Stoma Duration Research Articles

The problems of patients with stoma and its effects on daily living activities

Objective: This study was conducted to determine the problems of individuals with stoma and its effects on the daily life activities Material and Methods: The study was conducted individuals with at least one month's stoma, agreed to participate in the study, over the age of 18 years, between January 1 and June 1, 2016 in individuals attending a General Surgery Clinic of a University. In the study, used survey form was prepared by the researchers in the direction of the literature. Results: The mean age of patients was 56.67±11.07 and 70.4% were male. When social lives of the individuals were examined after stoma, it was found that 22.2% of them prevented the daily activities of the stoma, 14.8% of them had changed in their family, friends and neighbors relations, The 7.42% were embarrassed due to stoma, The 27.8% of them went to liquid beverage restriction, The 16.7% have decreased appetite due to smell. No statistically significant difference was found between the sexes, pre-stoma education status, stoma type and stoma duration according to daily life activities, nutritional status, mental status, dressing and social life (p> 0,005). Conclusion: It has been determined that stoma influences social life together with mental problems at individuals and restricts their daily activities.

Quality of Life (QoL) Among Ostomized Patients – a cross-sectional study using Stoma-care QoL questionnaire about the influence of some clinical and demographic data on patients’ QoL

IntroductionIn Portugal around 20,000 individuals are ostomized, with all the associated changes in patients’ everyday life that can compromise their Quality of Life (QoL). ObjectivesAssess and compare QoL of a group of ostomized patients according to sex, age group, type of surgery, primary disease, stoma duration and stoma type. Material and methodsOstomized patients observed in Stomatherapy department in between January 1st and May 30th 2017 was enrolled. QoL was assessed using the questionnaire Stoma Care QoL Questionnaire). Four domains were evaluated: Self-esteem and Self-image – SeSi Score; relation with Family and Friends – FF Score; relation with Sleep and Fatigue – SF score and ostomy Device Functioning insecurities – DeF score. ResultsUrostomy patients had significantly higher Total Scores, SeSi and FF scores than colostomy and ileostomy patients. Regarding SeSi Score, patients aged 70 years old or more and malignant diseases presented significantly higher scores than their younger counterparts and benign causes, respectively. FF Score document that patients with malignant diseases have significantly higher scores than patients with benign diseases. ConclusionsIleostomy and colostomy patients have a significantly lower QoL than urostomy patients mostly because of its impact on social relations and self-esteem and self-image.

PGI26 - COST SAVING ANALYSIS OF A COMMUNITY STOMA CARE SERVICE

Patients with stomas (ostomates) are at high risk of peri-stomal skin complications (PSC), leading to patient distress and financial burden. This study investigated if a community specialist nurse-led review and intervention programme conferred cost savings. Ostomates from 179 primary care practices were invited to attend a review from stoma care specialist nurses, where the; prevalence of complications and whether the patient would have sought help elsewhere, were recorded. Interventions carried out included; advice, stoma product changes and ceasing inappropriate products. A cost analysis model was used to; quantify the annual cost of treating PSC using £204.77/7 weeks × 7.4 episodes, and to quantify decreased resource usage. To calculate cost savings from avoided visits, unit costs per appointment were; £127 stoma care nurse (SCN), £37 General Practitioner (GP) and £202 Emergency Department (ED). Savings from changed product usage were based on individual product costs. Initial visits were conducted with 1968 ostomates, median age of 72 years (62-80 IQR). Demographics were; males 54% (n=1,065), cancer 40% (n=792) and stoma duration greater than 5 years 47% (n=920). PSC was reported by 24% (n=469). The annual mean cost per patient of treating PSC was £1515.27 and for the sample was £715,690.50. The mean annual cost savings from avoided appointments were; £53,523 (SCN), £6,618 (GP) and £346 (ED). A 10% decrease in product costs was seen, corresponding to £450,106 as an annual cost saving in the study group. A nurse led review programme identified previously unrecognised stoma issues reported by ostomates, including among those with long term stomas. Nurse led intervention conferred cost benefits not only from decreasing product costs but by diverting ostomates from alternative NHS resources.

Long term outcomes of intestinal rehabilitation in children with neonatal very short bowel syndrome: Parenteral nutrition or intestinal transplantation

Intestinal rehabilitation is the preferred treatment for children with short bowel syndrome (SBS) whatever the residual bowel length, and depends on the accurate management of long-term parenteral nutrition (PN). If nutritional failure develops, intestinal transplantation (ITx) should be discussed and may be life-saving. This study aimed to evaluate survival, PN dependency and nutritional status in children with neonatal very SBS on PN or after ITx, in order to define indications and timing of both treatments. This retrospective cross-sectional study enrolled 36 children with very SBS (<40cm) who entered our intestinal rehabilitation program from 1987 to 2007. All the children on long-term PN (n=16) survived with a follow-up of 17 years (9-20). Six of them were eventually weaned off PN. Twenty children underwent ITx: eight children died (40%) 29 months (0-127) after Tx. The others 12 patients were weaned off PN 73 days (13-330) after Tx. Follow-up after transplantation was 14 years (6-28). Seven out of 8 (88%) patients with a history of gastroschisis required ITx. Patients who required ITx had longer stoma duration. Survival rate of children with very short bowel was excellent if no life-threatening complications requiring transplantation developed. Gastroschisis and delayed ostomy closure are confirmed as risk factor for nutritional failure. Intestinal rehabilitation may allow a total weaning of PN before adulthood. A follow-up by a multidisciplinary team is necessary to avoid PN complications in order to minimize indications for ITx.

A Descriptive, Cross-sectional Study to Assess Quality of Life and Sexuality in Turkish Patients with a Colostomy.

A stoma affects personality, self-esteem, and body image, inevitably impacting lifestyle and quality of life (QOL). A descriptive, cross-sectional study was conducted between May 1, 2015 and May 1, 2016 to evaluate the effect of a stoma on sexual function and QOL among patients receiving care in a general surgery clinic of a university hospital in the western region of Turkey.Eligibility requirements included patients willing to participate, >18 years of age, with a colostomy for at least 4 months, who were married and/or with a sexual partner and in otherwise good physical and mental health with no rectal nerve damage or receiving radio- or chemotherapy. Data were collected during face-to-face interviews. Demographic variables (age, gender, body mass index [BMI], educational status, income level); and clinical information (duration of the precipitating disease, and stoma duration, cause, and type) were collected, and the International Index of Erectile Function (IIEF) measure; the Index of Female Sexual Function (IFSF); and a Stoma Quality of Life Scale (SQOLS) were completed. Statistical analyses were performed using descriptive statistics, Spearman's correlation coefficient, and the Mann-Whitney U test. Of the 57 study participants, 57.9% were >60 years old (mean age: 59.81 ± 10.12), more than half (57.92%) were male, 33.3% had a permanent stoma, and the mean duration of the stoma was 9.60 ± 6.40 months. Scores for all 3 outcomes were low; mean IIEF score was 3.64 ± 2.47 (range 2-10), mean IFSF score was 13.04 ± 5.19 (range 9-29), and mean SQOLS was 45.10 ± 18.88 (range 0-100). Eighteen (18) of the 33 men (54.5%) had severe, 5 (15.2%) had moderate, and 9 (27.3%) had mild erectile dysfunction. The IFSF total score for all female patients was <30; all female patients experienced sexual dysfunction. A negative correlation between age and the SQOLS subscale sexuality/body image was found (rs = -0.305, P <.05). A positive correlation was found among BMI, erectile function (rs = 0.350, P <.05), sexual desire (rs = 0.474, P <.01), and intercourse satisfaction (rs = 0.385, P <.05). These study results provide reference data for future study and underscore the importance of assessing and addressing QOL and sexuality concerns among patients with a colostomy.

Diversion proctocolitis and response to treatment with short-chain fatty acids--a clinicopathological study in children.

Diversion proctocolitis (DPC) frequently develops in the colorectum after diversion of the fecal stream characterized by bleeding from the inflamed mucosa. Short-chain fatty acids (SCFA) are responsible for growth and differentiation of enterocytes. Adult series have reported variable response of DPC to luminal SCFA. There is dearth of studies in children. We aimed to study incidence, clinical, endoscopic, and histopathological characteristics of DPC and effect of SCFA in children. Prospectively clinical, endoscopic, and histopathological evaluation was done for DPC in children undergoing fecal diversion. Patient characteristics, type and duration of stoma, symptoms, endoscopy and biopsy findings, duration of treatment and response to SCFA, time of closure of stoma, and any associated gut anomaly were recorded. Fifteen children completed the study. Anorectal malformation was the commonest indication for stoma. Sixty percent were symptomatic within 2-9months, excessive mucous discharge being the commonest symptom. All had at least one positive endoscopic finding; erythema, edema, and exudates being the commonest findings. All DPCs improved clinically and endoscopically following SCFA. Histological resolution was seen in 78%, while 22% had persistent disease. Closure of stoma showed complete resolution of DPC. DPC was common (87%) following stoma formation in children with strong male preponderance (6.5:1). The commonest indication for stoma was anorectal malformation (67%). Clinical, endoscopic, and histopathological changes appeared within 2-9months with symptomatic DPC in 60%. All patients (100%) had at least one positive endoscopic finding, histopathological examination confirmed the diagnosis. SCFA led to symptomatic, endoscopic, and histopathological resolution of DPCs. Closure of stoma cured all the persistent DPCs.

Patient perspectives of silicone technology in stoma care.

British Journal of NursingVol. 24, No. Sup5 Patient ExperiencePatient perspectives of silicone technology in stoma careNanna KeelingNanna KeelingSearch for more papers by this authorNanna KeelingPublished Online:10 Mar 2015https://doi.org/10.12968/bjon.2015.24.Sup5.S20AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Dykes PJ, Heggie R, Hill SA (2001) Effect of adhesive dressings on the stratum corneum of the skin. J Wound Care 10(2): 7–10 Link, Google ScholarHong KS, Oh B-Y, Kim E-J, Chung SS, Kim KH, Lee R-A (2014) Psychological attitude to self-appraisal of stoma patients: prospective observation of stoma duration effect to self-appraisal. Ann Surg Treat Res 86(3): 152–60. doi: https://doi.org/10.4174/astr.2014.86.3.152 Crossref, Medline, Google ScholarKiliç E, Taycan O, Belli AK, Ozmen M (2007) The effect of permanent ostomy on body image, self-esteem, marital adjustment, and sexual functioning. Turk Psikiyatri Derg 18(4): 302–10 Medline, Google ScholarMeaume S, Van De Looverbosch D, Heyman H, Romanelli M, Ciangherotti A, Charpin S (2003) A study to compare a new self-adherent soft silicone dressing with a self-adherent polymer dressing in stage II pressure ulcers. Ostomy Wound Management 49(9):44–51 Google ScholarNugent KP, Daniels P, Stewart B, Patankar R, Johnson CD (1999) Quality of life in stoma patients. Dis Colon Rectum 42(12): 1569–74 Crossref, Medline, Google ScholarOzturk O, Murat Yalcin B, Unal M, Yildirim K, Ozlem N (2015) Sexual dysfunction among patients having undergone colostomy and its relationship with self-esteem. J Family Med Community Health 2(1):1028 Google ScholarSimmons KL, Smith JA, Bobb KA, Liles LL (2007) Adjustment to colostomy: stoma acceptance, stoma care self-efficacy and interpersonal relationships. J Adv Nurs 60(6): 627–35 Crossref, Medline, Google ScholarTao H1, Songwathana P, Isaramalai SA, Zhang Y et al. (2014) Personal awareness and behavioural choices on having a stoma: a qualitative metasynthesis. J Clin Nurs. 23(9-10):1186-200. doi: https://doi.org/10.1111/jocn.12309. Epub 2013 Crossref, Medline, Google ScholarWaring M, Bielfeldt S, Mätzold K, Wilhelm KP, Butcher M (2011) An evaluation of the skin stripping of wound dressing adhesives. J Wound Care 20(9): 412–22 Link, Google ScholarWhite M (2014a) Using silicone technology to maintain healthy skin in stoma care. Br J Nurs 23(22): 1188–1193 Link, Google ScholarWhite M (2014b) Silicone use in stoma care. Br J Nurs 23(17): S14–S16 Link, Google ScholarZajac O, C, Spychała A, Murawa D (2008) Quality of life assessment in patients with a stoma due to rectal cancer. Reports of Practical Oncology & Radiotherapy 13(3): 130–4 Crossref, Google Scholar FiguresReferencesRelatedDetailsCited byDevelopments in silicone technology for use in stoma careThomas Swift, Gillian Westgate, Julie Van Onselen, Stewart Lee9 June 2021 | British Journal of Nursing, Vol. 30, No. Sup8Developments in silicone technology for use in stoma careThomas Swift, Gillian Westgate, Julie Van Onselen, Stewart Lee24 March 2020 | British Journal of Nursing, Vol. 29, No. 6Calidad de vida en personas portadoras de una ostomía digestiva.1 September 2019 | Revista Ciencia y Cuidado, Vol. 16, No. 3Comparing ostomates' perceptions of hydrocolloid and silicone seals: a surveyKeith Cutting9 December 2016 | British Journal of Nursing, Vol. 25, No. 22Silicone-based stoma accessories in clinical practiceElaine Cronin14 March 2016 | British Journal of Nursing, Vol. 25, No. 5 1 March 2015Volume 24Issue Sup5ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 10 March 2015 Published in print 1 March 2015 Information© MA Healthcare LimitedPDF download

Retrospective analysis of patients undergoing bowel transit reconstruction in a tertiary referral hospital of São Paulo's east side

IntroductionThe morbidity and mortality of patients undergoing bowel transit reconstruction reach significant values. Perhaps this and other factors could explain why 30–60% of patients end up with definitive ostomies, even those with initially temporary ostomies, due to the procedure risks. ObjectiveTo analyze retrospectively the medical records of patients undergoing bowel transit reconstruction in one of the SUS referral hospitals in São Paulo from October 2008 to December 2011. ResultsThe mean age of our patients was 53.9 years and 54% of those 100 patients studied between October 2008 and December 2011 had significant comorbidity. The indication for creating an initial ostomy was malignancy in 43%, and the mean stoma duration 14.3 months. The mortality rate was 6%. ConclusionAlthough the bowel transit reconstruction is a procedure quite desired by patients, its indication should be carefully evaluated, with an appropriate consent from the patient.

Enterostomy Closure Timing for Minimizing Postoperative Complications in Premature Infants

For premature infants with advanced acute abdomen, creating a temporary enterostomy is believed to be an appropriate surgical management. However, there is no consensus regarding the timing of enterostomy reversal. The aim of this study was to determine the optimal timing for enterostomy closure (EC) by analyzing EC-related complications. This was a retrospective study of preterm infants who underwent enterostomy for suspected acute abdomens and subsequent closure. EC-related complications occurred in 35 of 54 infants (65%). A univariate analysis determined the following risk factors for EC-related complications: lower weight and younger age at the time of EC and a shorter stoma duration. In a multiple logistic regression analysis, the only significant risk factor was a weight under 2660g at the time of the closure operation. Infants with EC-related complications were ventilated longer, were administered more vasopressors, and were more likely to undergo reoperation. Additionally, these infants required parenteral nutrition for a longer duration, had a longer length of hospital stay after EC, and had a significantly lower weight and height at a corrected age of 7-10months than infants without EC-related complications. Body weight may be one of the most important factors to consider for minimizing EC-related complications.

Psychological attitude to self-appraisal of stoma patients: prospective observation of stoma duration effect to self-appraisal.

PurposeIn recent years, many psychological problems in patients with stomas have been addressed in a number of studies. But there are only a few studies that use objective measures to take into account self-appraisal by patients with permanent or temporary stomas. The aim of this study is to compare the psychological attitude of patients with permanent and temporary stomas and to determine the most appropriate psychological supportive care.MethodsSixty-five patients, who received a stoma between January 2009 and March 2012, were classified into two groups with either permanent or temporary stomas and were observed prospectively. We developed a questionnaire with the aid of a psychiatrist to analyze the grade of psychological attitude of self-appraisal of patients. The questionnaire was categorized into three parts; body image scale, self-esteem scale, and depression scale. Patients responded to the questionnaire 4 weeks after the operation and the answers of each group were compared.ResultsOut of 65 patients, 42 received temporary stomas and 23 received permanent stomas. There was no significant mean difference between permanent and temporary stoma patients in the body image scale, the self-esteem scale, and the depression scale. However, patients with a permanent stoma tended to have a worse body image and lower self-esteem on some specific items within the questionnaires.ConclusionPatients with stomas have negative attitudes toward themselves and some meaningful differences were found between different types of stoma applied. Surgeons should be concerned about postoperative psychological support for patients with stomas.

The effect of early and late stoma closure on nutritional outcome at 12 months of age in children with meconium ileus secondary to cystic fibrosis

Introduction: A small but significant number of infants with cystic fibrosis (CF) require neonatal surgery to relieve bowel obstruction from meconium ileus (MI). This often results in stoma formation to encourage feeding, weight gain and recycling of stoma output. We have undertaken a retrospective review to determine the impact of time to stoma closure on nutritional status at 12 months of age. Methods: A retrospective case note review of patients currently attending the Royal Liverpool Children’s Hospital Regional CF Clinic (n, 282). We recorded duration of stoma and weight centile at three stages: stoma formation, closure, and at 12 month review. Complications of stoma and hospital stay were also noted. Stoma duration less than 8 weeks was classed as early closure (E) and more than 8 weeks as late (L). The change in weight centile at 12 month review was used as a measure of nutritional outcome. Results: 48 children presented with MI (1990–2007); data were available for 26 included in the study. The early and late closure groups consisted of 19 (median time to closure 5 weeks) and 7 patients (13 weeks) respectively. 63% of the early closure group showed an increased weight centile at 12 months compared to 57% of the late group. Stoma duration did not affect post-closure hospital stay. Late stoma closure was associated with increased cases of post closure obstruction (E vs. L; 15.8% vs. 57.1%). Conclusion: This review suggests that the time to stoma closure does not impact significantly on subsequent nutritional status. More studies are needed to determine the optimal post-operative management in this challenging group of children.

Meconium ileus in cystic fibrosis

Recent reviews of meconium ileus (MI) in cystic fibrosis (CF) have documented reduced mortality when compared to earlier studies but suggest significant morbidity is still present, with feeding difficulties and prolonged hospital admission. A chart review was made of 98 infants with MI and CF born in Victoria in the 20-year period 1973–1992. Results were analysed in two consecutive 10-year cohorts. A questionnaire about infant feeding was sent to all current patients from the most recent cohort. MI was the mode of presentation in 21% of all cases of CF. Results of the 1983–1992 cohort (n = 48) showed that 27 of 48 cases (56%) were uncomplicated MI without associated pathology or complications. The remaining 44% had complicated MI. Sixteen of the 27 infants (62%) with uncomplicated MI had a gastrografin enema (GE) performed with a success rate of 50%, with no complications. Surgery was performed in 36 of 48 infants, with the majority (89%) having a stoma fashioned, most commonly an ileostomy (84%), with a mean stoma duration of 17 days (range 5–83). Breast-feeding was established in 25 of 35 cases (71%). The mean duration of hospital stay was 27 days (range 5–90). There was an early mortality of 8%, with a 6-month survival of 90%. Early and late surgical complications were present in 17% of cases. The mean length of hospital stay for cases of uncomplicated MI was 12 days for patients managed non-operatively and 33 days for those treated surgically. Comparison of the two cohorts shows that there has been no further reduction in early mortality (8% in the recent cohort vs 10% in the earlier cohort) and 6-month survival remains unchanged at 90% in both 10-year cohorts. There has been a reduction in early and late surgical morbidity (17% versus 29%). A greater proportion of cases of uncomplicated MI managed non-operatively would result in a reduction in both early and late surgical complications and a shorter hospital stay. The majority of infants with MI do not require long-term parenteral nutrition or pre-digested formula, but can be successfully breast-fed.