Preoperative Stoma Site Research Articles

Clinical changes after the adoption of preoperative stoma site marking in the national health insurance.

Clinical changes after the adoption of preoperative stoma site marking in the national health insurance.

Is the preoperative stoma site always marked?

Is the preoperative stoma site always marked?

Preoperative ostomy education and stoma site marking.

Preoperative ostomy education and stoma site marking.

Stoma siting and the ‘arcuate line’ of Douglas: might it be of relevance to later herniation?

Preoperative stoma site marking aims to select an appropriate location for stoma positioning but there are no fixed anatomical points of reference. A stoma raised below the arcuate line (AL) of the posterior rectus sheath may be a contributing factor to later herniation. The patients' preferred position for a stoma was marked preoperatively by a nurse stomatherapist in 75 unselected cases. The position of the AL was determined in relation to standard anatomical landmarks (umbilicus, xiphoid process, pubic symphysis and the anterior superior iliac spines). The proportion of patients whose stoma trephine was sited below the AL varied with the anatomical landmark examined. Measurements of symphysis pubis to xiphoid process or height above the iliac spines revealed 36-41% of chosen sites were at or below the AL. In 16 of 29 (55%) women the marked sites were at or below the AL. Of 44 patients who had their site marked above the AL, 23 (53%) were within 2cm of the AL. In obese patients and those with a waist circumference greater than 100cm over 50% had their site marked at or within 2cm of the AL. To ensure a stoma site is above the AL of the posterior rectus sheath its centre should be at least 4cm above a horizontal line between the anterior superior iliac spines. This might reduce later herniation rates.

Preoperative Stoma Site Marking in the General Surgery Population

Preoperative teaching and stoma site marking are supported by research and professional organizations as interventions that can reduce the incidence of problematic stomas and improve patient outcomes. This study investigated the translation of this research into practice in the acute care surgery population. A retrospective chart review using convenience sampling was conducted at a large urban hospital in the Midwestern United States. Thirty patients underwent a surgical procedure that resulted in the creation of a fecal ostomy over a 5-month period. Descriptive statistical analysis examined the reason for surgery, preoperative length of stay (LOS), the percentage of patients who received preoperative teaching and stoma marking and the relationship between preoperative LOS and the use of preoperative teaching and stoma marking. Twenty-one of 30 patients were admitted to hospital 24 hours or more before surgery. No participants were admitted urgently. Three (14%) of those admitted for more than 24 hours received preoperative marking or teaching. There was no significant relationship between preoperative LOS and preoperative teaching and stoma marking. The opportunity exists to promote successful adaptation in this surgical population through the implementation of the evidence-based interventions of preoperative teaching and stoma marking. Additional study is needed to determine barriers to their use as well as to develop effective implementation strategies.

The Impact of Preoperative Stoma Site Marking on the Incidence of Complications, Quality of Life, and Patient’s Independence

Preoperative stoma site marking and counseling aim to improve patients' rehabilitation and adaptation to a new medical condition. Objective studies are needed to provide evidence of the impact of care by stoma therapists. Key quality indicators include patients' quality of life, independence, and complication rates as affected by the variable modes of stoma site marking and planning. The aim of this study was to evaluate the impact of preoperative stoma site marking on patients' quality of life, independence, and complication rates. : A validated stoma quality-of-life questionnaire was used as the main assessment tool. Complications were noted on regular postoperative visits. This is a single-center, clinical study. The study was conducted at the Rambam Health Care Campus in Haifa, Israel. Rambam Health Care Campus is a tertiary university hospital. All patients who underwent an elective stoma creation between 2006 and 2008 were included. Evaluated parameters included demographics, stoma type, marking status, complication rates, quality of life, and independence parameters. : One hundred five patients (60 men and 45 women) were included, of whom 52 (49.5%) were preoperatively marked and 53 (50.5%) were not marked. Sixty stomas (57%) were permanent, and 45 (43%) stomas were temporary. The quality of life of patients whose stoma sites were preoperatively marked was significantly better than that of the unmarked patients (p < 0.05 in 18 of 20 items), their independence parameters were significantly better, and their complication rates significantly lower. All of these results were significant irrespective of the stoma type. Preoperative stoma site marking is crucial for improving patients' postoperative quality of life, promoting their independence, and reducing the rates of postoperative complications. The role of the enterostomal therapist is very important in the ostomates' pre- and postoperative care.

Ostomy Literature Review 2010

Ostomy Literature Review 2010

Preoperative stoma siting and education by stomatherapists of colorectal cancer patients: a descriptive study in twelve Spanish colorectal surgical units

Patients with colorectal cancer who need a stoma should undergo preoperative marking of the stoma site and education by a trained stomatherapist. This study examined the care received by ostomy patients with colorectal cancer in Spanish colorectal surgery units, to assess its quality and to detect areas for improvement. A prospective study was conducted in twelve Spanish colorectal surgery units in Spain including patients visited by the stomatherapist after surgery for colorectal cancer. Each patient answered a questionnaire about their stoma care. Between September 2007 and May 2008, 270 patients were included, (63% colostomies, 37% ileostomies). Of whom; 75% had elective and 25% emergency surgery. Stomatherapist marked the stoma site in 45,6% of patients (0% emergency created stomas and 58,8% elective). However, patients who saw a stoma therapist preoperatively presented significantly lower rates of stoma complications (p < 0.001) and anxiety (p < 0.001) compared to those who did not postoperatively. The study has demonstrated the importance of preoperative stomatherapy assessment.

Intestinal Diversion (Colostomy or Ileostomy) in Patients With Severe Bowel Dysfunction Following Spinal Cord Injury

Spinal cord injury (SCI) affects motor and sensory nervous integrity resulting in paralysis of lower or both upper and lower extremities, as well as autonomic nervous system function resulting in neurogenic bowel. SCI leads to diminished or lost sensations of the need to defecate or inability to distinguish the presence of gas versus liquid versus solid stool in the rectal vault. Sensory loss, incomplete evacuation of stool from the rectal vault, immobility, and reduced anal sphincter tone increase the risk of fecal incontinence. Gastrointestinal symptoms are associated with depression, anxiety, and significant impairments in quality of life (QOL) in a significant portion of persons with SCI. 1. To compare clinical, functional, or quality of life outcomes in spinal cord injured patients with gastrointestinal symptoms managed by conservative measures versus intestinal diversion (colostomy or ileostomy). 2. To identify complications associated with ostomy surgery in patients with bowel dysfunction and SCI. A systematic review of electronic databases MEDLINE and CINAHL (from January 1960 to November 2007) was undertaken using the following key words: (1) ostomy, (2) stoma, (3) colostomy, and (4) ileostomy. Boolean features of these databases were used to combine these terms with the key word "spinal cord injuries." Prospective and retrospective studies that directly compared clinical, functional, QOL outcomes or satisfaction among patients with intestinal diversions to patients managed by conservative means were included. Creation of an ostomy in selected patients provides equivocal or superior QOL outcomes when compared to conservative bowel management strategies. Both colostomy and ileostomy surgery significantly reduce the amount of time required for bowel management. Patients who undergo ostomy surgery tend to be satisfied with their surgery, and a significant portion report a desire to be counseled about this option earlier. There are no clear advantages when functional, clinical, or QOL outcomes associated with colostomy are compared to those seen in SCI patients undergoing ileostomy. 1. The WOC nurse plays a pivotal role in both conservative bowel management and the decision to undergo ostomy surgery. 2. Preoperative stoma site marking is vital for the best surgical outcome. 3. The system best suited to an individual is based on a variety of factors including but not limited to stoma location, type of effluent, peristomal plane and contours, and the individual's capabilities and preferences. 4. Some individuals with a sigmoid or descending colostomy may benefit from colostomy irrigation as a management method. 5. Postoperatively, assessment of pressure points for signs of tissue breakdown, evaluation of treatment methods for existing pressure ulcers with suitable modification, and support surface assessment should be included in ongoing annual follow-up visits.

What the journals say

The combination of improved surgical techniques incorporating laparoscopic surgery and shortened hospital stay has meant a review of the role played by the stoma care nurse specialist in the management of patients with newly formed stomas. In this study, the authors consider whether preoperative teaching and stoma site marking affect the surgical outcome of patients undergoing stoma surgery. The decrease in length of stay necessitates the teaching of practical stoma management in the preoperative rather than the postoperative phase, to ensure the patients are discharged with the necessary skills to maintain independence.

Preoperative Stoma Site Assessment and Marking

Preoperative Stoma Site Assessment and Marking

The present condition of preoperative stoma site marking, and revaluation

The present condition of preoperative stoma site marking, and revaluation