Stoma Bridge Types and Their Impact on Patient Outcomes

Abstract

PURPOSE: The purpose of this study was to describe the effect of rigid or flexible stoma bridges used for loop ostomy diversions on peristomal skin integrity. Additional aims were to describe surgeon practices related to stoma bridges, and determine the availability of an ostomy nurse specialist. DESIGN: Retrospective chart review and cross-sectional survey. SAMPLE AND SETTING: The sample used to address the first aim (effect of stoma bridges) comprised 93 adult patients cared for at Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, an acute care facility. Data provided by 355 colorectal surgeons from 30 countries were used to describe surgeon practice in this area and determine the availability of an ostomy nurse specialist. Respondents were invited from an international roster of colorectal surgeons obtained with permission from the American Society of Colon and Rectal Surgeons (ASCRS). METHODS: In order to accomplish the initial aim, we retrospectively reviewed medical records of patients who underwent ostomy surgery from 2008 to 2015 and met inclusion criteria. In order to meet our additional aims, analyzed data were obtained from a survey of colorectal surgeons that queried practices related to stoma bridges, and availability of an ostomy nurse specialist. RESULTS: Patients managed with a rigid bridge were significantly more likely to experience leakage beneath the pouching system faceplate than were patients managed by a flexible bridge (42% vs 11%, P < .001). Slightly less than one quarter of patients who developed leakage (n = 22, 24%) experienced pressure and moisture-related peristomal skin complications. Peristomal wounds, inflammation, and infection were significantly higher when a rigid bridge was used (χ2 test, P < .003). The surgeon's survey (N = 355) showed variability in the use of bridges. Ninety-three percent of all surgeons indicated an ostomy nurse specialist was part of their health care team. CONCLUSIONS: Rigid ostomy bridges were associated with a higher likelihood of leakage from underneath the faceplate of the pouching system and impaired peristomal skin integrity. Analysis of colorectal surgeon responses to a survey indicated no clear consensus related to bridge use in patients undergoing loop ostomies.

Patient-Related Factors Associated With Stoma and Peristomal Complications Following Fecal Ostomy Surgery

“…Research indicates that up to 93% of all ostomy surgical services incorporate a WOC or ostomy nurse specialist as part of their health care team. 87 Follow-up of the patient by a WOC nurse and a physician should include both the immediate postoperative period and over time because ostomy complications that may need surgical intervention develop in the late postoperative period, mostly within the first 6 months after stoma creation. Further research is needed to improve the evidence-based surgical decision-making regarding the type of stoma and its placement as well as prevention and management of stoma and peristomal complications.…”

“…We found a single protective factor: stoma site marking and care by a WOC or ostomy nurse specialist. Research indicates that up to 93% of all ostomy surgical services incorporate a WOC or ostomy nurse specialist as part of their health care team 87. Follow-up of the patient by a WOC nurse and a physician should include both the immediate postoperative period and over time because ostomy complications that may need surgical intervention develop in the late postoperative period, mostly within the first 6 months after stoma creation.…”

The Patient With Fecal and Urinary Diversion

“…Rationale: The correct answer is D. Support bridges may be placed under and around the stoma during surgery to temporarily support the loop of the bowel on the abdominal wall, preventing stomal retraction, and are often made of soft silicone or firm, rigid plastic 1,2. Removal of support bridges typically occurs between 1 day to a month and results from a joint decision between the surgeon and the COCN®; it should not be left for long periods as it may cause intestinal necrosis, increased pain, peristomal skin complications, and difficulty obtaining pouching system seal 1…”