Stoma care appliances: an overview

A core aim in stoma care is to ensure the appliance (also known as a pouch or bag) establishes and maintains a secure seal, and so identifying the appropriate appliance for an individual ostomate is vital. This article presents a summary of the latest available range of stoma appliances on the market. There are two types of pouching systems: one and two piece. There are three main types of stoma appliances: closed, drainable and urostomy. Stoma care nurses need to be well informed about stoma appliance innovation, so that they can advise patients on what appliance is best for them. It is also the role of a stoma care nurse to educate patients on the technique for appliance application. If a patient is wearing an inappropriate appliance or they have a poor application technique, this can result in stoma complications, such as leakage and/or sore peristomal skin.

EP.FRI.50 Morbidity of presumed temporary loop de-functioning stomas in patients with colorectal cancer

Objectives The incidence of parastomal hernia (PSH) can be up to 80% of patients who have a stoma following abdominal surgery (1). Surgical intervention is required in 70% of patients due to pain, obstructive symptoms or stoma appliance issues (2). This study aims to show the morbidity related to a presumed temporary loop stoma. Methods This was a retrospective cohort study of all left-sided colorectal cancer resections undertaken in a single centre. Electronic healthcare records and Picture Archiving and Communication System (PACS) were used to gather data on patient demographics, operative details and details of de-functioning stoma fashioned. Morbidity related to de-functioning stoma was determined based on hospital admissions and length of inpatient stay related to stoma, complications in relation to the stoma, return to theatre, stoma reversal and fate of stoma site. Results 147 patients (87 M; 60 F, median age 69 (23-93)) underwent left sided colorectal cancer resections at a single centre. In total, 50 de-functioning loop stomas were fashioned (49 loop ileostomies and 1 loop colostomy.) At a median follow-up of 23 months (8-44), prior to reversal, 12 PSH were identified. 38 of the de-functioning stomas were reversed at a median time of 11 months (1-44), 5 of which were emergency procedures due to obstruction (n = 3) or high output (n = 2). There were 9 stoma related re-admissions identified in 7 patients. Conclusion Presumed temporary defunctioning loop ileostomies in Low anterior resections is associated with significant morbidity, but low risk in terms of life-threatening complication.

163 Morbidity of Presumed Temporary Loop De-Functioning Stomas in Patients with Colorectal Cancer

Objectives The incidence of parastomal hernia (PSH) can be up to 80% of patients who have a stoma following abdominal surgery (1). Surgical intervention is required in 70% of patients due to pain, obstructive symptoms, or stoma appliance issues (2). This study aims to show the morbidity related to a presumed temporary loop stoma. Method This was a retrospective cohort study of all left-sided colorectal cancer resections undertaken in a single centre. Electronic healthcare records and Picture Archiving and Communication System (PACS) were used to gather data on patient demographics, operative details and details of de-functioning stoma fashioned. Morbidity related to de-functioning stoma was determined based on hospital admissions and length of inpatient stay related to stoma, complications in relation to the stoma, return to theatre, stoma reversal and fate of stoma site. Results 147 patients (87 M; 60 F, median age 69 (23-93)) underwent left sided colorectal cancer resections at a single centre. In total, 50 de-functioning loop stomas were fashioned (49 loop ileostomies and 1 loop colostomy.) At a median follow-up of 23 months (8-44), prior to reversal, 12 PSH were identified. 38 of the de-functioning stomas were reversed at a median time of 11 months (1-44), 5 of which were emergency procedures due to obstruction (n = 3) or high output (n = 2). There were 9 stoma related re-admissions identified in 7 patients. Conclusions Presumed temporary defunctioning loop ileostomies in Low anterior resections is associated with significant morbidity, but low risk in terms of life-threatening complication.

Timing of neonatal stoma closure: a survey of health professional perspectives and current practice

Optimal timing for neonatal stoma closure remains unclear. In this study, we aimed to establish current practice and illustrate multidisciplinary perspectives on timing of stoma closure using an online survey sent to all 27 UK neonatal surgical units, as part of a research programme to determine the feasibility of a clinical trial comparing ‘early’ and ‘late’ stoma closure. 166 responses from all 27 units demonstrated concordance of opinion in target time for closure (6 weeks most commonly stated across scenarios), although there was a high variability in practice. A sizeable proportion (41%) of respondents use weight, rather than time, to determine when to close a neonatal stoma. Thematic analysis of free text responses identified nine key themes influencing decision-making; most related to nutrition, growth and stoma complications. These data provide an overview of current practice that is critical to informing an acceptable trial design.

Psychological issues affecting patients living with a stoma

Stoma surgery is an intrusive operation, with outcomes that can impact seriously on daily life, not just in the immediate postoperative and recovery period, but for the rest of the patient's life. There are changes in bodily function, altered body image, physicality and personal care needs. These changes require acceptance and adaptation and can necessitate a re-ordering of daily life, socially, emotionally and in terms of work. Assessing the patient's needs through the trajectory of diagnosis, surgery and a stoma, is not just important during the treatment phase but needs to continue throughout the lifespan. Traditionally, patient outcome measures after bowel surgery have included overall self-efficacy, checking for stoma complications, clinical health status, function and psychological status. However, over the past three decades there has been increasing recognition that quality of life (QoL), which is now regarded as a key measurement, needs further consideration. Patients report difficulties when explaining to health professionals the challenges they face, and their reactions as they try to make the adjustments to their new normal of life with a stoma. This article examines stoma patients' perceptions of their outcomes from recent research. It discusses how more can be done by health professionals to support stoma patients through their initial transition to life with a stoma and for the rest of their life.

Diverting Stoma Complications in Rectal Cancer Surgery.

Background: A consensus regarding diverting stoma (DS) construction in rectal cancer surgery was reached to avoid reoperation related to anastomotic leakage. However, the incidence of stoma-related complications (SRCs) remains high. In this study, we aimed to examine the perioperative outcomes of DS construction in patients who underwent sphincter-preserving surgery for rectal cancer.Methods: Between 2005 and 2017, we included 400 participants who underwent radical sphincter-preserving surgery for rectal cancer. These participants were divided into two groups: DS (+) and DS (-) groups, and the outcomes, including postoperative complications (POCs), were compared.Results and conclusion: The incidence of ileus was higher in the DS (+) group (P<0.01); however, no patient showed anastomotic leakage of grade3. Furthermore, early SRCs were observed in 33 patients (21.6%) and bowel obstruction -related stoma outlet syndrome occurred in 19 patients (12.4%). There was no intergroup difference in the incidence of grade 3b POCs. However, the most common reason for reoperation was different in the two groups: anastomotic leakage in 91.7% of patients with 3b POCs in the DS (-) group, and SRCs in 85.7% of patients with 3b POCs in the DS (+) group.In patients with DS, there was an increase in the incidence of overall POCs, severe POCs (grade 3), and bowel obstruction, including stoma outlet syndrome, compared to patients without DS. Therefore, it is important to construct an appropriate DS to avoid SRCs and to be more selective in assigning patients for DS construction.

Prospective Study of Clinical Profile and Early Complications of Ileostomy

BACKGROUND Ileostomy is a lifesaving procedure in cases like perforation, peritonitis, typhoid fever, tuberculosis, and trauma. Ileostomy serves the purpose of diversion, decompression, and exteriorisation. Construction of ileostomy is still a common and frequently performed procedure, even though it is a major advancement in the field of surgery. This study intends to evaluate the clinical profile of ileostomy and assess early postoperative complications of ileostomy. METHODS A total number of 36 patients admitted in MMIMSR, Mullana (Ambala), managed and operated with ileostomy were followed up closely from the day of admission in the hospital to the day of discharge. Different parameters were studied. RESULTS The clinical profile, techniques, complications, indications of ileostomy were studied in detail and along with various early complications encountered with ileostomy formation. The most common complication was peristomal irritation in 33 patients (91.7 %), followed by skin excoriation in 24 patients (66.7 %), fistula in 21 patients (58.3 %), high output stoma in 17 patients (47.2 %), stomal retraction in 3 patients (8.3 %), abscess in 2 patients (5.6 %), necrosis in 1 patient (2.8 %), and stenosis in 1 patient (2.8 %). CONCLUSIONS Construction of ileostomy and its management was associated with high rate of complications. However, most patients tolerated the complications of ileostomy well and the overall compliance was satisfactory. Loop ileostomy was the most commonly performed stoma and was associated with high rate of complications. KEY WORDS Intestinal Stoma, Complications, Loop Ileostomy, End Ileostomy, Skin Excoriation, Fistula, High Output Ileostomy