Effect of Follow-up Telephone by Enterostomal Nurses on Patients with Permanent Colostomy: A Systematic Review

Background: Patients with permanent colostomy experience quality of life (QoL) decrease, complications, and colostomy adjustment problems. Technology-based interventions can be provided with telephone follow-up (TFU) to provide health education and advice on managing symptoms, identifying complications, and providing quality care services. Objective: To systematically describe and assess the effect of TFU on permanent colostomy include population, model and duration, instruments used, and effect of TFU. Materials and Methods: A systematic review was carried out using the Randomized Controlled Trial (RCT) approach in eight databases, including PubMed, Proquest, ScienceDirect, EBSCOhost, CANCERLIT, Wiley, Gray literature, and Scopus, to identify studies reported in English, published in the last ten years, available full text, and about TFU in permanent colostomy patients. Results and Discussion: Based on the 11 RCT articles analyzed, it was found that the TFU duration ranged from 27 days to 3 years. The TFU improved self-efficacy, QoL, colostomy adjustment, self-care, self-management, service satisfaction, and complications. Conclusion: The TFU has more effect on self-efficacy, QoL, and complications in patients with a permanent colostomy, and effective TFU was performed for at least three months. Further research is needed on the frequency or duration of telephone calls. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 54-66

O01 PROPHYLACTIC MESH PLACEMENT DURING FORMATION OF AN END-COLOSTOMY LONG TERM RCT ON EFFECTIVENESS AND SAFETY

Aim To determine if prophylactic mesh placement is an effective, safe, and cost-effective procedure to prevent parastomal hernia (PSH) formation in the long term. Material and Methods In this multicenter superiority trial patients undergoing formation of a permanent colostomy were randomly assigned to either retromuscular mesh reinforcement or conventional colostomy formation. The primary endpoint was the incidence of a PSH after 5 years. Secondary endpoints were morbidity, mortality, quality of life and cost-effectiveness. Results A total of 150 patients were randomly assigned to the mesh group (n = 72) or non-mesh group (n = 78). For the long term follow up, we could analyse 113 patients since 37 patients were lost to follow-up. After a median follow-up of 60 months (IQR 48.6 – 64.4), 49 patients developed a PSH, 20 (27.8%) in the mesh group and 29 (37.2%) in the non-mesh group (p = 0.22; 95% CI -24 – 5.5). A total of 25 patients developed an incisional hernia, seven in the mesh group (10.4%) versus 18 in the non-mesh group (27.2%) (p = 0.013, 95% CI 3.5 – 30.0). No relevant differences were found in quality of life or cost-effectiveness between both study group. Conclusions Use of a prophylactic retromuscular mesh at the ostomy site delays but not reduces the incidence of PSH after 5 years of follow-up. It leads to less severe PSH according to the EHS and MM classification with fewer repairs needed. Furthermore it causes patients to have fewer stoma related complications necessitating change of appliances and it is safe without any adverse events or increase in morbidity.

Evaluation of Long-term Oncological Outcomes of Inter-Sphincter Resection Compared with Traditional Abdominoperineal Resection in Treatment of Low Rectal Cancers: A Cross Sectional Study

Objectives abdominoperineal resection (APR), is considered the gold standard surgical treatment for low rectal cancer. Patients with low rectal tumors, tumor’s distance less than 5 cm from the anal verge, are likely to require permanent colostomy after APR. Thus, anus-preserving alternative procedures have been tested to avoid the need for permanent colostomy. the aim of the present study is to compare the functional results, and oncological outcome of traditional APR method. Methods Patients' demographic information as well as tumor characteristics were evaluated through a patient's information form. All patients were followed after the operation every three months for two years, and then every six months for at least three years. Results The study was performed on 60 patients with rectal cancer. In the group that performed APR, 9 (30%) patients developed with disease recurrence. In the ISR group, 10 (33.3%) had relapses. Based on this result, the two groups were nearly similar in the recurrence rate of disease and the difference between these two groups was not statistically significant (P value = 0.8). Conclusion In summary, the results of the present study concluded that there is no significant difference in efficacy of ISR method compared with the conventional APR in treatment of ultra-low rectal cancer. We surveyed that the ISR method is associated with beneficial long-term survival. Considering the post-operation complication associated with APR surgery including permanent colostomy, and disappointing functional outcomes, we encourage physicians to expand the use of anus-preserving procedures in treatment of low-grade distal rectal cancer.

Comparison between the Extraperitoneal Route with the Transperitoneal Route for the Permanent Colostomy: A Meta-Analysis with Rcts and Systematic Review

AimTo assess the efficacy of extraperitoneal colostomy(EPC) in the prevention of stoma-related complications.BackgroundTransperitoneal colostomy (TPC) is still a widely used surgical approach. However, TPC has been reported with highly incidence of stoma-related complications, like parastomal hernia, stomal retraction, stomal prolapse.The purpose of EPC is to prevent these complications. But it is still lack of evidence-based basis.Material and methodsMEDLINE, EMBASE, Web of Science, Scopus, MOOSE, Pubmed, Google Scholar, Baidu Scholar, and the Cochrane Library were searched to conduct a systematic review and meta-analysis with RCTs. Revman 5.4 was performed in the meta-analysis.ResultsA total of 5 RCTs were eligible in this study. Compared with TPC, EPC group had lower incidence in Parastomal Hernia (RR, 0.14; 95% CI, 0.04–0.52, P=0.003, I2=0%), Stomal Prolapse (RR, 0.27; 95% CI, 0.08–0.95, P=0.04, I2=0%) and a higher rate of defaecation Sensation (RR, 3.51; 95% CI, 2.47–5.0, P＜0.00001, I2=37%). No statistical difference was observed in Stoma Retraction, Colostomy Construction Time, Stoma Ischemia, and Necrosis.ConclusionAn extraperitoneal colostomy is associated with a lower rate of postoperative complication compared to transperitoneal colostomy. Randomized controlled trial meta-analysis showed better results in permanent colostomy after abdominoperineal resection.

“Living with a Stoma”: Exploring the Lived Experience of Patients with Permanent Colostomy

Introduction: Living with a permanent colostomy brings severe changes in patients’ lives. The general health status as well as the personal, social and professional life of patients are significantly affected. Aim: The aim of the present study was to investigate the lived experience of patients undergoing permanent colostomy. Material and Methods: A qualitative research design based on interpretive phenomenology was carried out. Semi-structured interviews were conducted as the data collection method to obtain in-depth information regarding the research topic. The study sample consisted of eight (8) patients who had undergone a permanent colostomy. The data analysis was performed by the method of content analysis. Results: From the analysis of the data, three main themes emerged, namely: (A) Experiencing a traumatic event; (B) Living a new reality; (C) Efforts to improve quality of life. Five subthemes were formulated which were encompassed within the respective main themes accordingly. Conclusion: Patients with permanent colostomy face significant life changes that are experienced in a traumatic way. Issues such as autonomy, family and organizational support, self-management and empowerment can significantly improve the patients’ quality of life. Further research, regarding caregivers’ experience, improved community nursing care as well as nurses’ views on the needs of colostomy patients and their families, is suggested.

SUBJECTIVITIES AND CHALLENGES OF PEOPLE LIVING WITH AN INTESTINAL OSTOMY

Objective: Identify experiences of the person with intestinal ostomy related to their social life. Methods: Descriptive study, qualitative in nature, carried out with ten people with intestinal ostomy. Data collection was performed at the Stomatherapy Service of a teaching hospital in the Federal District, through semi-structured interviews relating to family and social experience before and after the ostomy. Results: Six men and four women participated, with a mean age of 49 years, most with a permanent colostomy. From the analysis, two categories emerged: “What is it like to live with an ostomy and its challenges”; and “Strategies developed in the face of changes”. In the first category, the following stand out: self-care, lack of adequate bathroom, work activity, eating habits, disruption of body image and embarrassing situations. In the second category, they seek to support religiosity, maintain positive feelings and preserve emotional balance. Conclusion: The ostomy interferes with family and social life. It was evident that the person with ostomy develops strategies to face changes. It is believed that social isolation stems, in part, from the lack of information from society, the lack of quality material that offers comfort and safety, and, finally, the lack of adapted public and private bathrooms.

Research on Anal Squamous Cell Carcinoma: Systemic Therapy Strategies for Anal Cancer

Anal squamous cell carcinoma (ASCC) is a rare malignancy, with most cases associated with human papilloma virus and an increased incidence in immunocompromised patients. Progress in management of ASCC has been limited not only due to its rarity, but also the associated lack of research funding and social stigma. Historically, standard of care for invasive ASCC has been highly morbid surgical resection, requiring a permanent colostomy. Surgery was associated with disease recurrence in approximately half of the patients. However, the use of chemotherapy (5-fluorouracil and mitomycin C) concomitantly with radiation in the 1970s resulted in disease regression, curing a subset of patients and sparing them from morbid surgery. Validation of the use of systemic therapy in prospective trials was not achieved until approximately 20 years later. In this review, advancements and shortcomings in the use of systemic therapy in the management of ASCC will be discussed. Not only will standard-of-care systemic therapies for locoregional and metastatic disease be reviewed, but the evolving role of novel treatment strategies such as immune checkpoint inhibitors, HPV-based vaccines, and molecularly targeted therapies will also be covered. While advances in ASCC treatment have remained largely incremental, with increased biological insight, an increasing number of promising systemic treatment modalities are being explored.

Two case reports of malignant melanoma rectum

Malignant melanoma of the rectum is an extremely rare disease. It typically presents in the fifth or sixth decade predominantly in female sex. The first symptoms are nonspecific such as bleeding, anal mass or pain. A timely diagnosis of melanoma is made even more difficult due to lack of obvious pigmentation and histologically amelanotic. Anorectal malignant melanoma spread along submucosal planes and are often beyond complete resection at the time of diagnosis. Prognosis is very poor. We present a rare case of malignant melanoma of rectum in a 21-year-old male, who was diagnosed at advanced stage, and a case of malignant melanoma in a 50-year-old male, who underwent abdominoperineal resection with permanent colostomy. Anorectal malignant melanoma is difficult to diagnose and prognosis is poor.

Review of Intersphincteric Resections for Rectal Cancer Treatment

Colorectal cancer is the third most common cancer, second most common cancer in women, and the fourth leading cause of death in the world. Radical surgical treatment with Total Mesorectal Excision (TME) is considered the best treatment for cancer found in the lower third of the rectum and has benefits of complete tumor removal to reduce risk of recurrence and to improve survival. Advances in preoperative chemoradiation therapy have increased chances of achieving a 1 cm distal margin and allowed successful sphincter-preserving surgery by intersphincteric resection (ISR) and Coloanal Anastomosis (CAA) that allows normal defecation. MRI is particularly useful in evaluating localization of the tumor, involvement of anal sphincter (internal and external sphincters), levator ani muscles, and adjacent structures to the anus, with an accuracy of 85%, sensitivity of 87%, and specificity of 75%. Performing ISR with TME oncologic principles achieves similar results to Low Anterior Resection (LAR), but depends on the presence of sufficient Distal Rectal Margin (DRM); if a sufficient DRM cannot be achieved, then patients are offered an Abdominoperineal Resection (APR) with permanent colostomy and poor quality-of-life results.