A randomised clinical study on the postoperative use of two commercially available ostomy seals (STEPS study)

Background: Ostomy seals are an accessory product used to enhance the fit of an ostomy skin barrier. Research into the clinical and health economic impact of ostomy seals is limited. Aims: To evaluate the clinical and economic impact of two commercially available ostomy seals when used on patients with a newly created stoma, 1–2 days postoperatively. Methods: A non-powered, exploratory, multi-centre, two-country, open-label, parallel-randomised clinical study was conducted. Patients were randomised to the Dansac TRE Seal (Dansac A/S, Fredensborg, Denmark) or the Coloplast Brava Protective Seal (Coloplast A/S, Humlebæk, Denmark) and were followed up to 9 weeks after the stoma was created. Clinical outcomes were primarily assessed via the validated Pittman Ostomy Complication Severity Index (OCSI). Economic outcomes were assessed via the collection of stoma-related healthcare resource use. Satisfaction measures with seal performance were also collected. Findings: In total, 42 participants were enrolled (20 TRE and 22 Brava). Lower peristomal skin complication (PSC) incidence (TRE 50.0% vs Brava 72.7%; p=.16), greater PSC resolution (TRE 70.0% vs Brava 43.8%; p=.22) and slightly less severe peristomal and stomal complications (average OCSI score TRE 2.2 vs Brava 3.4; p=.19) were observed in the TRE group. On average, participants in the TRE group used 1.3 seals per day compared with 1.4 seals per day for those in the Brava group (p=.83). Lastly, 100% of clinicians and 100% of patients reported positive satisfaction with the overall performance of TRE and Brava seals. Conclusions: Participants randomised to TRE seal were observed to have lower PSC incidence, greater PSC resolution and slightly less severe peristomal and stomal complications relative to participants using the Brava seal. No substantive differences were found in stoma-related healthcare resource use. Positive satisfaction was noted for both ostomy seals. Study results provided valuable insights into the postoperative use of ostomy seals for individuals with newly created ostomies.

Complications in colostomy patients: analysis and assessment of risk factors

Background The increasing prevalence of people living with a colostomy (and a stoma in general) has made understanding, assessing and managing stomal complications an increasingly important objective. Aims The aim of this study was to analyse the onset of stomal complications in relation to comorbidities to evaluate any predisposing pathologies. Methods This retrospective analysis was conducted on the patient records of colostomates admitted to a hospital in Milan, Italy, from 2015 to 2018. Findings The analysis showed that 54% of patients presented with more than one complication. The most common were peristomal skin lesions (42%) and oedema (25%). The disease that showed the highest correlation with stomal complications was heart disease (23%). Conclusions Despite a limited sample size of 101 patients, this study demonstrated a correlation between stomal complications and heart disease. Nurses should pay particular attention to ostomates with cardiovascular issues.

Colorectal Surgery in Cirrhotic Patients

Patients with cirrhosis have a greater risk of morbidity and mortality following colorectal surgery. Therefore, preoperative medical optimization and risk assessment using criteria such as the MELD score are vital in preventing complications. Some risk factors include age, urgency of surgery, and ASA score. Postoperative morbidity and mortality are related to portal hypertension, ascites, infection, and anastomotic and stomal complications. This review highlights the assessment of risk and perioperative management of cirrhotic patients undergoing colorectal surgery.

Prevention of paracolostomal complications following abdominoperineal extirpation of the rectum

Aim. To find an optimal way of end colostoma formation in patients with colorectal cancer following abdominoperineal extirpation of the rectum. Methods. Results of surgical treatment (rectum extirpation ended with sigmoidostomy) of 142 patients with malignant tumors of lower part of rectal ampulla treated from 2005 to 2012 are presented. Data of 101 patients (comparison group) were retrospectively analyzed, in whom the same approach of choosing the colostomy technique was applied. The main group consisted of 41 patients in whom the efficacy of authors-introduced technique of colostomy with alloplasty for colostomal wound consolidation from the abdominal cavity side was prospectively defined. Results. The prevalence of early post-operative stomal complications was 18,8% (in 19 out of 109 patients) in comparison group. Ileum volvulus around the stoma causing bowel obstruction was diagnosed in 2 cases, necrosis of stoma wall - in 2 patients, evisceration around stoma site - in 3 patients, perforation of sigmoid stoma - in 1 patient, stoma retraction - in 1 patient, bleeding at stoma site - in 3 patients, paracolostomal mass - in 1 patient. 14 patients from comparison group developed late post-operative stomal complications, including parastomal hernia - 8 patients, stoma prolapse - 3 patients, colostomal fistula - 1 patient, stomal stenosis - 2 patients. Treatment results in the patients from the main group were satisfactory. Early complications included 1 case of bleeding from stoma site, 1 case of partial necrosis of stoma wall. No late complications were registered. The gained data allows to provide successful rehabilitation to patients who underwent colorectal cancer surgery. The described technique is contraindicated in case of infected peritoneal effusion. Conclusion. The use of the method proposed by authors not only significantly improves colostomy results, but significantly decreases the rate of both early and late post-operative complications of stomas compared to standard methods.

Late stomal complications and their surgical correction

Aim. To conduct a detailed analysis of the causes of development of late stomal complications, to determine the indications for surgical correction, to evaluate the effectiveness of new methods of surgical treatment. Methods. Conducted was an analysis of the causes of late stomal complications in 141 patients with a stoma of the colon. Results. A parastomal hernia was diagnosed in 44 (31.2%), prolapse - in 29 (20.6%), stricture - in 9 (6.4%) patients. Introduced into practice were new methods of surgical correction of complicated stomas. Parastomal hernia was detected in 44 (31.2%) patients - 26 (59.1%) females and 18 (40.9%) males, all patients with this complication were older than 50 years, the age group 71-80 years included 43.5% of patients. Since 2005 performed were 17 reconstructive operations for parastomal hernias (Russian Federation patent №2406454 and №2395238). Stoma prolapse was observed in 29 (20.6%) patients, 10 cases - in patients aged 71 to 80 years. Most often this complication developed in patients with double-barreled transverse stomas - in 10 (76.9%) of 13 patients. 4 patients underwent surgery due to prolapse. Stoma stricture was diagnosed in 9 (6.4%) patients. In 7 patients with a stoma stricture in the early postoperative period registered was festering of the parastomal wound (4 cases), marginal necrosis of the stoma (2 cases), and stoma retraction (1 case). Correction with the use of stents for the prevention of recurrence (Russian Federation patent №2357681) was conducted in all cases. The so-called «lock-stoma» was diagnosed in 16.3% of cases (23 patients). Although this condition does not belong to stomal complications in its pure form, however in most cases it causes the inability to use the incontinence bag, reducing the quality of life. Conclusion. Despite the inevitability of the development of parastomal complications, provided proper surgical techniques can either prevent or delay their appearance; reconstructive operations for complicated stomas, conducted by moving the stoma to a new place with retroperitoneal conduction makes it possible to obtain satisfactory results, significantly improve the quality of life that promotes full social adaptation of stomal patients.

Ileal Conduit and Continent Ileocecal Pouch for Patients Undergoing Pelvic Exenteration: Comparison of Complications and Quality of Life

Objectives:Creating a continent urinary pouch has become an alternative to the ileal conduit for patients undergoing exenteration for advanced gynecologic malignancies. The objective of this study was to compare clinical outcomes for the 2 methods.Methods:In this retrospective study, we compared intraoperative and postoperative complications and quality-of-life scores for the modified ileocecal pouch and the ileal conduit in anterior or total pelvic exenteration.Results:In 33 of 100 patients, an ileal pouch (IP) was created; the other 67 were treated by an ileal conduit (IC). Creating an IP prolonged the exenterative procedure by 97 minutes compared to an IC (IC, 453 minutes vs IP, 550 minutes;P= 0.009). Overall complication rates were similar, but patients with an IP had significantly more complications of urinary diversion (48%) than patients with an IC (31%;P= 0.03). Follow-up showed urinary loss and frequency of micturition to be comparable, but in patients with an IP, surgery for stomal complications (n = 2) and treatment of bladderstones were necessary more frequently (n = 3). Quality of life according to the 12-item Short Form Health Survey questionnaire was similar in both groups.Conclusion:A continent IP is an alternative to the IC in cases of pelvic exenteration. Early complications are more frequent with an IP than with an IC. The mode of urinary diversion has little influence on the quality of life in patients with advanced genital cancer.