Stoma‐related complications: a report from the Stoma‐Const randomized controlled trial

Abstract

Aim The impact of construction techniques on the development of stoma complications is partly undiscovered. The aim of this paper was to report and analyse the impact of the three surgical techniques in a randomized controlled trial Stoma‐Const on stoma‐related complications as well as identifying risk factors and patient‐reported stoma function as a planned secondary analysis. Methods This was a randomized, multicenter trial where all patients scheduled to receive an end colostomy were invited to participate. Patients were randomized to one of three techniques for stoma construction; cruciate fascial incision, circular incision or prophylactic mesh. Stoma complications were assessed by a surgeon and stoma care nurses within 1 year postoperatively. Results Two hundred and nine patients were randomized. Patient demographics were similar in all three groups. Data on stoma‐related complications were available for analysis in 201 patients. A total of 127 patients (63%) developed some type of stoma complication within 1 year after surgery. The risk ratio (95% CI) for stoma complications was 0.93 (0.73; 1.2) between cruciate vs. circular incision groups and 1.02 (0.78; 1.34) between cruciate vs. mesh groups. There were no statistically significant differences between the groups regarding parastomal hernia rate and no risk factors could be identified. Conclusion This randomized trial confirmed a high prevalence of stoma‐related complications but could not identify an impact of surgical technique or identify modifiable risk factors for stoma‐related complications.

Surgical techniques and stoma-related complications associated with emergency stoma creation

“…Although most of the complications are not severe and can be managed with conservative treatments, these not only decrease the QOL of patients but also increase medical costs [4]. Risk factors for stoma-related complications include high body mass index (BMI), diabetes mellitus, cancer, low stoma height, and emergency surgery [2,5]. To improve the QOL of patients undergoing ostomy, physicians need to be aware of these risk factors to reduce stoma-related complications.…”

Predicting life with a permanent end colostomy: A prospective study on function, bother and acceptance

“…[2][3][4] Stoma-related complications, such as parastomal herniation, prolapse, stenosis and skin irritation, are common and overall complication rates vary between 20% and 70%. [5][6][7] Studies on how a stoma affects quality of life (QoL) have reported diverse and contradictory results. [8][9][10][11][12] A poorly functioning stoma may have a negative impact on QoL, but acceptance of a stoma may also be influenced by personal, cultural and geographical factors independent of bodily limitations.…”

“…Furthermore, approximately 20%-25% of patients operated with an anterior resection with a primary anastomosis end up with a permanent stoma, with anastomotic leakage or unsatisfactory anorectal function considered as two major reasons [2][3][4]. Stoma-related complications, such as parastomal herniation, prolapse, stenosis and skin irritation, are common and overall complication rates vary between 20% and 70% [5][6][7].…”

History of Issue, Epidemiological and Surgical Aspects of Acute Large Bowel Obstruction of Tumoral Genesis

“…al. [32] studied the relationship between the technique of forming intestinal stoma and the incidence of complications. The demographics of patients in all three groups are the same.…”