) for acute diverticulitis with peritonitis) and other randomized trials found laparoscopic lavage to be a feasible and safe alternative. The medium-term follow-up results of DILALA are reported here.

Concepts: Clinical trial, Randomized controlled trial, Surgery, ClinicalTrials.gov, Pharmaceutical industry, Diverticulitis, Colostomy, Hartmann's operation

2

The treatment of rectal cancer has greatly evolved because of numerous diagnostic and therapeutic advances. More accurate staging by MRI has allowed more appropriate use of neoadjuvant therapy as well as more standardized high-quality total mesorectal excision. Lower rates of perioperative morbidity, permanent colostomy creation, and improved rates of oncologically acceptable rectal excision have led to lower recurrence and greater disease-free survival rates. The recognition of the need for pathologic assessment of the quality of total mesorectal excision, the status of the circumferential resection margins, and the finding of a minimum of 12 lymph nodes as well as identification of extramural vascular invasion has improved staging. These evolutions in imaging, surgical management, and pathologic specimen assessment are interdependent and have been repeatedly shown on national levels to be best operationalized in a multidisciplinary team environment.

Concepts: Medicine, Cancer, Lymph node, Cure, Chemotherapy, Therapy, Total mesorectal excision, Colostomy

2

A stoma rod or bridge has been traditionally placed under the bowel loop while constructing loop colostomies. This is believed to prevent stomal retraction and provide better faecal diversion. However, the rod can cause complications such as mucosal congestion, oedema and necrosis. This single centre prospective randomized controlled trial compared outcomes after loop colostomy creation with and without a supporting stoma rod. The primary outcome studied was stoma retraction rate, and other stoma related complications were studied as secondary outcomes.

Concepts: Epidemiology, Randomized controlled trial, Pharmaceutical industry, Colostomy

1

Ostomy surgeries involving the placement of an ostomy bag (eg, colostomy, ileostomy, urostomy, etc) have been shown to have a negative impact on health-related quality of life. To date, no studies have been conducted examining what impact, if any, wearable biosensors have on the health-related quality of life of ostomy patients.

Concepts: Biology, Life, Surgery, Gastroenterology, Stoma, Ileostomy, Colostomy, Ostomy pouching system