Peristomal Hernia Research Articles

N05 Are we meeting the sexual wellbeing concerns of patients with IBD and a stoma? A survey on current practice in addressing sexual wellbeing

Abstract Background People with inflammatory bowel disease have a high incidence of stoma formation, either temporary or permanent. Although a stoma can be a life saver, for some it can negatively impact body image and psycho-emotional wellbeing. Sexual function can also be affected by a poor body image. Therefore, intimacy and sexuality should be addressed in clinical settings during stoma care. We aimed to explore the experiences of sexual wellbeing concerns of people living with IBD and a stoma, and how these were addressed by healthcare professionals. Methods This was Stage 1 of an international mixed method study. Data were collected via an anonymous online survey advertised on social media platforms and charity webpages. Results These are the quantitative results. 134 participants with IBD responded: 11 had colostomy and 123 had ileostomy. Time from stoma formation to survey response was between 2 weeks to 32 years. Peristomal hernia was reported by 27.6% (n=37) participants. Only 30.5 % (n=41) reported that sexual wellbeing was discussed around the time of their stoma formation, mainly with their surgeon or stoma nurse. Some 33.5% (n=45) reported having had no intimacy and sexuality concerns at all at the time of stoma formation. The patient perspective on barriers for asking healthcare professionals (HCPs) questions about sexual wellbeing despite having concerns, were reported as being ashamed to ask, afraid of being judged by their HCPS, and not knowing what to ask as being overwhelmed with technical information related to stoma care. Around 66% (n=89) reported having concerns related to their intimacy and sexuality following stoma formation, with the top three reported concerns being appearance/body image, fear of rejection from partner, and bag leakages. All participants reported wanting sexual wellbeing discussed routinely at any point of care, and the majority wanted partners involved in these discussions. Conclusion Patients expect to be informed about intimacy and sexuality aspects as an integral part of stoma care. Current practice does not meet the patient’s care needs, with potential for having a negative impact on their overall quality of life, since a significant number of ostomates report sexual wellbeing concerns after the stoma formation.Sexual wellbeing conversations should be an integral part of perioperative and stoma care to prevent persistent concerns within this patient group. Not providing adequate information during stoma care about sexual wellbeing can negatively impact their quality of life. The results will form the basis of an interview guide for the second (interview) stage of the study, to understand better the reasons behind these findings.

Construction of a Perioperative Care Protocol for Individuals with Intestinal Ostomies

Objective: To develop a nursing protocol to guide perioperative care for individuals with intestinal ostomies. Method: A methodological study conducted between March and June 2022, using a quantitative approach. The study was divided into three stages: 1) an exploratory phase to determine the characteristics of the target population using a questionnaire; 2) the definition of perioperative recommendations based on Enhanced Recovery After Surgery® (ERAS); and 3) the creation of the protocol. Data analysis involved simple descriptive statistics. Results: Ten (10) patients responded preoperatively, while only six (6) responded postoperatively. Preoperative education was provided by nurses in 50% of cases. Findings showed an absence of ostomy site marking in 90% of cases, insufficient self-care in 60%, and postoperative complications in 60%, including edema, mucocutaneous separation, contact dermatitis, peristomal hernia, edge maceration, and granuloma. The proposed protocol consists of a care flowchart with four lines of follow-up within the institution and a consolidated framework with four key axes of perioperative nursing actions. Each axis includes sub-axes that detail specific guidelines to be implemented. Conclusion: The situational analysis of the target population and perioperative complications demonstrated the feasibility of developing a perioperative care protocol focused on the immediate preoperative, intraoperative, and postoperative phases.

Preliminary results of Polish national multicenter study on colostomy reversal - LICO (Liquidation of Colostomy) study.

Creation of colostomy is still a commonly performed procedure in emergency settings, when intestinal anastomosis cannot be performed safely. Reversing a stoma has been linked with high rates of morbidity and also mortality. The primary goal of the study was to identify the risk of postoperative complications in patients undergoing colostomy liquidation. The secondary goal was to assess perioperative care parameters. The LIquidation of COlostomy (LICO) study is an open multicenter prospective cohort study that began in October 2022 and will continue until December 2023. Data from 20 Polish surgical departments were collected. Overall 45 patients were reported over the initial 3 months; based on that group we performed a preliminary analysis. Mean operative time was 163 min. Patients were operated on by specialists in 93.3% of cases. Complications occurred in 15 (33.3%) patients. Wound infection was the most common complication (17.8%). In 3 (6.7%) cases anastomotic leakage was diagnosed, and in 2 of those cases reoperation was required. The overall mortality rate was 2.2%. The mean length of hospital stay was 10.1 days. Preoperative fasting was used in 53.3% of patients, and the mechanical bowel preparation rate was 75.6%. Only in 8.9% of cases was laparoscopic access used for stoma reversal, and only in 1 out of 45 cases was mesh used for incisional peristomal hernia prophylactics. The stoma site was closed by single sutures in 73.3%, and negative pressure assisted closure was performed in 6.7% of patients. Colostomy liquidation is associated with significant morbidity and minor mortality in the Polish population. Standardized perioperative care should be established for stoma reversal surgery.

The Role of Ileostomy in the Prevention and Treatment of Anastomotic Leakage after Elective Rectal Cancer Surgery - A Retrospective Analysis of Specific Risk Factors, Outcomes, and Complications.

Background: The objective of this paper is to highlight the role and place of ileostomy from the perspective of the risk of anastomotic leakage (AL). Materials and method: This was a retrospective study of 74 (46.54%) low and ultra-low anterior resections from 159 cases of rectal cancer operated on in a seven-year interval (2015 - 2021). The cases were divided into two groups: Group A with protective ileostomy (47 cases = 63.51%) and Group B without protective ileostomy (27 cases = 35.49%). Results: The type of anastomosis was low colorectal for 15 cases and ileorectal for two cases, both in Group A, with either mechanical or manual sutures. Continuous loop ileostomy was the only fecal diversion procedure used for protection. The ileostomy-specific complications recorded in Group A were peristomal skin lesions (8 cases), early peristomal hernia (2 cases), and severe dehydration with acute renal-insufficency (7 cases). The closure of the ileostomy was performed in 42 cases (89.36%), with the time between the primary operation and the closure being 4.28 months on average, with limits between 12 days and 10 months. AL treatment was conservative in 13 (76.47%) cases and surgical in four cases, with the types of operations performed at reintervention being take-down of the anastomosis + left terminal colostomy + ileostomy closure in three cases (2 in Group A and 1 in Group B) and terminal ileostomy in one case in Group A. Conclusions: To reduce its specific complications, ileostomy should be performed in well-selected patients. Those with risk factors for leakage include males, the elderly, and those having important comorbidities, neoadjuvant chemoradiotherapy, low tumors below 5 cm from the anal verge, or complete circumferential stenosis and peritumoral inflammatory infiltrate.

Indocyanine Green Fluorescence Identification of Ureters in Robotic Hartmann Reversal

Introduction: Hartmann reversal is a complex surgical procedure associated with significant morbidity. Injuries of the urinary tract can occur in 10% to 15% of primary colorectal resections and complex reconstructive surgeries. Indocyanine green (ICG) intraureteral injection has been advocated recently for ureteral identification during pelvic surgery. Decreasing the rate of ureteral injuries directly impacts length of stay, costs, morbidity, and mortality rate. This video illustrates the utility of intraureteral ICG during a Hartmann reversal procedure in a complex pelvis. Materials and Methods: Intraureteral injection of ICG was used in five patients, three Hartmann reversals and two rectal bulky tumors. All patients underwent robotic procedures except one patient with a bulky and perforated rectal tumor combined with a left pelvic kidney. This specific video highlights a patient who underwent a laparoscopic Hartmann procedure for pelvic abscess caused by a perforated sigmoid diverticula. A Hartmann reversal was performed 2 months later. A robot-assisted Hartmann reversal was carried out and off-label bilateral intraureteral infusion of ICG was performed. A 5F ureteral catheter was inserted in both ureters before surgery, 10 cm beyond the ureteral orifice and then retracted back to 2 cm. When requested, 25 mg of ICG were dissolved in 10 mL of saline and injected into both ureters. ICG reversibly binds to proteins of the urothelial layer. ICG is a fluorescent dye, made of hydrophobic molecules that usually is injected intravenously and binds to plasma proteins and is excreted by liver. It becomes fluorescent when excited by the robotic laser light (Firefly Fluorescence Endoscope System; Intuitive Surgical, Inc., Silicon Valley in Sunnyvale, CA). Injection time was 15 minutes and ICG helped identify the right ureter that was slightly medialized and adherent to the rectal stump. A peristomal hernia was present and treated by direct suture after an adhesiolysis. After dissecting the rectal stump from the right ureter and pelvic wall, the rectal stump was re-transected and a colorectal end-to-end mechanical anastomosis was performed. A perianastomotic suction drainage was placed in the pelvis. Both ureteral catheters were removed at the end of the procedure. Results: Neither ureteral injuries nor ICG-related intraoperative and/or postoperative adverse events, nor renal failures were experienced in all the treated cases. A transient hematuria was observed in two patients. Conclusions: Use of intraureteral ICG may be a safe and helpful procedure to identify ureters in complex pelvic and colorectal surgery. It can serve as a valid tool in preventing iatrogenic ureteral injuries. No competing financial interests exist. Runtime of video: 7 mins 52 secs

Exercise After Ostomy Surgery and Peristomal Hernia: A View From Here.

Exercise After Ostomy Surgery and Peristomal Hernia: A View From Here.

The embodied experience of pregnancy with an ileostomy.

To understand women's experience of pregnancy with an ileostomy following bowel resection for inflammatory bowel disease or familial adenomatous polyposis. While symptoms of IBD/FAP can be debilitating and life-threatening, ostomy formation can effectively manage symptoms. Research on pregnant women with an ostomy is sparse. While some literature suggests pregnant women with an ostomy can have a normal pregnancy and birth, documented stoma complications include intestinal obstruction, peristomal hernia, retraction, stenosis, laceration, bleeding, prolapse, pouching problems, nausea, vomiting and dehydration. Hermeneutic phenomenology. All known women (n=8) who had been pregnant with an ileostomy were recruited from the stomal therapy departments of two teaching hospitals. Single in-depth interviews were digitally recorded and transcribed verbatim. Hermeneutic phenomenological analysis was guided by the philosophy of Merleau-Ponty. Reporting rigour was guided by the consolidated criteria for reporting qualitative research. There was a lower level of concern among pregnant woman with an ostomy than anticipated. Women described the following: the "hell" of the disease; the stoma as a lifeline; heading into uncharted waters; wanting to be normal; the shared space of the baby and the diseased abdomen; pregnancy as a dark tunnel; and the unreliable body. Women with inflammatory bowel disease frequently experience debilitating symptoms and serious ill health. Ileostomy formation improves symptoms and the sense of "feeling normal," facilitating readiness for conception, pregnancy and motherhood. However, women's uncertainty about conception and pregnancy persists due to the scarce information and experiences offered by clinicians, and fears around their unreliable body during pregnancy. Given this uncertainty for both women and their treating clinicians, outcomes should be documented and shared to reassure women of child-bearing age that pregnancy and birth can be safe with a stoma. Women and clinicians should aim for disease remission, peer support, ongoing monitoring and involvement of a Stomal Therapy Nurse.

Reducing the incidence of parastomal hernia with a simple surgical technique.

The incidence of parastomal hernia is reported at between 10% and 50%. The development of a hernia after stoma surgery can lead to both physical and psychological problems and may reduce the individual's quality of life. Many garments and appliances are aimed at managing a stoma and a peri-stomal hernia. From a surgical perspective, to date there has been no real success in achieving a reduction in parastomal hernia incidence. The cost of managing a parastomal hernia is reported as being in excess of £1 million a year in England for non-surgical management alone. Surgical repair of parastomal hernia carries not only a financial burden but an increased risk of mortality and morbidity.

When is the best time for temporary stoma closure in laparoscopic sphincter-saving surgery for rectal cancer? A study of 259 consecutive patients.

There is no consensus regarding the best timing for temporary stoma closure after proctectomy for rectal cancer, especially if the patient requires adjuvant chemotherapy. This study aimed to assess whether the timing of stoma closure could influence postoperative morbidity. Patients with rectal cancer undergoing laparoscopic proctectomy with temporary stoma were included and divided into three groups according to the delay of stoma closure after proctectomy: ≤60 days (Group A), 61-90 days (Group B), and >90 days (Group C). From 2008 to 2013, 259 patients (146 men, median age 61 years) were divided into Groups A (n = 65), B (n = 115), and C (n = 79). At the time of stoma closure, seven (11%) patients received adjuvant chemotherapy in Group A versus 42 (37%) in Group B (p = 0.0002) and 24 (30%) in Group C (p = 0.004), and peristomal hernia was noted in four patients (6%) in Group A versus 14 (12%) in Group B and 21 (27%) in Group C (p < 0.0001). Although overall postoperative morbidity was similar between groups, anastomotic leakage (at the stoma closure site) was noted in one patient in Group A versus zero in Group B versus four in Group C (p = 0.03). Median hospital stay was 5 days in Group A versus 6 in Group B versus 6 in Group C (p = 0.004). Our results suggested that timing of temporary stoma closure can influence postoperative morbidity. Best results were obtained if stoma closure was performed before 90 days, even during adjuvant chemotherapy. There is no benefit in delaying stoma closure after completion of adjuvant chemotherapy.

Comparative study of morbidity and mortality between ileal conduit and ureterosigmoidostomy after radical cystectomy for bladder neoplasm

ObjectivesDespite the growing trend in the development of orthotopic neobladders, the procedure cannot be performed in many cases, thereby retaining the validity of other techniques. We propose a comparative analysis between patients with radical cystectomy for bladder neoplasm and reconstruction using the ileal conduit (IC) or ureterosigmoidostomy (USG). Patients and methodObservational retrospective study on 255 patients with radical cystectomy between 1985 and 2009, selecting group assignments by the use of IC and USG. Analysis of the demographic and preoperative characteristics, perioperative complications, pathology and medium to long-term complications. Comparison of groups using T-Student, U-Mann–Whitney and chi square tests, with p<0.05 indicating statistical significance. Preparation of survival tables according to Kaplan–Meier, establishing comparisons using the log-rank test. ResultsThere were 41 cases of IC and 55 cases of USG, with a mean patient age of approximately 61 years. USGs were performed on a greater number of females than ICs. There were no differences in the need for transfusion, with similar results as other series. There was a greater trend toward the appearance of intestinal fistulae and greater morbidity and mortality in the postoperative period in USG, although it was not significant. There was a greater long-term presence of eventrations in IC, and of pyelonephritis and the need for taking alkalinizing agents in USG. The appearance of peristomal hernias in IC was less than in previous series. With a mean follow-up greater than 50 months, the overall survival was 40% at 5 years, with no differences according to urinary diversion. ConclusionsIC and USG are two applicable urinary diversions in the event that orthotopic neobladder surgery cannot be performed. They have a similar long-term complication and survival profile in our series, although with a higher morbidity in postoperative complications for USG.

Estudio comparativo de morbimortalidad entre conducto ileal y ureterosigmoidostomía tras cistectomía radical por neoplasia vesical

ObjectivesDespite the growing trend in the development of orthotopic neobladders, the procedure cannot be performed in many cases, thereby retaining the validity of other techniques. We propose a comparative analysis between patients with radical cystectomy for bladder neoplasm and reconstruction using the ileal conduit (IC) or ureterosigmoidostomy (USG). Patients and methodObservational retrospective study on 255 patients with radical cystectomy between 1985 and 2009, selecting group assignments by the use of IC and USG. Analysis of the demographic and preoperative characteristics, perioperative complications, pathology and medium to long-term complications. Comparison of groups using T-Student, U-Mann-Whitney and chi square tests, with P<.05 indicating statistical significance. Preparation of survival tables according to Kaplan-Meier, establishing comparisons using the log-rank test. ResultsThere were 41 cases of IC and 55 cases of USG, with a mean patient age of approximately 61 years. USGs were performed on a greater number of females than ICs. There were no differences in the need for transfusion, with similar results as other series. There was a greater trend towards the appearance of intestinal fistulae and greater morbidity and mortality in the postoperative period in USG, although it was not significant. There was a greater long-term presence of eventrations in IC, and of pyelonephritis and the need for taking alkalinizing agents in USG. The appearance of peristomal hernias in IC was less than in previous series. With a mean follow-up greater than 50 months, the overall survival was 40% at 5 years, with no differences according to urinary diversion. ConclusionsIC and USG are two applicable urinary diversions in the event that orthotopic neobladder surgery cannot be performed. They have a similar long-term complication and survival profile in our series, although with a higher morbidity in postoperative complications for USG.

Minimally Invasive Colostomy Revision for Palliation of Large Stomal Prolapse and an Adherent Sliding Peristomal Hernia

Minimally Invasive Colostomy Revision for Palliation of Large Stomal Prolapse and an Adherent Sliding Peristomal Hernia

Gastric Gangrene “An Iatrogenic Misadventure”

In gastrointestinal system gangrene commonly involves intestines. Involvement of stomach is a rare finding. Herein we describe a case of gastric gangrene secondary to herniation of stomach through an iatrogenic defect. Gangrene of the stomach is a rare and a catastrophic occurrence as stomach is a highly vascularised organ. Gastric gangrene could be secondary to atherosclerosis, arterial embolism, iatrogenic gelfoam embolism, venous thrombosis, gastric volvulus, bulimia nervosa, endoscopic haemostatic injections, diaphragmatic hernia and infectious gastritis. Most reported cases have occurred due to gastric volvulus (Amin El-Gohary and Etiaby, Paedr Surg Intl 9:486-488, 1994; Al-Salem, Pediatr Radiol 30(12):842-5, 2000). Few cases have been reported as complicated hernias either a Bochdalek hernia (Ghanem, Chankun, Brooks, BJS V74(9):779, 2005) or as peristomal hernias which initially lead to gastric outlet obstruction (Ellingson, Maki, Kozarek, Patterson, J Clin Gastroenterol 17(4):314-6, 1993).

RACE Toward the Goal of Certification

RACE Toward the Goal of Certification

Community Acquired Clostridium difficile Ileitis in a Patient with Crohnʼs Disease and Ileostomy

Purpose: Background: Clostridium difficile is linked with antibiotic-associated colitis. Antibiotic use, hospitalization, older patients, and long-term care facility residents are recognized as main risk factors. Community-acquired cases are increasing and underdiagnosed. We report a case of a community acquired Clostridium difficile infection of the ileum in a patient with Crohn's disease who underwent total colectomy. Case presentation: The patient is 41-year-old woman with a history of myelodysplastic syndrome and Crohn's disease, which was diagnosed at age 23; she underwent proctocolectomy with ileostomy in 1998. She subsequently underwent resection of a part of her distal small bowel secondary to obstruction. She presented to the ER with 5 days of increasing ileostomy bag output and diffuse abdominal pain, accompanied by intermittent nausea. Patient had been treated with steroids, aminosalicylates, and 6-mercaptopurine on different occasions, but she was not on any treatment for her Crohn's at time of this presentation. She was not on antibiotics and had not used antibiotics recently. On physical exam, the patient had diffuse abdominal tenderness, no guarding or rebound and had hyperactive bowel sounds. Laboratory data showed no white count elevation. A basic metabolic panel was normal. KUB and CT of the abdomen showed a left peri-stomal hernia without evidence of obstruction and no small bowel thickening. A sample of the patient's iejunostomy effluent tested positive for C. difficile toxin by enzyme immunoassays (EIAs). Treatment was initiated with rehydration, and she was started on metronidazole. Over the course of her stay (3 days), she reported a gradual decrease in the ostomy output and it returned to baseline. She was discharged home to complete 10 days of metronidazole. Conclusion:C. difficile is third most common cause of infectious diarrhea in patients aged 75 years and older seen by general practitioners according to the Intestinal Infectious Disease Survey in England. Clostridium difficile enteritis is a rare infection and associated with a higher mortality rate (60- 80%) than that reported with C. difficile colitis 10-30%. Kim et al. found only 56 cases of C. difficile enteritis had been reported between 1980 to 2010. With a reported increase in the incidence of community acquired infections, we believed that this is the first case of community acquired small bowel C. difficile infection, and given that previous articles have suggested C. difficile enteritis has a more severe clinical course than colitis, clinical awareness especially in patients with IBD, early diagnosis and treatment are imperative.

Factors Affecting Ostomy-Related Complications in Korea

We sought to determine the type and incidence of ostomy-related complications and identify associated factors in Korean ostomy patients. A retrospective analysis of medical records of 1,170 patients who underwent end colostomy in Samsung Medical Center between October 1994 and February 2005 was completed. Complications were classified as stomal or peristomal. Stomal complications included bleeding, necrosis, mucocutaneous separation, prolapsed stoma, retracted stoma, and stenosis. Peristomal complications included varices, hernia, irritant contact dermatitis, allergic contact dermatitis, maceration, folliculitis, hyperplastic granulation, bacterial infection, candidal infection, malignancy in the peristomal area, mechanical damage, and pyoderma gangrenosum. A flat (flush) stoma was the most common stomal complication, occurring in 8.5% of subjects. Irritant contact dermatitis, occurring in 15.5%, was the most common peristomal complication. Gender and body mass index were associated with irritant contact dermatitis, hyperplasia, peristomal hernias, flat stomas, and retracted stomas. Education for preventing irritant contact dermatitis, such as proper pouching and peristomal skin protection, and for weight control, should be emphasized in a self-care program for persons living with an ostomy. Preoperative marking by a WOC nurse is needed to reduce the prevalence of flat (flush) stomas.

Application of GORE-TEX Dual Mesh fixing into peritoneum in sigmoid-colostomy to prevent peristomal hernia

To investigate the effect of GORE-TEX Dual Mesh fixing into peritoneum in sigmoid-colostomy on the prevention of peristomal hernia. Sixty patients undergone sigmoid-colostomy from Jan. 2003 to Jan. 2005 in the first affiliated hospital of Sun Yat-sen University were selected and randomly divided into two groups. Patients received papillary sigmoid-colostomy through rectus abdominis and peritoneum in control group and GORE-TEX Dual Mesh fixing into peritoneum during sigmoid-colostomy in observation group. Complications and recurrence rate were recorded in follow-up period. Peristomal hernia occurred in eight patients (8/30) in control group (26.7%), while no hernia happened in observation group (0/30). GORE-TEX Dual Mesh fixing into peritoneum in sigmoid-colostomy can prevent peristomal hernia.

Stoma‐related complications and stoma size – a 2‐year follow up

The purpose of the study was to prospectively describe stoma configuration and evaluate stoma-related complications and their association with possible risk factors. All elective patients (n = 180) operated on with a formation of colostomy, ileostomy or loop-ileostomy between 2003 and 2005 were included in the study. Follow up took place on the ward postoperatively and five times during 2 years after discharge. On these occasions the diameter and height of the stoma were recorded. Complications such as peristomal skin problems, necrosis, leakage caused by a low stoma, stenosis, granuloma formation, prolapse and peristomal hernia formation were evaluated. Most complications occurred 2 weeks after discharge; 53% of patients with colostomies, 79% with loop-ileostomies and 70% of patients with end-ileostomy had one or more complications. The most common complication was skin problems and it was most common in patients with end-ileostomies (60%) and loop-ileostomies (73%). Postoperatively at ward review, the most common complication was necrosis, which occurred in 20% of patients with a colostomy. Granuloma formation was most frequent in colostomies. Almost all patients with an end-ileostomy and loop-ileostomy with a height lower than 20 mm had leakage and skin problems as had half of the patients with a colostomy height lower than 5 mm. To prevent stoma-related complications, it is important to produce an adequate height of the stoma, with early and regular follow ups and adjustment of the appliance. To work closely in collaboration with the colorectal surgeons is of utmost important to provide feedback and in turn, to improve stoma outcome.

Perfil do paciente ostomizado e complicações relacionadas ao estoma

OBJETIVO: elaborar o perfil dos pacientes ostomizados e as complicações relacionadas ao estoma. MATERIAL E MÉTODO: estudo retrospectivo em que foram analisados prontuários dos pacientes cadastrados no Programa de Ostomizados do Centro de Especialidades Médicas da Prefeitura Municipal de Campo Grande-MS. RESULTADOS: foram avaliados 178 prontuários (56.7% homens e 43.3% mulheres). A média de idade entre os pacientes foi de 46.8 anos para o sexo masculino e de 54.6 anos para os do sexo feminino. Dentre as ostomias, foram encontradas 152 colostomias (85.4%), 21 ileostomias (11.8%) e 5 urostomias (2.8%). O principal motivo para confecção dos estomas foi a neoplasia maligna (46.6%), seguido do trauma abdominal (7.3%), e do desvio de trânsito intestinal devido a úlceras de pressão (6.7%). Adaptação inadequada da placa ao estoma foi encontrada em 90 pacientes (50.6%). Complicações do estoma foram encontradas em 103 pacientes (57.9%), dentre elas, dermatite peri-estomal (28.7%), estoma plano (18.6%), hérnia para-colostômica (10.7%) e retração do estoma (10.1%). CONCLUSÕES: No grupo estudado, o principal motivo para a confecção de ostomia foi a neoplasia de retossigmóide e canal anal. A complicação mais comum foi a dermatite peri-estomal.

Management of faecal evacuation via a colostomy: A Systematic Review

Review Objectives: The objective of this review is to critique and summarise the best available research on the management of colostomy emptying by CI. Review Qquestions: What is the most effective fluid regimen for CI in terms of colostomy management? How does effective colostomy management impact on secondary outcomes such as quality of life, satisfaction level, emotional functioning, self esteem, stress/anxiety and depression? Criteria for considering studies for this review: Types of participants: The review will consider all studies that included colostomised patients, independently of the stoma’s cause, time of setting-up and localization. Patients with stomal prolapse or peristomal hernia, temporary stoma or patients receiving chemotherapy, pelvic or abdominal radiation treatments, or diarrhea-pouching medications are excluded. Age on the other hand should not be considered a contraindication, as CI has been shown to be effective regardless of the person’s age.1, 4 Types of interventions: All interventions that use any fluid regimes with any colonoplegic agents to manage colostomy emptying will be included. Types of outcome measures: Primary outcome: Fluid inflow time, total wash out time, hemodynamic changes during irrigation cramps, leakage episodes.