Local treatment of colostomy prolapse with the MESH STRIP technique: A novel and highly efficient day hospital technique

Sobrado, Carlos Walter; Guzela, Vivian Regina; Sobrado, Lucas Faraco; Nahas, Sérgio Carlos; Cecconello, Ivan

doi:10.6061/clinics/2020/e1353

Cited by 10 publications

(8 citation statements)

References 6 publications

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“…In some countries, the cost of staples is not covered by health insurance [ 7 - 8 , 12 , 14 , 17 - 18 ]. In general, local repair was associated with no or very low rates of postoperative complications in all studies [ 5 , 7 - 14 , 17 , 20 , 22 , 24 ], suggesting that surgery can be performed in a minimally invasive manner. The choice of surgical procedure may be considered based on the relevant symptoms and pathophysiology of SP, such as redundant intestine, mobile intestine, or the space between the abdominal wall and the intestine.…”

Section: Discussionmentioning

confidence: 92%

“…The mobile intestine can be fixed using button-pexy [ 21 ], endoscopic-assisted procedures [ 22 ], or laparoscopic enteropexy [ 23 ]. The space between the abdominal wall and intestine can be narrowed by local treatment using a mesh strip technique [ 24 ] or Thiersch’s technique [ 10 ]. The advantage of local repair appears to be its simplicity and applicability as a first-line treatment, without the need for laparotomy for laparoscopy under general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

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Mid-term Efficacy of Local Repair Using Modified Altemeier Technique for Stomal Prolapse: A Case Series

Tsujinaka¹,

Kakizawa²,

Hatsuzawa³

et al. 2022

Cureus

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Introduction: Stomal prolapse (SP) is characterized by full-thickness protrusion of the bowel through the stoma site. The surgical procedures for SP include local repair, abdominal wall fixation, and stoma relocation. However, previous reports were mostly case reports or case series with a small number of patients and lacked long-term results. A modified Altemeier technique (MAT) has been used for the local repair of SP in our institution, and this study aimed to evaluate its mid-term efficacy. Methods: We reviewed patients who underwent MAT for SP between August 2013 and December 2020. The variables included patient characteristics, type of stoma, indications of stoma creation, the time interval from stoma creation to prolapse, site of prolapse, reasons for SP surgery, perioperative variables, complications during SP surgery, and length of follow-up. Recurrence of SP was defined as the need for change in stoma care or re-protrusion of the stoma by more than 5 cm in length. Results: Ten patients were included in this study. The median age at the time of SP surgery was 71.5 years. The indications of stoma creation included unresectable or recurrent intra-abdominal malignancies in four patients, diverting ileostomy with rectal cancer surgery in two, transverse colon cancer in one, gastric and rectal cancer in one, rectovaginal fistula in one, and non-occlusive mesenteric ischemia in one. The median interval from stoma creation to prolapse was 2.5 months. Six patients underwent elective SP surgery, and four patients underwent emergency surgery for incarcerated prolapse. The median operative time was 75.5 min. Postoperative complications that included transient mucosal ischemia and subcutaneous abscess occurred in one patient. There were four recurrences (40%), and the median time interval from surgery to recurrence was 4.5 months. Two patients underwent repeated MAT, one of whom underwent stomal reversal with laparotomy for re-recurrence. The median follow-up duration was 19 months. Conclusion: MAT for SP is associated with a high recurrence rate in mid-term follow-up.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Mid-term Efficacy of Local Repair Using Modified Altemeier Technique for Stomal Prolapse: A Case Series

Tsujinaka¹,

Kakizawa²,

Hatsuzawa³

et al. 2022

Cureus

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“…This procedure, a new day surgery reported in 2020, narrows the stoma outlet by putting polypropylene mesh around the stoma at the abdominal wall level under local anesthesia. Sobrado et al [ 62 ] reported no recurrence in 10 cases undergoing this procedure during a median follow-up period of 25 months ( Table 1 ). Exclusion criteria for this procedure include an American Society of Anesthesiologists physical status grade of II or more, defects in the main abdominal wall impacting this procedure, infections around the stoma, and stoma prolapse over 20 cm.…”

Section: Present State Of Surgical Treatmentsmentioning

confidence: 99%

“…As methods to repair the stoma outlet, fixing the stoma to the abdominal wall, fascia fixation [ 6 ] and conventional methods [ 26 ] have also been reported. Moreover, to narrow the stoma outlet, the mesh strip technique [ 62 ] and the purse-string suture technique [ 63 , 64 ] have been reported. The choice between these 2 methods to narrow the stoma outlet depends on the operation site (the stoma orifice or skin level).…”

Section: Classification Of Surgical Treatments According To Pathophys...mentioning

confidence: 99%

Prolapse of intestinal stoma

Maeda¹

2022

Ann Coloproctol

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Stoma prolapse can usually be managed conservatively by stoma care nurses. However, surgical management is considered when complications make traditional care difficult and/or stoma prolapse affects normal bowel function and induces incarceration. If the stoma functions as a fecal diversion, the prolapse is resolved by stoma reversal. Loop stoma prolapse reportedly occurs when increased intraabdominal pressure induces stoma prolapse by pushing the stoma up between the abdominal wall and the intestine, particularly in cases of redundant or mobile colon. Therefore, stoma prolapse repair aims to prevent or eliminate the space between the abdominal wall and the intestine, as well as the redundant or mobile intestine. Accordingly, surgical repair methods for stoma prolapse are classified into 3 types: methods to fix the intestine, methods to shorten the intestine, and methods to eliminate the space between the stoma and the abdominal wall around the stoma orifice. Additionally, the following surgical techniques at the time of stoma creation are reported to be effective in preventing stoma prolapse: an avoidance of excessive fascia incision, fixation of the stoma to the abdominal wall, an appropriate selection of the intestinal site for the stoma orifice to minimize the redundant intestine, and the use of an extraperitoneal route for stoma creation.

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“…Realiza-se, em resposta, a redução manual e postural do prolapso com o uso de lubrificantes ou produtos que diminuem o edema. 9 Aponta-se, quando o paciente tiver muita dificuldade para manter o equipamento coletor aderido, afetando a sua vida cotidiana, que a indicação da cirurgia para a correção deve ser avaliada pela equipe cirúrgica. 5 Pontua-se que a ocorrência de complicações gera impactos negativos na vida dos pacientes com estomias, principalmente, no que se refere ao autocuidado e ao bem-estar.…”

Section: Introductionunclassified

Cuidados De Enfermagem Na Redução Manual De Prolapso De Estomia

Paczek

Brum

Brito

et al. 2021

Rev enferm UFPE on line.

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Objetivo: relatar um caso sobre a redução manual do prolapso em um estoma intestinal. Método: trata-se de um estudo qualitativo, descritivo, tipo relato de caso clínico, sobre a redução manual do prolapso em um estoma intestinal de um paciente. Relata-se que o cenário foi um centro de referência no atendimento ao estomizado. Avaliaram a efetividade das intervenções de Enfermagem com base na comparação dos resultados iniciais e finais do procedimento. Resultados: nota-se a presença de lesões e permeabilidade na presença de prolapso, realizando a manobra de redução digital, até a sua total regressão, facilitando a limpeza da pele e a colocação do equipamento coletor, observando as possíveis lesões periestomais e na mucosa. Conclusão: informa-se que os pacientes com prolapso em estoma intestinal têm um desconforto devido ao volume dentro do equipamento coletor e ao pouco espaço para conter as suas eliminações. Utiliza-se a técnica de redução manual para facilitar a troca do equipamento coletor, esta deverá ser realizada por enfermeiro estomaterapeuta ou capacitado. Salienta-se que os casos em que se afeta o desenvolvimento de atividades cotidianas merecem uma avaliação da equipe cirúrgica.

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Local treatment of colostomy prolapse with the MESH STRIP technique: A novel and highly efficient day hospital technique

Cited by 10 publications

References 6 publications

Mid-term Efficacy of Local Repair Using Modified Altemeier Technique for Stomal Prolapse: A Case Series

Mid-term Efficacy of Local Repair Using Modified Altemeier Technique for Stomal Prolapse: A Case Series

Prolapse of intestinal stoma

Cuidados De Enfermagem Na Redução Manual De Prolapso De Estomia

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