Ostomy creation is a common surgical procedure performed by a variety of surgical specialties. Complications associated with stomas are frequent and run the gamut from technical, mechanical, physiologic, and psychologic. The impact of these complications ranges from simple inconvenience to life threatening. The majority of these complications may not occur for years following creation of the stoma. In this article, the author reviews many of the late complications associated with stomas and options regarding their management.KEYWORDS: Ostomy, colostomy, ileostomy, urostomy, complication, stricture, prolapse, parastomal herniaObjectives: On completion of this article, the reader should be able to recognize many of the late complications of creation of a variety of ostomies. The reader should also be able to begin the appropriate diagnostic work-up and corrective interventions.Ostomy creation is a frequently performed surgical procedure. The number of patients living with stomas in the United States is unknown, but estimates range up to 450,000 people, with 120,000 new stomas created each year. Other estimates predict the number of ostomates to increase by 3% per year. 1 Average age for all stomates is 68.3 years. And the distribution of procedures is 36.1% colostomy, 32.2% ileostomy, and 31.7% urostomy. 1 Indications vary from emergency procedures performed for trauma, intestinal perforation, or operative misadventure to elective permanent stoma creation as part of radical cancer surgery. Although ostomy creation is frequently meant to be temporary, up to 40 to 60% will never be reversed. Many stomas are created to improve quality of life; however, complications related to the stoma often have a significant reduction in quality of life and lead to social isolation.In this article, we focus on complications related to stomal creation that develop late after creation of the stoma and after the initial period of patient adjustment. Several factors effect the type and frequency of complications including surgical specialty and experience, emergency versus elective creation, preoperative marking by a dedicated enterostomal nurse, 2 and patient issues such as patient age, obesity, diabetes, and ability to care for the stoma. 3 Late complications are defined as occurring after the period of physiologic adjustment. For most patients this is 6 to 10 weeks. One large series identified 93% of late complications occurred within the first 6 months. 4 Other series identified new complications diagnosed up to 15 years after stomal creation. Rates of overall late complications vary from a low of 6% 2 to highs exceeding 76% in selected series. 5
The creation of intestinal stomas for diversion of enteric contents is an important component of the surgical management of several disease processes. However, complications of stoma creation are seen frequently, despite extensive measures aimed at reducing them. Early complications (those seen less than one month postoperatively) are frequently technical in nature. These include, but are not limited to, peristomal skin irritation, improper stoma site selection, acute peristomal herniation and bowel obstruction, and vascular compromise, along with several others. These authors review the early complications associated with stoma creation, discuss means of preventing them, and outline the management strategy for such complications when they do occur.Objectives: On completion of this article, the reader should be familiar with the diagnosis, management, and prevention of early complications arising from intestinal stoma creation.
Negative pressure therapy was associated with decreased surgical site infection. Negative pressure therapy offers significant potential for quality improvement.
Background-The transversus abdominis plane (TAP) block is an important non-narcotic adjunct for post-operative pain control in abdominal surgery. Surgeons can use laparoscopic guidance for TAP block placement (LTAP), however, direct comparisons to conventional ultrasound guided TAP (UTAPs) have been lacking. The aim of this study is to determine if surgeon placed LTAPs were non-inferior to anesthesia placed UTAPs for post-operative pain control in laparoscopic colorectal surgery. Methods-This was a prospective, randomized, patient and observer blinded parallel-arm noninferiority trial conducted at a single tertiary academic center between 2016-2018 on adult patients undergoing laparoscopic colorectal surgery. Narcotic consumption and pain scores were compared for LTAP vs. UTAP for 48 hours post-operatively. The trial was registered at clinicaltrials.gov Identifier NCT03577912. Results-60 patients completed the trial (31 UTAP, 29 LTAP) of which 25 patients were female (15 UTAP, 10 LTAP) and the mean ages (SD) were 60.0 (13.6) and 61.5 (14.3) in the UTAP and LTAP groups, respectively. There was no significant difference in post-operative narcotic consumption between UTAP and LTAP at the time of PACU discharge (median [IQR] milligrams of morphine, 1.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.