Stoma Site Research Articles

A descriptive study to determine the bacterial flora and antibiotic sensitivity of lower respiratory tract in tracheostomised patients

<p class="abstract"><strong>Background:</strong> Tracheostomy is one of the commonest operations performed by an otorhinolaryngologist for various indications and in different age groups and tracheo-bronchitis is a common complication in tracheostomised patients. This study designed to determine the bacterial flora and antibiotic sensitivity of lower respiratory tract following tracheostomy in hospitalized patients.</p><p class="abstract"><strong>Methods:</strong> This is a descriptive study of 50 tracheostomised patients carried out from December 2017 to May 2019, at VIMS Ballari. </p><p class="abstract"><strong>Results:</strong> Stridor was the most common indication for tracheostomy (70%). Tracheal aspirate was sent for bacterial culture and sensitivity on day 0, 1 week and 3 weeks post tracheostomy. Majority of the patients showed no growth in the day 0 and 3weeks post tracheostomy bacterial cultures of the tracheal aspirate. Bacterial cultures yielded growth in majority of the patients in the 1-week post tracheostomy cultures. The sensitivity pattern, intermediate response pattern and resistance pattern to the first line antibiotics that are regularly used in our hospital were studied in all the 3 samples of tracheal aspirates that were sent for bacterial culture from all the 50 tracheostomised patients.</p><p class="abstract"><strong>Conclusions:</strong> It is a good practice to send the tracheal aspirate for culture and sensitivity following Tracheostomy. If the patient is started on suitable antibiotics based on the culture postoperative recovery will be hastened, risk of postoperative infections like tracheitis, tracheobrochitis, stoma site infection and other lower respiratory tract infections can be reduced.</p>

A single centre 10-year experience of Mitrofanoffs procedure for varied indications with its outcome

Background: To evaluate long term efficacy and complications of Mitrofanoffs procedure in patients with bladder dysfunction.Methods: Authors retrospectively reviewed the medical records of 51 patients who underwent construction of a continent catherisable channel (mitrofanoffs and monti) from 2009 till 2019 in our institution. Clinical findings and investigations result along with surgical techniques used were noted for these patients. Postoperative complications along with urinary continence and renal outcome were evaluated.Results: Mean age was 7 years and mean follow up was for 3 years. 27 patients were with neurogenic bladder and 24 with non-neurogenic bladder. The most common type of conduit was appendicovesicostomy (38) followed by illeal monti (12) and ureter (1). The most common stomal site was umbilicus (44) followed by right lower abdominal quadrant (6). Catherterizable conduit complications included stomal leakage in 3, mucosal prolapse at the stoma site in1 and an intra peritoneal leak requiring exploratory laprotomy and revision in1. Relative stomal continence was achieved in 98%. The preoperative serum creatinine & blood urea nitrogen (BUN) at the time of mitrofanoffs procedure at the last follow up after the procedure were sought and compared using Chi square test showed statistically significant improvement (p<0.01). No differences in outcome and complication rates were noted between different types of conduit, sites of implantation, or segments used for augmentation.Conclusions: Mitrofanoff is a safe and reliable procedure in children who are dependent on intermittent catherisation in developing countries. Appendicovesicostomy is our first option followed by yang -monti illeovesicostomy. While stomal continence is excellent patient education, family motivation and cost reduction are important factors for its lasting efficiency.

Hernia at the stoma site after loop ileostomy reversal

PurposeTo estimate the incidence of and risk factors for stoma site hernia after closure of a temporary diverting ileostomy.MethodIn a non-comparative cohort study, charts (n = 216) and CT-scans (n = 169) from patients who had undergone loop ileostomy closure following low anterior resection for rectal cancer 2010–2015 (mainly open surgery) at three hospitals were evaluated retrospectively. Patients without hernia diagnosis were evaluated cross-sectionally through a questionnaire (n = 158), and patients with symptoms of bulging or pain were contacted and offered a clinical examination or a CT scan including Valsalva maneuver.ResultsIn the chart review, five (2.3%) patients had a diagnosis of incisional hernia at the previous stoma site after 8 months (median). In 12 patients, the CT scan showed a hernia, of which 8 had not been detected previously. The questionnaire was returned by 130 (82%) patients, of which 31% had symptoms of bulging or pain. Less than one in five of patients who reported bulging were diagnosed with hernia, but the absolute majority of the radiologically diagnosed hernias reported symptoms. By combining clinical and radiological diagnosis, the cumulative incidence of hernia was 7.4% during a median follow up time of 30 months. Risk factors for stoma site hernia were male sex and higher BMI.ConclusionHernia at the previous stoma site was underdiagnosed. Less than a third of symptomatic patients had a hernia diagnosis in routine follow up. Randomized studies are needed to evaluate if prophylactic mesh can be used to prevent hernias, especially in patients with risk factors.

Does Preoperative Ostomy Education Decrease Anxiety in the New Ostomy Patient? A Quantitative Comparison Cohort Study.

The purpose of this study was to determine if patients undergoing presurgical ostomy education and routine postoperative education experienced less postsurgical anxiety than patients undergoing routine preoperative education. Quantitative, prospective, comparison cohort study. The sample comprised 30 participants divided into 2 groups; one group received preoperative ostomy education and stoma site marking, along with postoperative ostomy education, while the other received only postoperative ostomy education. Each group had an equal number of males (n = 11) and females (n = 4). The mean age for the groups was 65.27 (SD = 9.97) and 61.87 (SD = 17.56) years, respectively; this difference was not statistically significant (P > .05). The intervention group included 9 patients who underwent colostomy, 4 who underwent ileostomy, and 2 who underwent urostomy. The comparison group comprised 10 patients with colostomies, 4 with ileostomies, and 1 with a urostomy. The study setting was a 385-bed tertiary hospital in Northern California. Data collection occurred from November 2, 2018, to February 22, 2019. Postoperative anxiety levels were evaluated in both groups during their postoperative ostomy education session. Anxiety level was measured using the anxiety domain of the Hospital Anxiety and Depression Survey (HADS), which was administered during their postoperative educational session. Analysis of variance was used to compare the difference between the HADS anxiety domain scores between the groups. Patients who received preoperative ostomy education had statistically significant lower postsurgical anxiety scores than patients who had standard education (P < .001). Study findings suggest that preoperative ostomy education, when offered in addition to routine preoperative education, significantly lowers anxiety when compared to patients managed by routine preoperative education alone.

Prophylactic biological mesh reinforcement versus standard closure of stoma site (ROCSS): a multicentre, randomised controlled trial

SummaryBackgroundClosure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site.MethodsIn this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964.FindingsBetween Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43–0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26–0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60–1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54–1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events.InterpretationReinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias.FundingNational Institute for Health Research Research for Patient Benefit and Allergan.

Current Management of Intestinal Stomas and Their Complications.

Inappropriate stoma site, improper management of stoma, and stoma complications lead to diminished quality of life of ostomates. Healthcare professionals involved in stoma creation and/or care should have the fundamental and updated knowledge of the management of stomas and their complications. This review article consists of the following major sections: principles of perioperative patient management, early complications, and late complications. In the “principles of perioperative patient management” section, the current concepts and trends in preoperative education, stoma site marking, postoperative education, and patient educational resources are discussed. In the “early complications” section, we have focused on the etiology and current management of ischemia/necrosis, fluid and electrolyte imbalances, mucocutaneous separation, and retraction. In the “late complications” section, we have focused on the etiology and current management of parastomal hernia, stoma prolapse, parastomal varices, and pyoderma gangrenosum. Pre- and postoperative patient education facilitates the patient's independence in stoma care and resumption of normal activities. Healthcare providers should have basic skills and updated knowledge on the management of stomas and complications of stomas, to act as the first crisis manager for ostomates.

Predictors for 30-day mortality and complications following radiologically inserted gastrostomies: a single centre, large cohort review

To measure the 30-day mortality and delayed complication rates following radiologically inserted gastrostomy (RIG) placement and determine the predictive risk factors for 30-day mortality and delayed complications to aide pre-procedure informed consent. Retrospective analysis was undertaken of RIG insertions between July 2012 and August 2017 at a single tertiary centre, which included 373 patients (56% male; median age: 65 years, range: 19-92 years). Data were collected from electronic databases on patient demographics, RIG indication, all-cause mortality, complication rates, patient co-morbidities, and biochemical/haematological parameters. Multivariate analysis was performed to identify predictive risk factors for complications and mortality. The RIG procedural success rate was 97.9%. The overall 30-day mortality rate was 7.8%; associated with pre-procedural haemoglobin <130g/l in men (p=0.030, odds ratio [OR] 23.38), white cell count >11×109/l (p=0.001, OR 4.18), C-reactive protein >10mg/l (p=0.003, OR 10.10) and international normalised ratio (INR) >1.2 (p=0.03, OR 4.63). Inpatient RIG referrals were associated with 10% 30-day mortality; compared to 1.1% for outpatients (p=0.028, OR 9.51). The incidence of immediate and delayed complications was 2.4% and 42.1%, respectively. Neuromuscular disease was associated with gastrostomy dislodgement (p=0.0001, OR 4.99) and fracture (p=0.0009, OR 13.45), cerebrovascular disease with gastrostomy dislodgement (p=0.009, OR 2.51), cardiovascular disease with sepsis 30-days post-RIG (p=0.02, OR 2.94), and diabetes mellitus with gastrostomy dislodgement (p=0.0001, OR 29.45), fracture (p=0.027, OR 5.63) and stoma site infections (p=0.0003, OR 7.16). RIG 30-day mortality was significantly associated with inpatient procedures compared to outpatient, and a range of biochemical/haematological parameters that suggest infection pre-intervention. It is advised that the markers of infection and catabolism are investigated pre-intervention, which may reduce mortality and complication rates.

Safety and efficacy of prophylactic resorbable biosynthetic mesh in loop-ileostomy reversal: a case-control study.

Loop ileostomy (LI) is a widely used temporary stoma technique. Reversal of LI is generally considered a minor and safe procedure, with very low short-term postoperative mortality and morbidity rates. Complications include incisional hernia (IH), carrying a high probability of surgical repair. Clinical measures to reduce the IH rate warrant consideration. Recent researches suggest the use of a prophylactic non-absorbable mesh to reduce IH rate; however, surgeons are reluctant to implant a permanent foreign material in contaminated operative fields, because of a higher risk of mesh-related complications, infection, seroma, and pain. The aim of the present study is to assess feasibility, potential benefits, and safety of a prophylactic biosynthetic mesh placed during LI reversal. From January 2016 to December 2018, 26 consecutive patients underwent LI reversal positioning a resorbable biosynthetic mesh in an on-lay position [mesh group (MG)]. The mesh used was a GORE BIO-A tissue reinforcement, a biosynthetic mesh composed of a bioabsorbable polyglycolide-trimethylene carbonate copolymer. The MG was matched with 58 patients [control group (CG)], undergoing LI reversal without mesh placement from January 2013 to December 2018. To detect IH, abdominal wall was studied according to clinical and ultrasonographic criteria. Primary endpoint was IH rate on LI site, at 6 and 12months after stomal reversal. Secondary endpoints included incidence of wound events. Thirty-day morbidity was classified according to Clavien-Dindo score; mortality and length of hospital stay were also collected. Mean follow-up was 15.4 ± 2.3months (range 12.4-22.0) for MG vs 37.2 ± 26.9 (range 24.9-49.7) for. CG. At 1year of follow-up, IH rate was lower in MG (n = 1/26 [3.8%]) vs CG (n = 19/58 [32.7%]; P < 0.05). A clinically evident IH was less frequent in MG (n = 0 [0%]) vs CG (n = 13 [68%]; P < 0.05). A radiologic IH was less frequent in MG (n = 1 [3%]) vs CG (n = 6 [31%]; P < 0.05). Stoma site hernia was repaired in 9/19 patients (47%) in CG; no patient of MG has hernia repaired. Incarcerated IH was observed in one patient of CG. No postoperative mortality was reported. Overall postoperative morbidity showed no difference comparing MG and MG (n = 5 [17%] vs n = 15 [19%], respectively; P > 0.05). Surgical site infections (SSI) were treated with antibiotic therapy, no debridement was necessary. Seroma occurred in two patients, one for each group. No statistically significant difference for surgical outcomes was found between the two groups at 30days. Early results of the present study suggest that an on-lay prophylactic placement of GORE BIO-A tissue reinforcement might lower IH rate at LI site. The procedure seems to be safe and effective, even long-term results and further studies are needed.

Social impact of tracheostomy: Our experiences at a tertiary care teaching hospital of Eastern India

Background: Tracheostomy is a common surgical procedure performed in upper airway obstruction or in critically ill patients requiring prolonged ventilation. Although tracheostomy is a life-saving surgery, it is associated with higher rates of morbidity along with social stigma if stays for longer period. Although there are several studies for indications, complications, and different techniques for tracheostomy, but majority do not provide any insight into social impact of tracheostomy. Objective: The objective of this study is to assess the social impact of tracheostomy at a tertiary care teaching hospital. Materials and Methods: This is a retrospective observational study. The study was carried out from December 2017 to January 2020.There were 34 tracheostomy patients participated in this study. The observed complications in tracheostomy patients such as surgical/medical and social issues were documented. We conducted structured interviews with care givers of patients with tracheostomy. Results: Medical or surgical complications included excess mucus production (61.76'), infections at the stoma site (23.52'), blockage (17.64'), granulations around the stoma (11.76'), and maggots at the stoma (2.94'). The social impacts on tracheostomy patients included family reluctance to accept the patient with tracheostomy tube, unable to communicate and problems in social integration. Conclusion: Tracheostomy has several ranges of effects on quality of life of care givers and patients with tracheostomy. The management of social stigma associated with permanent tracheostomy is more challenging than any other complications due to tracheostomy procedure itself. It can be solved with proper counseling with family members those involved with patients.

The prevalence of fascial defects at prior stoma sites in patients with colorectal cancer

PURPOSE: Stoma reversal sites are a common location for incisional hernias. We aim to evaluate fascial defects at previous stoma sites in patients with a history of colorectal cancer. METHODS: This was a retrospective cohort study from a single center. We included adult patients diagnosed with colorectal cancer, who underwent stoma reversal from 2011 to 2018 with at least one postoperative computed tomography scan. RESULTS: Of 92 patients, 40 (43%) were female, with a mean age of 58 years. Fascial defects were noted in 45 (49%) patients, with stoma-site hernias present in 24 (26%) patients. Posterior sheath defects were not associated with subsequent hernia development, and most hernias occurred within 2 years. Body mass index >30 was associated with increased risk of stoma-site hernia (odds ratio 11.9, P = 0.002), but smoking, hypertension, stoma type, pathologic stage, and chemotherapy within 90 days were not found to be significant. CONCLUSIONS: The incidence of stoma-site hernias is high. Obesity appears to be a significant risk factor for the development of these hernias and most hernias occur quickly following surgery.

Reliability of the rectus abdominis muscle confirmation technique using a diagnostic ultrasound imaging system for stoma site marking by nursing students

Reliability of the rectus abdominis muscle confirmation technique using a diagnostic ultrasound imaging system for stoma site marking by nursing students

Indications and complications of colostomy in newborn: our experience

Background: The aim of the present study was to evaluate the indications, complications and outcome of colostomy in newborn patients.Methods: This is a descriptive, retrospective study carried out in the Department of Pediatric surgery, Gandhi Medical College Bhopal to evaluate acceptance and outcome of colostomy in newborn over a one year period from March 2018 to March 2019. All newborn with diagnosis of anorectal malformation, Hirshsprungs disease and other emergency conditions underwent transverse loop colostomy by expert and trained pediatric surgeon.Results: Out of 40 patients operated complications of colostomy was seen in 18 (45%) patients. Most common complication was skin excoriation in 08 patients (20%), bleeding from stoma site in 02 (05%) cases. Stoma prolapse occurred in 02 (05%) patients. Wound infection, dehiscence, stomal stenosis and parastomal hernia was seen in one patient each 2 (2.5%). 2 (0.5%) patient died due to multiple congenital anomalies.Conclusions: Colostomy in children is associated with significant morbidity in developing country. To minimize these problems, the pediatric surgeon should focus on the management and early closure of a colostomy.

Cloacal Malformation in Female Children: Outcome of Initial Management.

Objective:To document our experience of initial management of Cloacal malformation in female patients.Methods:A descriptive retrospective study was conducted in the Department of Pediatric Surgery of the National Institute of Child Health Karachi from January 2010 to September 2018. Female patients with diagnosis of Cloacal malformation were included in this study. Data regarding the age at presentation, mode of presentation, clinical features, presence of hydrocolpos, and associated anomalies were noted. Surgical procedures performed in these patients and the outcomes were also documented. Data was analyzed on SPSS Version 20.Results:Sixty females were included in the study. Age ranged from birth to three years with a median of four days. Patients admitted through emergency were 44 (73.33%) while 16 (26.66%) were admitted through outpatient clinic. Hydrocolpos was found in 15 (25.00%) patients. Five (8.33%) patients had massive abdominal distention and were presented with severe respiratory distress. Among them three had massive hydrocolpos, one patient had pneumoperitoneum secondary to Meckel’s perforation and one patient was having massive colonic dilatation. Hydronephrosis and hydroureter were found in 14 (23.33%) patients, while dilated bladder was found in three (5.00%) patients. After optimization of patients, bowel diversion was done as transverse colostomy in 39 (65.00%) patients, high sigmoid colostomy in 17(28.33%) patients while ileostomy was done in three (5.00%) patients. All patients with hydrocolpos had tube vaginostomy. None of the patients required bladder diversion and urinary tract dilatations were gradually subsided in nine patients in the post-operative period. Associated anomalies were found in 22(36.66%) of cases predominantly of sacral origin. Operative complications were found in 18(30.00%) patients, including stoma site in infection in 12(20.00%) patients, vaginal tube dislodgement in two patients, wrong placement of tube in one patient and vaginostomy stenosis in one case. While bowel stoma retraction occurred in four patients, prolapsed was found in three patients. Renal failure occurred in one patient. In total, 37(61.00%) patients had smooth recovery, 18(30.00%) patients had some complications, while Five (8.33%) patients were expired due to sepsis.Conclusions:Majority of cloacal malformations present in neonatal life. Initial management is an important step in dealing with these patients. Care must be taken during the abdominal exploration regarding drainage of hydrocolpos and appropriate placement of bowel stoma.

Analysis of Outcomes by Extraction Site following Subtotal Colectomy in Ulcerative Colitis: A Retrospective Cohort Study

BackgroundUlcerative colitis frequently requires surgery as a definitive management strategy. The colonic specimen can be extracted from various sites including a midline incision, the stoma site, or a Pfannenstiel incision. It is unclear if one extraction site offers improved outcomes and fewer complications. MethodsA retrospective review of charts obtained of colorectal surgery patients was conducted for all patients with ulcerative colitis who underwent a subtotal colectomy between 2008 and 2016 at a single tertiary care institution. Demographic data and outcomes data including parastomal and incisional hernias, advanced wound/ostomy certified nurse referrals, surgical site infections, reoperations, and readmissions were collected. Univariate and multivariate analyses were completed to detect any significant differences in outcomes between groups based on extraction site (midline incision, stoma site, or Pfannenstiel incision). ResultsUnivariate analysis did not show any statistical differences between groups in regard to outcomes. Stoma site extraction did not statistically differ from midline extraction in regard to hernias, advanced ostomy referrals, infections, or reoperations, but midline incision extraction did have a lower risk of readmission (OR = 0.56, p = 0.0066). Pfannenstiel extraction had lower risk of incisional hernias (OR = 0.25, p = 0.0002), advanced ostomy referrals (OR = 0.45, p = 0.0164) and readmission (OR = 0.26, p < 0.0001) as compared to stoma site extraction. ConclusionsWhile stoma site extraction can be successfully performed for most patients requiring subtotal colectomy for ulcerative colitis, Pfannenstiel extraction leads to the fewest number of complications and provides the most consistent results.

A simple, novel laparoscopic feeding jejunostomy technique to prevent bowel obstruction after esophagectomy: the “curtain method”

Feeding jejunostomy (FJ) is a common treatment to support patients with esophageal cancer after esophagectomy. However, severe FJ-related complications, such as bowel obstruction, occasionally occur. We investigated the ability of our simple, novel FJ technique, the "curtain method," to prevent bowel obstruction. In laparoscopic surgery, the main mechanism of bowel obstruction involves torsion of the mesentery accompanied by migration of the intestine across the fixed FJ through the space surrounded by a triangle comprising the ligament of Treitz, fixed FJ, and spleen rather than adhesion. Our "curtain method" involves closure of this triangle zone with omentum, and the appearance of the lifted omentum resembles a curtain. Sixty patients treated with this modified FJ were retrospectively compared with 13 patients treated with conventional FJ in terms of the incidence of bowel obstruction, peritonitis, stoma site infection, and catheter obstruction. From 2013 to 2017, 60 patients underwent esophagectomy and gastric conduit reconstruction accompanied by modified laparoscopic FJ. The median observation period, including the period after tube removal, was 644days. No FJ-associated bowel obstruction, the prevention of which was the primary aim, occurred in any patient. Likewise, no peritonitis or dislodgement occurred. Eight patients (13%) developed a stoma site infection with granulation. The feeding tube became occluded in 11 patients (18%); however, a new feeding tube was reinserted under fluoroscopy for all of these patients. From 2003 to 2012, 13 patients underwent conventional FJ. The median observation period was 387days. Three patients (23%) developed bowel obstruction by torsion 71 to 134days after the first surgery, and all were treated by emergency operations. Other FJ-related complications were not different from those in the modified FJ group. Our simple, novel technique, the "curtain method," for prevention of laparoscopic FJ-associated bowel obstruction after esophagectomy is a safe additional surgery.

Percutaneous endoscopic primary gastrostomy button (PEG-B) is safe and significantly reduces the need for general anaesthetic tube changes in children when compared to the percutaneous endoscopic gastrostomy tube (PEG-T): a prospective study

To compare the clinical outcomes and financial implications of the percutaneous endoscopic primary button gastrostomy (PEG-B) insertion using T-fastener technique with the percutaneous endoscopic gastrostomy tube insertion (PEG-T) using a push–pull technique. Data were prospectively gathered on 122 patients undergoing gastrostomy insertion over a 3-year period (2016–2019). Our primary outcome measure was the number of second general anaesthetics (GA) required in relation to the gastrostomy tube. Secondary outcome measures included complications and cost. Following exclusion criteria of lap assisted, concomitant procedure or insufficient data, 105 patients were analysed. Sixty-two (61%) PEG-B were inserted using a T-fastener technique. Forty-three (39%) PEG-T were inserted using a push–pull technique. Two (3.2%) patients with a PEG-B required a GA change or reinsertion of device compared with 31 (72%) of the PEG-T group who underwent a tube change under GA to either a button or a new tube in the study period (p < 0.01). The requirement for GA changes in the PEG-T group results in a considerably higher cost for this approach than the PEG-B approach. There was no difference between the number of peri-operative and post-operative complications between the two groups; however, the PEG-T group appeared to have higher rate of major operative complications (n = 3 bowel injuries). Whereas in the PEG-B group: complications were minor technical issues and displacement requiring replacement under fluoroscopy. In the follow-up period, rates of granulation tissue requiring intervention and stoma site infections were equivalent between groups. The PEG-B technique of placing a gastrostomy avoids the need for a replacement of gastrostomy tube under GA and its associated risk of repeat GA and financial cost. Furthermore, the technique is potentially associated with fewer major complications. We conclude, therefore, that the PEG-B approach reduces the interventional and financial burden on the patient, their family, and the healthcare provider, and could be considered as a safe alternative for paediatric gastrostomy insertion.

Short-term and Medium-term Outcomes of Low Midline and Low Transverse Incisions in Laparoscopic Rectal Cancer Surgery.

PurposeLimited data exist on the use of low midline and transverse incisions for specimen extraction or stoma sites in laparoscopic rectal cancer surgery (LRCS). We compared the short-term and medium-term outcomes of these incisions and assessed whether wound complications in specimen extraction sites (SES) are increased by specimen extraction through the stoma site (SESS) in LRCS.MethodsFrom March 2010 to December 2017, 189 patients who underwent LRCS and specimen extraction through low abdominal incisions were divided into 2 groups: midline (n = 102) and transverse (n = 87), and perioperative outcomes were compared.ResultsThe midline group showed a higher frequency of temporary stoma formation (P = 0.001) and splenic flexure mobilization (P < 0.001) than the transverse group. The overall incisional hernia and wound infection rates in the SES were 21.6% and 25.5%, respectively, in the midline group and 26.4% and 17.2%, respectively, in the transverse group (P = 0.494 and P = 0.232, respectively). In patients who underwent SESS, the incisional hernia and wound infection rates of SES after stoma closure were 39.1% and 43.5%, respectively, in the midline group, and 35.5% and 22.6%, respectively, in the transverse group (P = 0.840 and P = 0.035, respectively).ConclusionIn terms of incisional hernia and wound infection at the SES, a low midline incision may be used as a low transverse incision in patients without temporary stoma in LRCS. However, considering the high wound complication rates after stoma closure in patients with SESS in this study, SESS should be performed with caution in LRCS.

Cancer survivors' challenges with ostomy appliances and self-management: a qualitative analysis.

An ostomy poses significant health-related quality of life (HRQOL) issues for cancer survivors. Survivors must learn to manage pouching appliances and adjust to the psychosocial consequences of living with an ostomy. We explored, through qualitative analysis, the challenges with self-management and ostomy appliances reported by cancer survivors. Pooled data from two studies with a question on the greatest challenge of living with an ostomy and intervention session notes were analyzed using content analysis approach. The themes were reviewed and agreed upon by the research team, and counts were tallied for each theme based on the number of times they were mentioned by participants. Of the 928 greatest challenge responses and session notes, a total of 106 mentions (11%) were focused on ostomy appliances, associated repercussions, and time taken for ostomy care. Eight themes emerged: bleeding, pain, leakage, skin problems/irritation/rash, wafer-related issues, materials getting under the wafer, time to care for ostomy, and solutions to clean the stoma. Challenges described included poor wafer adherence, allergic reactions to adhesives, and pain around the stoma site. These challenges resulted in anxiety related to leakage, odor, and/or skin irritation, which negatively impacted on participation in social activities and self-confidence with ostomy care. Cancer survivors living with an ostomy experience multiple obstacles with ostomy appliances and caring for their ostomy. Continued innovation in ostomy appliance design and technology is needed to help cancer survivors with successfully managing ostomy care.

Outcome of Early versus Late Tracheostomy in Neurosurgical critical Patient

The Study was conducted to evaluate the effectiveness of early tracheostomy and of late tracheostomy in neurosurgical critical patients. A retrospective chart review of Neurosurgical critical patients who underwent Tracheostomy from September 2017 to March 2019. Patients were divided into two groups: early tracheostomy occurring within 7 days and late tracheostomy after 7 days of mechanical ventilation. Two groups were compared in terms of days under ventilation, Complication and outcome. There were 30 patients over 18 month period. Age range from 18years to 86 years with means of 52.93±16.59 years. Male: Female ratio was 3:1. 12 (40%) had Early tracheostomy (ET) and 18 (60%) had Late tracheostomy (LT). Day on ventilation on ET group was 14.8±10.25 while on LT group was 20±8.4.Procedure related complication were more common in Late tracheostomy group with 11.11% and 16.66% tracheostomy site hematoma and pneumonia respectively, and subcutaneous emphysema were 8.33% of LT versus a 5.55% of ET, Stomal site infection were 11.11% in late tracheostomy versus 8.33% in ET. Early tracheostomy compare to late tracheostomy reduces the days on Mechanical ventilation, the ICU length of stay, hospital stay and procedural related complication, but it does not affect the mortality rate.

Effect of preoperative stoma site marking on early and late outcomes of intestinal stoma creation

Purpose To evaluate how preoperative markings of the stoma site influence patients’ quality of life (QOL), whether they improve patients’ independence, and what is their effect on the rates of postoperative early and late complications. Patients and methods This is a nonrandomized prospective cohort study that included 60 patients who underwent elective intestinal stoma creation in Alexandria Main University Hospital. Patients were divided into two groups. Group A included 30 patients who experienced preoperative marking of their stoma site according to the educational guide developed by the American Society of Colon and Rectal Surgeons and the Wound, Ostomy and Continence Nurse Society, and group B included 30 patients who did not experience preoperative marking of their stoma site. A structured, validated questionnaire was used to assess patients’ QOL and the stoma QOL 1 month after surgery. The occurrence of complications was noted during regular outpatient follow-up encounters, with median follow-up of 1 year, and was evaluated by stoma and equipment-related complication scale. Results A total of 60 patients (48.3% females and 51.7% males) were included. Their mean age was 48.32±14.10 years. It was found that the QOL score of patients whose stoma site was marked (group A) was significantly better (45.03–65.01 vs. 33.58–56.19). Overall satisfaction was significantly better in group A (5.27±1.78 vs. 2.73±2.32). Conclusion The patients whose stoma sites were preoperatively marked had significantly better QOL and significantly fewer early postoperative complications, and these results are irrespective of the stoma type.