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PubMed2002

[Surgical creation of a reservoir-colostomy with reflex evacuation].

The authors consider that the problem of social rehabilitation of "colostomized" patients consists in an involuntary and sudden character of evacuation from the ostomy due to the absence of normal imperative urge to defecation. For this purpose a method of reservoir-retaining colostomy modulating the appearance of urge to defecation was worked out in experiments and used in clinic in 17 patients. Preconditions for the appearance of the urge were regular sensations due to mediated distention of the parietal peritoneum after filling the reservoir-retaining volume. The subjective sensations preceding the evacuation from the colostomy appeared 10-20 minutes before defecation and were felt as discomfort and abdominal cramping towards of the external end of the colostomy in 15 (88.2%) and as elements of intestinal colic in 2 (11.8%) patients. So, 9 (53%) patients managed to sufficiently control the evacuation from the ostomy and not to use the pouch. Five patients (29.4%) demonstrated the ability to restrain defecation for 10-15 minutes by straining the anterior abdominal wall muscles when the urge appeared. Evacuation from the ostomy was reiterative (2-4 times), once or twice a day, rarely 3-4 times a day and lasted from 15 till 60 minutes.

Colostomy↗
PubMed2004

Independent predictors of morbidity and mortality in blunt colon trauma.

We sought to determine the impact of (1) grade of the colon injury, (2) the formation of an ostomy, and (3) associated injuries on outcomes such as morbidity and mortality after blunt colon injuries. We retrospectively reviewed 16,814 cases of blunt abdominal trauma. Patients with colonic injuries were selected and charts reviewed for demographic, clinical, and outcomes data. Injuries were grouped by the Colon Injury Scale (grades I-V). Independent risk factors of morbidity included spine and lung injuries, as well as increased age. A higher grade of colon injury trended toward a significant association with intra-abdominal complications. Independent risk factors of mortality included liver, heart, and lung injuries, as well as intracerebral blood and female gender. The grade of colon injury, the formation of an ostomy, and management of the colon trauma did not independently predict increased intra-abdominal complications, morbidity, or mortality. These results indicate that patients afflicted with blunt colon trauma experience a high rate of morbidity and mortality from associated injuries and or increased age. Treatment regimens directed at these factors will be most helpful in reducing the high morbidity and mortality after blunt colon trauma. Factors such as ostomy formation and management strategy are not associated with increased morbidity or mortality after blunt colon trauma.

Adolescent↗
PubMed2004

Peristomal skin complications: prevention and management.

Peristomal skin complications are the most common reason ostomy patients visit an outpatient wound, ostomy, and continence nursing service. Prevention and management of peristomal skin complications are critical components of ostomy care. Identifying risk factors for the occurrence of peristomal skin complications according to types of injury and clinical features can help optimize assessment and management approaches. Treatment can further be addressed based on etiology - chemical injury (irritant contact dermatitis, pseudoverrucous lesions, and encrustations); mechanical injury (pressure/shear, stripping, mucocutaneous separation, mucosal transplantation); infection (Candidiasis, folliculitis); immunologic disorders (allergic contact dermatitis); and disease-related lesions (varices, pyoderma gangrenosum, malignancy). The importance of prevention and the impact of having access to knowledgeable care providers cannot be over-emphasized.

Documentation↗
PubMed1991

Effect of ethanol perfusion on creatinine removal in a Roux-Y intestinal segment.

Five rats and 2 goats had a bypass operation to allow infusion of sorbents through an inlet ostomy. The sorbents passed through one limb of intestine isolated from food contact to join a food limb which included 30-40% of the original length of small intestine. In goats, serum creatinine levels were elevated by infusion of sterile creatinine solutions intravenously. Twenty-four hour urines were collected before, during and after periods of infusion of sorbents into the inlet ostomy. Infusion of charcoal into the ostomy had little effect on the total daily urinary creatinine excretion (TDUC). However infusion of 4.3 g/kg/day ethanol decreased the TDUC significantly, in both species. In rats, 8.6 g/kg/day ethanol infusion had an even greater effect on TDUC. Studies of intraluminal creatinine concentration in the distal part of the sorbent segment indicated that especially when serum concentration of creatinine is over 2 mg%, ethanol greatly increases the intraluminal creatinine concentration in the intestine. It is concluded that ethanol, in combination with intestinal sorbents or alone, could allow intestinal dialysis to remove considerably more creatinine, and possibly aid transport of other organic substances.

Anastomosis, Roux-en-Y↗
PubMed1995

In vivo evaluation of timing, degree, and distribution of bacterial translocation following experimental small bowel transplantation.

These studies were designed to evaluate the correlation between morphologic and functional changes after heterotopic auxiliary small bowel isograft with systemic venous drainage and two ostomies in 20 Lewis rats. Morphologic damage of the graft was scored by full-thickness biopsies before surgery and 1, 3, 5, and 7 days after transplant. Functional evaluation of the graft was done, at the same time points, by urinary excretion of lactulose and mannitol injected in the proximal ostomy. The intestinal permeability was also studied by injecting Escherichia coli labeled with indium-111 oxine in the proximal ostomy. Translocation of radiolabeled bacteria was quantitated in extraintestinal tissues by radionuclide counts and number of viable organisms and in vivo by scintigraphic imaging. One day after transplant, significant graft damage (score 17.2 +/- 4.2) was observed when compared with the pretransplant value (7.3 +/- 2.6). The degree of tissue injury was similar on days 3 (15.8 +/- 3.5) and 5 (16.1 +/- 3.9) after transplant and remained high on day 7 (11.8 +/- 2.8). The lactulose to mannitol ratio showed a significantly increased permeability on day 1 (17.5) versus pretransplant values (2.6), remained high on day 3 (8.6), and returned to normal values on day 5 (2.8). Translocation of bacteria to distant organs, as measured by both radionuclide counts and number of viable organisms, was strikingly enhanced on day 1 after transplantation, compared with control animals, but returned to the pretransplant value on day 3. A good qualitative and quantitative correlation was observed between radionuclide counts in the extraintestinal organs and in vivo images obtained by scintigraphic scanning. In conclusion, in this model, timing and degree of bacterial translocation do not seem to correlate well, with the exception of the acute post-transplantation phase, with morphologic and permeability changes of the graft. Evaluation of translocation by scintigraphic imaging appears a suitable approach to study in vivo the kinetics and distribution of this process.

Animals↗
PubMed1998

[Incidence and prevalence of colostomies. The future of stoma societies. Results of a Côte-d'Or survey. Federation of Stoma Patients in France].

Few data are available in France about the impact of Ostomy Associations in the population of patients with permanent colostomy. The aim of this study was to assess the percentage of patients with permanent colostomy involved in local Ostomy Associations in a well-defined population (Côte-d'Or department, 493,931 inhabitants) in 1992. A minimum number of incident colostomy cases was computed using data from the Digestive Tract Tumor Registry in case of cancer and using the surgical reports from the University Hospital in case of benign disease. The maximum number of incident cases was computed using results from a survey conducted by the Public Administration (Social Security) during the same period. An interval of prevalent cases was assessed the number of collecting pouches based on sold during 1992 in the same area. A colostomy was set up in 37 to 84 patients. The number of prevalent cases was in a range of 274 to 410 patients. The corresponding percentages of Ostomy Associations members were included in a 8.3% to 19% range for incident cases and 9.5% to 19% for prevalent cases. These percentages are less than 30%, which is the presumed value previously evaluated in a survey conducted among physicians. As the incidence of colostomy cases continues to decline regularly, more effective methods must be developed to maintain a constant number of members.

Colostomy↗
PubMed1990

The surgical management of children with ulcerative colitis. The old vs. the new.

The authors' experience with children who have chronic ulcerative colitis was reviewed to compare their current surgical approach (ileoanal anastomosis) with earlier methods of management. Between 1960 and 1984, 137 children with chronic ulcerative colitis underwent surgery (mean duration of follow-up, 7.1 years). In 91 patients, the procedures were a total proctocolectomy with ileostomy or Kock pouch (66) or a lesser colectomy with either an ileostomy (16) or an ileorectal anastomosis (9) (group I). Forty-six patients underwent an ileoanal anastomosis procedure (group II). Children in group I were more likely to have significant preoperative loss of weight, a debilitated condition, and malnutrition. Urgent or emergency surgical intervention was required in 25 percent of patients in group I but in only 4 percent of patients in group II. Trends included 1) a younger age at operation in group II, 2) a higher mortality in group I (7.7 percent) than group II (0 percent), and 3) a higher perioperative mortality with emergency operations (23 percent) than elective procedures (1.6 percent). In group I, 98 percent of patients had an abdominal ostomy, but no patients in group II had an abdominal ostomy. The children with an ileoanal anastomosis had an average of 4.8 stools during waking hours and 1.3 stools each night. On the basis of this experience, the authors recommend use of the ileoanal anastomosis procedure in the surgical treatment of chronic ulcerative colitis in children.

Adolescent↗
PubMed2005

Rectovaginal fistulas after rectal cancer surgery: Incidence and operative repair by gluteal-fold flap repair.

BACKGROUND: We investigated the correlation between operative procedures for rectal carcinoma and postoperative rectovaginal fistulas (RVF), and treatment for RVF. METHODS: The medical records of 161 female patients with rectal carcinoma were examined retrospectively with respect to the cause, incidence, and methods of treatment for RVF occurring after rectal cancer operations, and to the outcomes of gluteal-fold flap repairs for RVF. RESULTS: Of the 161 patients, 16 developed RVF clinically. The incidence of RVF was significantly higher in patients who were anastomosed by the double stapling technique (DST) and had concomitant resection of the vaginal wall. No statistical difference was found between the established diverting ostomy group and the no-stoma group. Six patients recovered by the establishment of a diverting ostomy only. The gluteal-fold flap technique was performed for 5 patients. No RVF recurrences were noted in these 5 patients. CONCLUSIONS: The incidence of RVF was higher in the patients who were anastomosed by DST or had concomitant resection of the vaginal wall. Although some RVFs heal with only fecal diversion, for patients in whom RVF is caused by involvement of the vaginal wall in the circular staple or intersphincteric resection, good results are obtained with the gluteal-fold flap repair technique.

Aged↗
PubMed2000

Integrating advanced practice and WOC nursing education.

The increased use of advanced practice nurses (APNs) in all health care settings provides new practice options for WOC nurses and new challenges for WOC nursing education. A number of WOC nurses are moving into APN roles, and APNs who are not WOC specialists are providing much of the primary care for patients with wounds, ostomies, and incontinence. New educational approaches are needed to prepare APNs for specialty practice in wound, ostomy, and/or continence care. In addition, the need exists to incorporate key WOC nursing content into the core curriculum for APNs who provide primary care for patients with or at risk for wounds or disordered elimination. This article explores potential strategies for meeting these new demands.

Curriculum↗
PubMed1997

Myra E. Levine: a theoretic basis for ET nursing.

ET nursing is a challenging specialty that requires exact knowledge, complex skills, and a holistic approach to patients with wound, ostomy and continence problems. Myra E. Levine's conceptual framework for nursing practice is described and applied to ET specialty practice nursing. Examples of Levine's four conservation principles-energy, structure, personal integrity, and social integrity-are integrated into the nursing care of patients' wound, ostomy, and continence problems.

Humans↗
PubMed1997

Oral care and its role in WOC nursing.

The impact of nutritional status and the ability of the patient to fight infection directly are related to the practice of the WOC nurse, who is well versed in the care of the body's integument with respect to patients with ostomies, wounds, tubes, and incontinence. The status of the patient's oral cavity and its relationship with nutrition and wound healing have not; however been adequately addressed by WOC nurses. Involvement of the WOC nurse in preventive and therapeutic oral care can ensure a healthier gastrointestinal tract, improved nutritional status, and improved outcomes in caring for the person with a wound ostomy, or incontinence. This article reviews the literature related to oral care and discusses its relevance to WOC nursing practice.

Humans↗
PubMed2003

Quality of life in patients with stomas: the Montreux Study.

Ostomy surgery profoundly affects a person's life. To determine the extent of the effect, the Stoma Care Quality of Life Index instrument was developed from a quality-of-life index. After ascertaining its validity and reliability, the instrument was used to measure patient quality of life in a European-wide study (16 countries). Six hundred, eighteen (618) stoma care nurses recruited 4,739 patients following stoma surgery. The self-administered questionnaire was completed immediately following surgery and after 3,6, 9, and 12 months. The mean age of patients was 61.6 years (+/- 13.4 years), 53.7% were men, and the majority (66.5%) had a colostomy. Stoma Care Quality of Life Index scores were fairly consistent in all patients throughout Europe immediately following surgery. While scores improved steadily over time, only the difference between the postoperative and 3-month scores was significant (P < 0.001). Stoma Care Quality of Life Index scores were significantly higher in patients who were satisfied with the care received than in those who were not satisfied. Similarly, patients who had a good relationship with the stoma care nurse and felt confident about changing the appliance had significantly higher Stoma Care Quality of Life Index scores than those who did not have a good relationship or feel confident. The results of this study suggest that stoma patient quality of life can be assessed, that it changes over time, and that patient access to specialist ostomy care nurses is particularly important during the first 3 to 6 months following surgery.

Aged↗
PubMed2000

Conservative management of post prostatectomy incontinence.

BACKGROUND: Urinary incontinence after prostatectomy is a common problem. Conservative management of this condition includes pelvic floor muscle training, biofeedback, electrical stimulation using a rectal electrode, transcutaneous electrical nerve stimulation, or a combination of methods. OBJECTIVES: To assess the effects of conservative management for urinary incontinence after transurethral, suprapubic, radical retropubic or perineal prostatectomy. SEARCH STRATEGY: The Cochrane Incontinence Group's trials register, Medline, Cinahl, Embase, PsycLit and ERIC all up to January 1999, and reference lists of relevant articles. We contacted investigators to locate studies and we handsearched the following conference proceedings: American Urological Association (1989-1999); Society of Urologic Nurses and Associates (1991-1998); Wound Ostomy and Continence Nurses (1996-1999); and International Continence Society (1980-1998). Date of most recent searches: January 1999. SELECTION CRITERIA: Randomised or quasi-randomised trials which evaluated conservative management aimed at improving urinary continence after prostatectomy. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the methodological quality of studies and abstracted data from included trials onto a standard form. MAIN RESULTS: Only five randomised trials were identified which included 365 men, each evaluating different treatments, and all studying men after radical prostatectomy. The trials were of moderate quality and data were not available for many of the pre-stated outcomes. Confidence intervals for both dichotomous and continuous data were wide; it was not possible to reliably identify or rule out a useful effect. Men's symptoms tended to improve over time, irrespective of management. REVIEWER'S CONCLUSIONS: The value of the various approaches to conservative management of post prostatectomy incontinence remains uncertain. Further well designed trials are needed.

Biofeedback, Psychology↗
PubMed2003

Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection.

BACKGROUND AND OBJECTIVES: A strong association between high hospital procedure volume and survival following colon cancer resection has been demonstrated. However, the importance of surgeon case volume as a determinant of outcome has been less well studied, and it is unclear whether hospital or surgeon volume is the more powerful predictor of outcomes. METHODS: A retrospective population-based cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database identified 24,166 colon cancer patients aged 65 years and older who had surgery for a primary tumor diagnosed in 1991-1996 in a SEER area. Hospital and surgeon-specific procedure volume was ascertained based on the number of claims submitted over the 6-year study period. Outcome measures were mortality at 30 days and 2 years, overall survival, and the frequency of operations requiring an intestinal stoma. Age, sex, race, comorbid illness, cancer stage, socioeconomic status, emergent hospitalization, and the presence of obstruction/perforation were used to adjust for differences in case-mix. RESULTS: After adjusting for surgeon procedure volume, high hospital procedure volume remained a strong predictor of low post-operative mortality rates (P < 0.001 for each outcome with and without adjustment for surgeon procedure volume). Surgeon-specific procedure volume was also an important predictor of surgical outcomes (P = 0.002 for 30-day mortality, P = 0.001 for 2-year mortality), although this effect was attenuated after adjusting for hospital volume (P = 0.03 for 30-day mortality, P = 0.02 for 2-year mortality). Hospital volume and surgeon volume were each an important predictor of the ostomy rate. Among high volume institutions and surgeons, individual providers with unusually high ostomy rates could be identified. CONCLUSIONS: Both hospital and surgeon-specific procedure volume predict outcomes following colon cancer resection; but hospital volume may exert a stronger effect. Therefore, efforts to optimize the quality of colon cancer surgery should focus on multidisciplinary aspects of hospital care rather than solely on intraoperative technique.

Aged↗
PubMed1998

Complications of abdominal stoma surgery.

PURPOSE: This study was undertaken to review and summarize the complications of ileostomy and colostomy creation and subsequent closure. METHODS: The English-language medical literature for at least the past 15 years was reviewed comprehensively. RESULTS: Complications of surgery for the creation of end, loop, and "end loop" stomas are presented. Technical factors, which might influence complication rates, are discussed. Optimal management of ostomy complications is presented, especially for peristomal hernias. Similarly, techniques and complications for stoma closure are analyzed. CONCLUSIONS: Stoma creation is not a trivial undertaking; careful surgical technique minimizes complications (which are relatively frequent), and promotes good ostomy function. Peristomal hernias are difficult to cure permanently. The morbidity of ileostomy and colostomy closure is also appreciable.

Colon↗
PubMed2006

The management of 38 anastomotic leaks after 1,684 intestinal resections.

PURPOSE: This study was designed to evaluate the management of anastomotic leaks and assess the impact of outpatient leak presentation on clinical outcome. METHODS: Thirty-eight patients with clinical anastomotic leaks from 1,684 adult patients undergoing large and small intestinal anastomosis in a tertiary referral center between January 1, 2003 and September 1, 2005 were studied. All pediatric patients and adult patients with esophageal and gastric leaks were excluded. Charts were reviewed for information on anastomotic leak management, discharge status before leak presentation, length of stay, readmissions, and mortality. RESULTS: The overall leak rate was 2.3 percent. Eighty-seven percent of patients (n = 33) were managed operatively. Forty-two percent of patients (n = 16) were discharged after initial operation and presented as outpatients with anastomotic leak. The discharge and inpatient groups were comparable in respect to total length of stay (26.9 vs. 33.4 days) and number of readmissions (2 vs. 1.5). The overall mortality of 5 percent (n = 2) originated from the discharge group. A greater percentage of discharge patients required intensive care unit stays for more than two weeks (25 vs. 14 percent) and very long hospital admissions lasting more than two months (31 vs. 9 percent). A smaller percentage of the discharge group patients had their ostomies reversed (31 vs. 50 percent). CONCLUSIONS: The primary management of clinical anastomotic leak remains intestinal diversion. Although length of stay was shorter in the discharge group, the number of patients who experienced significant intensive care unit stays and very long hospital stays was greater. Within the discharge group, mortality was higher and fewer patients had their ostomies reversed.

Anastomosis, Surgical↗
PubMed1992

Postobstructive enteropathy in infants with transient enterostomy: its consequences on the upper small intestinal functions.

Repeated or prolonged organic obstruction of the small intestine in the neonatal period can lead to severe refeeding problems, despite a transient ostomy. These problems are thought to result from a postobstructive enteropathy (POE) of the apparently normal small intestine segment above the obstruction. Ten infants with a POE, characterized by limited oral caloric and carbohydrate intakes and increased ostomy effluent, were compared with 8 controls with an enterostomy and a normal postoperative refeeding pattern. There was no statistical difference in the histomorphometric appearance of the mucosa or its digestive or absorptive capacity (brush-border hydrolases, glucose transport) between the two groups. The effluent and duodenal floras of the two groups were similar. However, all POE patients showed significant abnormal peristalsis characterized by barium and carmin transit times. This suggests that repeated or prolonged obstruction in the neonatal period could lead to a POE, caused by chronic motricity abnormalities of the small intestine above the obstruction. Although this POE is more frequent after small bowel atresia, it may also occur with other conditions causing prenatal and postnatal intestinal obstruction.

Enterostomy↗
PubMed1989

The effect of small intestinal transplantation on intraluminal levels of serotonin and substance P.

This study was performed to examine the effect of transplantation, and thus extrinsic denervation, of the small intestine on intraluminal release of serotonin and substance P. Heterotopic 40-cm-long proximal (jejunal) small intestinal isografts were performed in six 200- to 250-g adult male Lewis rats under general anesthesia. Bowel ends were exteriorized as ostomies. Six Lewis rats with neurovascularly intact 40-cm proximal small bowel Thiry-Vella loops exteriorized as ostomies served as the control animals. On the seventh postoperative day, the intestinal loops were perfused at 0.5 ml/min for three 10-min periods with normal saline followed by an equilibrium period and then for three 10-min periods with 20% dextrose. Perfusates were collected for each period and levels of serotonin and substance P were determined by radioimmunoassay. Intraluminal serotonin levels rose from 29 +/- 9 ng/ml during saline perfusion to 115 +/- 28 ng/ml during intestinal perfusion with 20% dextrose in the innervated loops and from 21 +/- 7 ng/ml to 94 +/- 26 ng/ml in the transplanted loops. While there was a statistically significant increase in mean intraluminal serotonin levels following perfusion with 20% dextrose in both the control and transplant groups, there was no difference in the intraluminal serotonin response between controls and transplant recipients. In contrast, 20% dextrose had no effect on luminal release of substance P in either group. These results indicate that extrinsic denervation of the small intestine has no effect on the intraluminal serotonin response to stimulation and suggest that serotonin and substance P are not released into the intestinal lumen by the same regulatory mechanisms.

Animals↗