Early vs. Standard Loop Ileostomy Closure: An Unmatched Case-Control Study / Cierre Temprano vs Estándar de Ileostomía en Asa. Estudio de Casos y Controles no Emparejado

SUMMARY: Early closure of a loop ileostomy (ECI) is a relatively new practice, for which there is insufficient evidence regarding its effectiveness in relation to closure at conventional times. The aim of this study was to report postoperative complications (POC) and hospital mortality in patients with loop ileostomy (LI) who underwent ECI, compared with patients with LI who underwent late closure. Un- matched case-control study. Patients with LI who underwent surgery at Clínica RedSalud Mayor Temuco (2010-2022) were included. Cases were defined as patients with LI who underwent early closure and controls as subjects who underwent closure at the usual times. No matching was performed, but a 1:1 relationship between cases and controls was considered. Outcome variables were postoperative complications and hospital mortality. Other variables of interest were surgical time and hospital stay. Descriptive statistics were applied with calculation of proportions and measures of central tendency. Subsequently, t-test and Pearson Chi2 for comparison of averages and proportions was applied, and odds ratios and their respective 95 % CI were calculated. In this study 39 patients with AI were operated on (18 cases and 21 controls). Age and BMI average of the studied subjects was 71.3±7.1 years and 27.3±19.8 kg/m2 respectively. Mean LI closure time, surgical time, and hospitalization were: 10.0±0.7 months; 62.5±10.6min; 3.8±0.1 days respectively. POC were only surgical site infections. Three in cases (16.7 %) and 3 in controls (14.3 %). No anastomotic dehiscence or hospital mortality was observed in either cases or controls. There were no differences in comorbidities or surgical site infection between cases and controls (OR of 0.6 and 1.2 respectively) In this experience, the results of performing the CTI were similar to the late closing in relation to the variables studied.

El cierre temprano de una ileostomía en asa (IA), es una práctica relativamente nueva, sobre la que no hay suficiente evidencia respecto de su efectividad en relación con el cierre en tiempos convencionales. El objetivo de este estudio fue verificar diferencias en la tasa de complicaciones postoperatorias (CPO) y de mortalidad hospitalaria en pacientes con IA sometidos a cierre temprano comparados con pacientes con IA sometidos a cierre tardío. Estudio de casos y controles sin emparejamiento. Se incluyeron pacientes con IA que fueron sometidos a cirugía en la Clínica RedSalud Mayor Temuco (2010-2022). Los casos se definieron como pacientes con IA sometidos a cierre temprano y los controles como sujetos con IA sometidos a cierre en tiempos habituales. No se realizó emparejamiento. Se consideró una relación 1:1 entre casos y controles. Las variables de resultado fueron CPO y mortalidad hospitalaria. Otras variables de interés fueron: tiempo quirúrgico y hospitalización. Se aplicó estadísticas descriptivas (cálculo de proporciones y medidas de tendencia central). Posteriormente, se aplicó prueba t-test y Chi2 para comparación de promedios y proporciones; y se calcularon odds ratios e intervalos de confianza del 95 %. Se operaron 39 pacientes con IA (18 casos y 21 controles). El promedio de edad e IMC fue 71,3±7,1 años y 27,3±19,8 kg/m2, respectivamente. El tiempo promedio de cierre de IA, tiempo quirúrgico y hospitalización fueron: 10,0±0,7 meses; 62,5±10,6 minutos; 3,8±0,1 días, respectivamente. Las CPO fueron infecciones del sitio quirúrgico (3 casos; 16,7 % y 3 controles; 14,3 %). No se observó dehiscencia anastomótica ni mortalidad hospitalaria en casos ni controles. No hubo diferencias en comorbilidades ni en infecciones del sitio quirúrgico entre casos y controles (OR de 0,6 y 1,2, respectivamente). No se evidenciaron diferencias entre realizar cierre temprano o tardío de IA, respecto de las variables CPO y de mortalidad hospitalaria.

Temporary stomas after rectal cancer resection; predilection of being permanent and predictors of complications?

Stomas are essential for colorectal surgery and are widely used not only for selected cases for bowel obstructions but also in rectal cancer operations to divert stool away from low rectal anastomosis. On the other hand, complications with stomas/ stomas reversal are not uncommon. In this study, we aimed at studying the frequency and the predictors of temporary stomas being permanent, and the contributing factors of surgical stoma/stoma closure related complications. In our cohort, only about 40% of the patient closed their initially planned temporary stomas. The occurrence of intestinal leak, wound sepsis, or any type of morbidity with 30 days of operation were significant predictors of permanent stomas. In addition, alarmingly although Hartmann's procedure was uncommon in our practice, only 9% of those who underwent Hartmann's have had it reversed. Moreover, the only factor that significantly increased stoma related complications was having an end colostomy. There was a tendency toward late closure of stomas with median 8.2 months, however early closure did not correlate to complications. In conclusion, further studies are needed to delineate the low rate of stoma closure. Patients who develop postoperative complications, even wound sepsis, would be at a higher risk of living with permanent stomas. Hartmann's procedures are commonly associated with stoma problems, and reluctance to reverse the stomas. (AU)

Epidemiological characterization of patients with intestinal stomas

Objective: To characterize the sociodemographic and clinical variables of people with intestinal stomas. Materials and Methods: We conducted a cross-sectional study with 47 patients of a Specialized Rehabilitation Center (CER II/APAE) in the municipality of Três Lagoas, state of Mato Grosso do Sul, Midwestern Brazil, from December 2019 to June 2020. Data was analyzed using inferential descriptive statistics (Anderson-Darling, Chi-squared, and Mann-Whitney normality tests). Results: Regarding the patients, 87.23% were from Três Lagoas, 51.06% were female, 40.43% were aged from 60 to 69 years, 59.57% were married, 53.19% were brown, 59.57% were catholic, 36.17% finished elementary school, 46.81% were retired, and 57.45% earned a monthly income below 1 minimum wage. Moreover, 61.70% had undergone terminal colostomy (61.70%), 61.70% had received guidance about its placing, 57.45% had it placed due to situations of urgency, 74.47% had a stoma installed due to a neoplasia, 38.30% were permanent, with 46.81% located in the inferior left quadrant (ILQ), 59.57% presented pasty effluent, 63.83% had a circular diameter, 53.19% had pouches with 2 pieces and 57.45%, with a flexible base, 87.23% had other adjunct equipment, and 95.74% had been trained in self-care. The most common complication was skin/peristomal irritant contact dermatitis (59,57%), and 65,95% of these cases were solved by teaching self-care. The type of stoma was significantly associated with the consistency of the effluent and the size of the protrusion (p> 0.05). Conclusion: The results found can support strategies to implement practices to promote health, develop new public policies, to provide training in self-care, and prevent and treat complications. (AU)

Tecnologia cuidativo-educacional para o autocuidado de mulheres e homens com estoma intestinal mediado pela aromaterapia / Care-educational technology the self-care of women and men with intestinal stoma mediated by aromatherapy / Tecnología cuidado-educativa el autocuidado de mujeres y hombres con ostoma intestinal mediado por aromaterapia

Objetivo: Descrever o processo de elaboração de instrumento para orientar o autocuidado mediado pela aromaterapia de mulheres e homens com estomas intestinais. Métodos: Estudo metodológico - desenvolvimento de produto técnico/inovação tecnológica, realizado em um município da Bahia, Brasil, no ano de 2023. Participaram do estudo 11 pacientes (seis eram mulheres e cinco, homens) e seis enfermeiras(os) avaliadoras(es). Realizou-se as etapas de pesquisa - levantamento da literatura, entrevista individual em profundidade, aplicação de óleos essenciais. Os dados foram submetidos à Análise de Conteúdo Temática Reflexiva, enquadramento teórico à luz da Teoria do Déficit do Autocuidado de Orem, a fim de derivar a estrutura da tecnologia. Resultados: Foi elaborada uma proposta de um instrumento clínico-assistencial de enfermagem para avaliação inicial e plano de cuidados para a implementação da aromaterapia junto a mulheres e homens com estomas intestinais. O instrumento foi composto pelos itens: Histórico de Enfermagem - avaliação inicial (dados sociodemográficos e relacionados à aromaterapia e achados clínicos; Diagnósticos de Enfermagem prioritários; Resultados de Enfermagem prioritários; Intervenções de Enfermagem prioritários; Avaliação/Acompanhamento e documentação clínica. Conclusão: A tecnologia constituiu uma inovação a ser aplicada no cotidiano profissional em enfermagem no Brasil, por ser constituída de conhecimentos próprios da profissão. (AU)

Objective: To describe the process of developing an instrument to guide self-care mediated by aromatherapy for women and men with intestinal stomas. Methods: Methodological study - development of a technical product/technological innovation, carried out in a conducted in a municipality of Bahia, Brazil, in the year 2023. Eleven patients (six women and five men) and six nurse evaluators participated in the study. The research stages were carried out - literature survey, in-depth individual interview, application of essential oils. Data were submitted to Reflective Thematic Content Analysis, a theoretical framework based on Orem's Self-Care Deficit Theory, in order to derive the structure of the technology. Results: A proposal for a clinical nursing care instrument was developed for the initial assessment and care plan for the implementation of aromatherapy with women and men with intestinal stomas. The instrument consisted of the items: Nursing History - initial assessment (sociodemographic data and data related to aromatherapy and clinical findings; Priority Nursing Diagnoses; Priority Nursing Outcomes; Priority Nursing Interventions; Assessment/Follow-up and clinical documentation. Conclusion: The technology constituted an innovation to be applied in the daily professional life of nursing in Brazil, as it was constituted of the profession's own knowledge. (AU)

Objetivo: Describir el proceso de creación de un instrumento para orientar el autocuidado mediado por aromaterapia para mujeres y hombres con estomas intestinale. Métodos: Estudio metodológico - desarrollo técnico de producto/innovación tecnológica, realizado en un municipio de Bahía, Brasil, en el año 2023. Participaron 11 pacientes (seis mujeres y cinco hombres) y seis enfermeros evaluadores. Se realizaron las etapas de la investigación - levantamiento bibliográfico, entrevista individual en profundidad, aplicación de aceites esenciales. Los datos fueron sometidos al Análisis de Contenido Temático Reflexivo, referencial teórico a la luz de la Teoría del Déficit de Autocuidado de Orem, con el fin de derivar la estructura de la tecnologia. Resultados: Se elaboró una propuesta de instrumento clínico-asistencial de enfermería para la evaluación inicial y plan de cuidados para la implementación de aromaterapia con mujeres y hombres con ostomías intestinales. El instrumento constó de: História de Enfermería - evaluación inicial (datos sociodemográficos y datos relacionados con la aromaterapia y hallazgos clínicos; Diagnósticos de Enfermería Prioritarios; Resultados de Enfermería Prioritarios; Intervenciones de Enfermería Prioritarias; Evaluación/Seguimiento y documentación clínica. Conclusión: La tecnología constituyó una innovación para ser aplicada en el cotidiano profesional de la enfermería en Brasil, ya que há sido desarollada por medio del conocimiento propio de la profesión. (AU)

Clinical value of mesh prophylaxis for parastomal hernia based on evidence-based medicine / 中华外科杂志

The incidence of parastomal hernia is substantially high, significantly affecting the quality of life of patients with stoma. How to effectively solve the problem of parastomal hernia is a long-term focus of hernia and abdominal wall surgery and colorectal surgery. The European Hernia Society guidelines on prevention and treatment of parastomal hernia published in 2018 has recommended the use of a prophylactic mesh to prevent parastomal hernia for the first time. In the following 5 years, more randomized controlled trials of multi-center, large-sample, double-blind, long-term follow-up have been published, and no significant effect of mesh prophylaxis has been observed on the incidence of parastomal hernia. However, whether mesh could decrease surgical intervention by limiting the symptoms of parastomal hernias would become a potential value of prophylaxis, which requires further research to elucidate.

Postoperative Complications and Stoma Rates After Laparoscopic Resection of Deep Infiltrating Endometriosis with Bowel Involvement / Complicações pós-operatórias e taxas de estomia após ressecção laparoscópica de endometriose infiltrativa profunda com envolvimento intestinal

Abstract Objective The purpose was to assess the rates of postoperative complications and the need of temporary stoma of laparoscopic surgical treatment for bowel endometriosis in a referral center. Methods The surgical indication, type of operation, operative time, length of hospital stay, need for a temporary stoma, rate of conversion to open surgery, postoperative complications were evaluated. Results One-hundred and fifty patients were included. The average duration of surgery was significantly longer for segmental resection (151 minutes) than for disc excision (111.5 minutes, p < 0.001) and shaving (96.8 minutes, p < 0.001). Patients with segmental resection had longer postoperative lengths of hospital stay (1.87 days) compared with patients with disc excision (1.43 days, p < 0.001) and shaving (1.03 days, p < 0.001). A temporary stoma was performed in 2.7% of patients. Grade II and III postoperative complications occurred in 6.7% and 4.7% patients, respectively. Conclusion Laparoscopic intestinal resection has an acceptable postoperative complication rate and a low need for a temporary stoma.

Resumo Objetivo O objetivo foi avaliar as taxas de complicações pós-operatórias e a necessidade de estomia temporária do tratamento cirúrgico laparoscópico para endometriose intestinal em um centro de referência. Métodos Foram avaliados a indicação cirúrgica, tipo de operação, tempo operatório, tempo de internação, necessidade de estomia temporária, taxa de conversão para cirurgia aberta, complicações pós-operatórias. Resultados Cento e cinquenta pacientes foram incluídos. A duração média da cirurgia foi significativamente maior para a ressecção segmentar (151 minutos) do que para a excisão do disco (111,5 minutos, p < 0,001) e shaving (96,8 minutos, p < 0,001). Pacientes com ressecção segmentar tiveram maior tempo de internação pós-operatória (1,87 dias) em comparação com pacientes com excisão de disco (1,43 dias, p < 0,001) e shaving (1,03 dias, p < 0,001). Um estoma temporário foi realizado em 2,7% dos pacientes. Complicações pós-operatórias de grau II e III ocorreram em 6,7% e 4,7% dos pacientes, respectivamente. Conclusão A ressecção intestinal laparoscópica apresenta taxa aceitável de complicações pós-operatórias e baixa necessidade de estomia temporária.

Protocolo de Avaliação de Sensibilidade Dermatológica para Pessoas com Estomias de Eliminação / Dermatological Sensitivity Assessment Protocol for People With Elimination Stomas / Protocolo de Evaluación de Sensibilidad Dermatológica para Personas con Stomos de Eliminación

Objetivo:Construir e validar um protocolo clínico direcionado à avaliação de sensibilidade dermatológica ocasionada por dispositivos coletores e adjuvantes utilizados por pessoas com estomias. Metodologia:Pesquisa metodológica, desenvolvida entre os anos de 2020 e 2021, para construção e validação de um protocolo de avaliação dermatológica para pessoas com estomias de eliminação. A construção do protocolo percorreu as etapas: diagnóstico situacional teórico, levantamento do referencial teórico e desenvolvimento do protocolo. Resultados: Para validação foram recrutados 21 juízes, enfermeiros, com experiência na área de Estomaterapia, cujo instrumento para validação do conteúdo avaliou objetivos, estrutura e relevância da tecnologia, sendo disponibilizado via e-mail por formulário eletrônico na plataforma Google Forms. Para análise dos dados utilizou-se a estatística descritiva e o cálculo de índice de validade de conteúdo (IVC). Obteve-se escore global de concordância entre os juízes de 0,92. Conclusão: Conclui-se que o protocolo criado possui fundamentação e validação prática, versatilidade de aplicação, viabilizando um processo assistencial mais congruente com a realidade da pessoa com estomia de eliminação.

Objective:To build and validate a clinical protocol aimed at evaluating the dermatological sensitivity caused by collection devices and adjuvants used by people with stomas. Methodology: Methodological research, developed between 2020 and 2021, for the construction and validation of a dermatological evaluation protocol for people with elimination stomas. The construction of the protocol went through the steps: theoretical situational diagnosis, survey of the theoretical framework and development of the protocol. Results: For validation, 21 judges, nurses, with experience in the area of enterostomal therapy, were recruited, whose instrument for content validation evaluated objectives, structure and relevance of the technology, being made available via e-mail through an electronic form on the Google Forms platform. For data analysis, descriptive statistics and the calculation of content validation index were used. A global score of agreement between the judges of 0.92 was obtained. Conclusion: It is concluded that the protocol created has a practical basis and validation, application versatility, enabling a care process that is more congruent with the reality of the person with an elimination stoma.

Objetivo:Construir y validar un protocolo clínico dirigido a la evaluación de la sensibilidad dermatológica provocada por los dispositivos colectores y adyuvantes utilizados por personas con ostomías. Metodología: Investigación metodológica, desarrollada entre 2020 y 2021, para la construcción y validación de un protocolo de evaluación dermatológica para personas con estomas de eliminación. La construcción del protocolo pasó por las etapas: diagnóstico situacional teórico, levantamiento del marco teórico y desarrollo del protocolo. Resultados: Para la validación fueron reclutados 21 jueces, enfermeros, con experiencia en el área de Estomaterapia, cuyo instrumento para validación de contenido evaluó objetivos, estructura y pertinencia de la tecnología, estando disponible vía e-mail a través de formulario electrónico en Google Plataforma de formularios. Para el análisis de los datos se utilizó la estadística descriptiva y el cálculo del Índice de Validación de Contenido. Se obtuvo una puntuación global de concordancia entre los jueces de 0,92. Conclusión: Se concluye que el protocolo creado tiene base práctica y validación, versatilidad de aplicación, posibilitando un proceso de atención más congruente con la realidad de la persona con ostomía de eliminación.

Interpretation of Chinese expert consensus on protective ostomy for mid-low rectal cancer in China (version 2022) / 中华胃肠外科杂志

This paper describes the background of Chinese expert consensus on protective ostomy for middle and low rectal cancer in China, interprets some key issues such as unification of relevant terminology and concepts, clinical value and indications of protective stoma, and clarifies surgical principles and details and perioperative ostomy care.

Chinese expert consensus on protective ostomy for mid-low rectal cancer (version 2022) / 中华胃肠外科杂志

The rate of sphincter-preserving surgery for mid-low rectal cancer is increasing, but anastomotic leakage remains to be one of the common serious complications after operation. How to reduce the morbility and mortality of anastomotic leakage is always a hot and difficult point in colorectal surgery. Protective ostomy is a common method to deal with the above problems in clinical practice. However, some problems such as inappropriate stoma and stoma-related complications etc. become the current clinical challenges. The purpose of this consensus focusing on indication of ostomy, clinical value, ostomy skills, prevention of stoma complications, reversion of stoma and stoma nursing aims to provide guidance for the clinical practice of protective ostomy in the operation of mid-low rectal cancer in China.

A participação da família no cuidado à pessoa com estoma: percepções de profissionais de enfermagem / La participación de la familia en el cuidado a la persona con estoma: percepciones de profesionales de enfermería / Participation of the family in the care for stomized people: perceptions of nursing professionals

RESUMO Objetivo: Conhecer a percepção dos profissionais de enfermagem quanto à participação da família no cuidado às pessoas com estoma intestinal de eliminação no transcorrer da hospitalização. Método: Estudo qualitativo, descritivo, cujos dados foram coletados mediante uso da entrevista guiada, com 21 profissionais de enfermagem de uma unidade de cirurgia geral em um hospital público do Sul do Brasil, e submetidos à técnica de espiral de análise. Resultados: A análise dos dados permitiu a organização de dois temas: "A família como parte e partícipe do cuidado de enfermagem" e "A família como elo que pode fragilizar e comprometer o cuidado", evidenciando a percepção dos profissionais de enfermagem. A participação da família é identificada como relevante, pois conforma uma rede de apoio ativa e efetiva para a manutenção dos cuidados com o estoma, mas também, como um elo que pode fragilizar e comprometer o cuidado, repercutindo, muitas vezes, na aceitação e adaptação dos pacientes frente à sua nova realidade de vida. Resultados: Considerações finais: A diferença presente no modo como os profissionais de enfermagem percebem a participação da família como copartícipe do cuidado e das orientações tende a influenciar no cuidado prestado.

RESUMEN Objetivo: conocer la percepción de los profesionales de enfermería en cuanto a la participación de la familia en el cuidado a personas con estoma intestinal de eliminación en el transcurrir de la hospitalización. Método: estudio cualitativo, descriptivo, cuyos datos fueron recogidos a través de entrevista dirigida, con 21 profesionales de enfermería de una unidad de cirugía general en un hospital público del Sur de Brasil, y sometidos a la metodología de espiral de análisis. Resultados: el análisis de los datos permitió la organización de dos temas: "La familia como parte y partícipe del cuidado de enfermería" y "La familia como eslabón que puede fragilizar y comprometer el cuidado", evidenciando la percepción de los profesionales de enfermería. La participación de la familia es identificada como relevante, pues conforma una red de apoyo activa y efectiva para el mantenimiento de los cuidados con el estoma, pero también, como un eslabón que puede fragilizar y comprometer el cuidado, repercutiendo, muchas veces, en la aceptación y adaptación de los pacientes frente a su nueva realidad de vida. Consideraciones finales: la diferencia presente en el modo como los profesionales de enfermería perciben la participación de la familia como copartícipe del cuidado y de las orientaciones tiende a influir en el cuidado prestado.

ABSTRACT Objective: To know the perception of nursing professionals regarding the participation of the family in the care of people with intestinal elimination stoma during hospitalization. Method: Qualitative, descriptive study, whose data were collected through the use of guided interviews, with 21 nursing professionals from a general surgery unit in a public hospital in southern Brazil, and submitted to the spiral analysis technique. Results: Data analysis allowed the organization of two themes: "The family as part and participant of nursing care" and "The family as a link that can weaken and compromise care", evidencing the perception of nursing professionals. Family participation is identified as relevant, as it forms an active and effective support network for maintaining stoma care, but also as a link that can weaken and compromise care, often impacting acceptance and adaptation of patients facing their new reality of life. Final considerations: The difference in the way nursing professionals perceive the family's participation as a co-participant in care and guidance tends to influence the care provided.

Perfil de usuários de um serviço de estomaterapia: análise de cluster / Perfil de usuarios de un servicio de estomaterapia: análisis de cluster / Profile of users of a stomatherapy service: cluster analysis

Resumo Objetivo Analisar o perfil das pessoas com estomias intestinais e/ou urinárias acompanhadas em serviço de estomaterapia, conforme variáveis sociodemográficas e clínicas. Método Trata-se de um estudo transversal, realizado com 90 usuários do serviço de estomaterapia. A coleta foi realizada de janeiro a fevereiro de 2020, por meio de dois instrumentos: COH-QOL-Ostomy, adaptado e traduzido para o contexto brasileiro; e City of Hope Quality of Life - Ostomy Questionnaire, instrumento original com questionário elaborado pelas próprias pesquisadoras, contemplando os aspectos sociodemográfico e clínico. Esses dados foram transferidos e organizados no Software Statistical Package for the Social Science, versão 22. Resultados Foram identificados quatro grupos distintos. No cluster 1, o grupo possui de duas a três complicações associadas ao estoma e 52,9% possuem colostomia. No cluster 2, 45% não apresentam nenhuma complicação e 70% têm urostomia. Já no cluster 3, a totalidade do grupo apresenta uma complicação e colostomia. E no cluster 4, nenhum participante do grupo apresenta complicação e todos têm colostomia. Conclusão e implicações para a prática O estudo proporcionou a geração de dados que podem auxiliar no planejamento do trabalho desenvolvido pelas equipes de saúde junto aos pacientes estomizados.

Resumen Objetivo Analizar el perfil de las personas con ostomías intestinales y/o urinarias seguidas en un servicio de estomaterapia, según variables sociodemográficas y clínicas. Método Se trata de un estudio transversal, realizado con 90 usuarios del servicio de Estomaterapia. La recolección de datos se realizó de enero a febrero de 2020, utilizando dos instrumentos: COH-QOL-Ostomy, adaptado y traducido al contexto brasileño; y City of Hope Quality of Life - Ostomy Questionnaire, instrumento original con cuestionario elaborado por las propias investigadoras, considerando aspectos sociodemográficos y clínicos. Estos datos se transfirieron y organizaron en Software Statistical Package for the Social Science, versión 22. Resultados Se identificaron cuatro clústeres distintos. En el clúster 1, el grupo tiene de dos a tres complicaciones asociadas con estoma y el 52,9% tiene una colostomía. En el grupo 2, el 45% no presenta complicaciones y el 70% tiene urostomía. En el clúster 3, todo el grupo presenta complicación y colostomía. Y en el clúster 4, ninguno de los participantes del grupo tiene complicaciones y todos tienen una colostomía. Conclusión e implicaciones para la práctica El estudio generó datos que pueden ayudar a planificar el trabajo que desarrollan los equipos de salud con pacientes ostomizados.

Abstract Objective To analyze the profile of people with intestinal and/or urinary ostomies followed up in a stomatherapy service, according to sociodemographic and clinical variables. Method This is a cross-sectional study, carried out with 90 users of the stomatherapy service. Data collection was carried out from January to February 2020, using two instruments: COH-QOL-Ostomy, adapted and translated to the Brazilian context; and City of Hope Quality of Life - Ostomy Questionnaire, an original instrument with a questionnaire prepared by the researchers themselves, considering the sociodemographic and clinical aspects. These data were transferred and organized in the Statistical Package for Social Science Software, version 22. Results Four distinct clusters were identified. In cluster 1, the group has two to three complications associated with the stoma and 52.9% have a colostomy. In cluster 2, 45% have no complications and 70% have urostomy. In cluster 3, the entire group presents a complication and colostomy. And in cluster 4, none of the participants in the group have complications and all have a colostomy. Conclusion and implications for practice The study provided the generation of data that can help in planning the work developed by the health teams with ostomy patients.

Terapia asistida con vacío y estoma flotante (floating stoma): una nueva forma de tratar un absceso periostomal / Vacuum assisted therapy and floating stoma: S new way to treat a periostomal abscess

Resumen Introducción: Los estomas flotantes se definen como un estoma que no está fijado a la piel de la pared abdominal, esta técnica se ha descrito en cirugía para fístulas entero-atmosféricas y de control de daños. Caso Clínico: Presentamos un reporte de caso de manejo de absceso paraostomal en paciente con antecedente de laparotomía por abdomen agudo, por lo que se decide uso de terapia de presión negativa asociada a estoma flotante, demostrando su utilidad en este tipo complejo de pacientes.

Introduction: Floating stomata are defined as a stoma that is not attached to the skin of the abdominal wall, this technique is described in surgery for entero-atmospheric fistulas and damage control. Clinical Case: We present a case report of the management of paraostomal abscess in a patient with a history of laparotomy due to acute abdomen, it was decided to use negative pressure therapy associated with a floating stoma, demonstrating its usefulness in this complex type of patient.

Elaboration and validation of flowchart for the prevention and treatment of intestinal peristomal skin complications

Objective: To build and validate a flowchart for the prevention and treatment of intestinal peristomal skin complications. Method: For the construction of the algorithms, a systematic reviewwas carried out in health sciences databases comprising the last 10 years. The evaluation of the algorithms was carried out by 38 nurses. For the validation of the algorithms, theDelphi technique was used. The statistical analysis used was the content validity index and the Cronbach alpha coefficient. The questionnaire was sent by e-mail and in person after approval by the Ethics and Research Committee. Results: In the first evaluation of the algorithms, there was no agreement among the experts. However, after making the corrections suggested by the evaluators, the algorithms were resent, with a 100% consensus among the evaluators. The questions used to validate the algorithms contributed favourably to the internal consistency and content validation of the instrument, since the respective Cronbach alpha was 0.9062 and the global content validity index (g-CVI) was 0.91 in the first validation and 1.0 in the second validation. Conclusion: After an integrative literature review, the flowcharts were built and validated by a professional with experience in the area, showing 100% agreement among the experts in the second evaluation. (AU)

Revising our concepts about stoma covering a low rectal anastomosis

Introduction: There has been conclusive evidence that defunctioning stoma with either transverse colostomy or ileostomy mitigates the serious consequences of anastomotic leakage. However,whether transverse colostomy or ileostomy is preferred for defunctioning a rectal anastomosis remains controversial. The present study was designed to identify the best defunctioning stoma for colorectal anastomosis. Objective: To improve the quality of life in patients with rectal resection and anastomosis and reduce the morbidity before and after closure of the stoma. Patients and Methods The present study included 48 patients with elective colorectal resection who were randomly arranged into 2 equal groups, with 24 patients each. Group I consisted of patients who underwent ileostomy, and group II consisted of patients who underwent colostomy as a defunctioning stoma for a low rectal anastomosis. All surviving patients were readmitted to have their stoma closed and were followed-up for 6 months after closure of their stomas. All data regarding local and general complications of construction and closure of the stoma of the two groups were recorded and blotted against each other to clarify the most safe and tolerable procedure. Results: We found that all nutritional deficiencies, dehydration, electrolytes imbalance, peristomal dermatitis, and frequent change of appliances are statistically more common in the ileostomy group, while stomal retraction and wound infection after closure of the stoma were statistically more common in the colostomy group. There were no statistically significant differences regarding the total hospital stay and mortality between the two groups. Conclusion and Recommendation: Ileostomy has much higher morbidities than colostomy and it also has a potential risk of mortality; therefore, we recommend colostomy as the ideal method for defunctioning a distal colorectal anastomosis. (AU)

The colostomy complications in anorectal malformation: a retrospective study

Background: A colostomy is a surgical approach that creates an opening for the colon, or/and large intestine through the abdomen. Anorectal malformations are a group of abnormalities of the rectum and anus that are present at birth. Objective: To analyze the common complications of colostomy in anorectal formations. Methods: This was a retrospective study conducted on 50 temporary colostomies performed in children at the Surgical Department of the Abu Ghraib General Hospital in the period from January 2018 to January 2020. Information was collected regarding the patients' age, sex, body weight, associated anomalies, colostomy types and sites, and the indications and complications of colostomies. Results: A total of 44 (88%) cases were reported in the children's 1st month of life. The ratio of male to female was 1:1. Pelvic colostomy was performed in 48 (96%) patients, as 40 (80%) children underwent a loop-type, and 8 (16%) patients underwent doublebarrel colostomy. Transverse colostomy was performed on two patients. Prolapse occurred in 50% of the patients, and skin excoriations occurred in 22% . A total of 10% of the children developed sepsis. Bleeding was seen in 4% of the children after colostomy performance. Stenosis presented in 6% of the children, and this was corrected by repeated dilatation and re-fashioning. Obstruction of intestines was observed in one patient. The retraction developed in 6% of patients. Conclusions: Imperforate anus was themost common indication for stoma formation in the pediatric age group. Loop colostomy was the most common type used, and it had the highest rate of complications. Prolapses and skin excoriation were the most common complications found. (AU)

Peristomal dermatitis: treatment with green banana peel (Musa sapientum) powder / Dermatite periestomal: tratamento com pó de casca de banana verde (Musa sapientum)

Objective: To develop green banana peel (Musa sapientum) powder for the treatment of peristomal dermatitis, and to evaluate its effectiveness and healing time. Methods: A clinical, analytical and longitudinal study. In total, 44 volunteers of both genders, aged>18 years, with intestinal ostomy, who presented peristomal dermatitis, participated in the research. The sample was divided into two groups: the study group used a powder containing 10% of green banana peel, and the control group used ostomy powder. The research was approved by the Ethics in Research Committees (Comitês de Ética em Pesquisa, CEP, in Portuguese) under opinion n° 2.381.904. Results: The healing time of the study group was shorter than that of the control group (p=0.022). To analyze the results, we used the two-sample t-test (mean days until healing for both study groups). Conclusion: The powder containing 10% of green banana peel was developed, and effective healing of the peristomal dermatitis was observed. Compared to the ostomy powder, it presented a shorter healing time. (AU)

Objetivo: Desenvolver o pó composto da casca da banana verde (Musa sapientum) para o tratamento de dermatite periestomal, e avaliar a eficácia e o tempo de cicatrização. Métodos: Estudo clínico, analítico e longitudinal. Participaram da pesquisa 44 voluntários, de ambos os gêneros, maiores de 18 anos, com estomias intestinais, e que apresentavam dermatite periestomal. A amostra foi dividida em dois grupos: o grupo de estudo usou umpó que continha 10% de casca de banana verde, e o grupo de controle usou pó para estomia. A pesquisa foi aprovada pelos Comitês de Ética em Pesquisa (CEP), sob o parecer n° 2.381.904. Resultados: O tempo de cicatrização do grupo de estudo foimenor do que o do grupo de controle (p=0.022). Para a análise dos resultados, empregou-se o teste t para duas amostras (média de dias de cicatrização de ambos os grupos). Conclusão: Desenvolveu-se o pó contendo 10% de casca de banana verde, e observouse cicatrização eficaz da dermatite periestomal. Em comparação com o pó para estomia, apresentou tempo menor até a cicatrização. (AU)

Surgery for Complicated Stomal Prolapse: Is the Altemeier Technique an Option? A Report of Three Cases / Cirurgia para prolapso de estoma complicado: A técnica de Altemeier é uma opção? Um relato de três casos

Abstract Introduction The incidence of stomal prolapse ranges from 2% to 22%. The risk factors include colostomy, the short length of the stoma, obesity, emergency surgery, and the improper (or even absence of) marking of the preoperative site for the stoma. Complicated stomal prolapse associated with severe mucosal irritation, ischemic changes, or bleeding requires surgical intervention. Objective To describe the use of the Altemeier technique in the management of cases of complicated prolapsed stoma after failure of the local medical measures and manual reduction. Methods Case series of three patients with past history of abdominoperineal resection of rectal cancer and permanent end colostomy presented with irreducible prolapse of the stoma. After the failure of the local measures and manual reduction, urgent surgical intervention using the modified Altemeier technique was necessary. Results The modified Altemeier technique is simple, presents low risk of operative and postoperative complications, besides enabling an early recovery, with a lower risk of recurrence during the first 6 months after the repair. Conclusion Themodified Altemeier technique may be a valid therapeutic modality in the setting of complicated prolapsed stoma.

Resumo Introdução A incidência de prolapso de estoma varia de 2 a 22%. Os fatores de risco incluem colostomia, comprimento curto do estoma, obesidade, cirurgias de emergência, e marcação não adequada (ou atémesmo ausente) do sítio pré-operatório para o estoma. Prolapso de estoma complicado e associado a irritação grave de mucosa, alterações isquêmicas, ou sangramento requer intervenção cirúrgica. Objetivo Descrever o uso da técnica de Altemeier para o manejo de prolapso de estoma complicado após fracasso das medidas médicas locais e da redução manual. Métodos Série de casos de três pacientes com histórico de ressecção abdominoperineal de câncer retal e colostomia terminal permanente apresentaram prolapso irredutível do estoma. Com o fracasso das medidas locais e da redução manual, fezse necessária intervenção cirúrgica de emergência usando a técnica de Altemeier modificada. Resultados A técnica de Altemeier modificada é simples e apresenta risco baixo de complicações operatórias e pós-operatórias, além de possibilitar uma recuperação precoce, com menor risco de recorrência durante os 6 primeiros meses após o reparo. Conclusão A técnica de Altemeier modificada pode ser uma modalidade terapêutica válida em casos de prolapso de estoma complicado.

Meta analysis of diseased bowel resection versus diversion enterostomy in the treatment of late severe complications of chronic radiation-induced rectal injury / 中华胃肠外科杂志

Objective: To investigate the efficacy and safety of diseased bowel resection and diversion enterostomy in the treatment of late severe complications of chronic radiation-induced late rectal injury (RLRI). Methods: Studies about comparison of diseased bowel resection and diversion enterostomy in the treatment of late severe complications of chronic RLRI were screened and retrieved from databases, including PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, CNKI, VIP, CBM and Wanfang. The following terms in Chinese were used to search [Title/Abstract]: radiation-induced intestinal injury, radiation proctitis, surgery. The following English terms were used to search: Radiation-induced intestinal injury, Bowel injury from radiation, Radiation proctitis, Surgery, Colostomy. Literature inclusion criteria: (1) studies with control groups, published at home and abroad publicly, about the postoperative effects of diseased bowel resection vs. diversion enterostomy on RLRI patients with late severe complications; (2) the period of the study performed in the literatures must be clear; (3) patients at the preoperative diagnosis for RLRI with refractory bleeding, narrow, obstruction, perforation or fistula, etc.; (4) diseased bowel resection included Hartmann, Dixon, Bacon and Parks; diversion enterostomy included colostomy and ileostomy; (5) if the studies were published by the same institution or authors at the same time, the study with the biggest sample size was chosen; studies conducted in different time with different subjects were simultaneously included; (6) at least one prognostic indicator of the following parameters should be included: the improvement of symptoms, postoperative complications, mortality, and reversed stomas rate. The stoma reduction rate was defined as the ratio of successful closure of colostomy after diseased bowel resection and diversion enterostomy. The method of direct calculation or the method of convert into direct calculation were used for stoma reduction rate. Exclusion criteria: (1) a single-arm study without control group; (2) RLRI patients did not undergo diseased bowel resection or diversion enterostomy at the first time; (3) RLRI patients with distant metastasis; (4) the statistical method in the study was not appropriate; (5) the information was not complete, such as a lack of prognosis in the observational indexes. After screening literatures according to criteria, data retrieval and quality evaluation were carried out. Review Manager 5.3 software was used for Meta-analysis. Sensitivity analysis was used to exam the stability of results. Funnel diagram was used to analyze the bias of publication. Results: A total of 11 literatures were enrolled, including 426 RLRI patients with late severe complications, of whom 174 underwent diseased bowel resection (resection group) and 252 underwent diversion enterostomy (diversion group), respectively. Compared with diversion group, although resection group had a higher morbidity of complication (35.1% vs. 15.9%, OR=2.67, 95% CI: 1.58 to 4.53, P<0.001), but it was more advantageous in symptom improvement (94.2% vs. 64.1%, OR=6.19, 95% CI: 2.47 to 15.52, P<0.001) and stoma reductions (62.8% vs. 5.1%, OR=15.17, 95% CI: 1.21 to 189.74, P=0.030), and the differences were significant (both P<0.05). No significant difference in postoperative mortality was found between the two groups (10.1% vs. 18.8%, OR=0.74, 95% CI: 0.21 to 2.59, P=0.640). There were no obvious changes between the two groups after sensitivity analysis for the prognostic indicators (the symptoms improved, postoperative complications, mortality, and reversed stomas rate) compared with the meta-analysis results before exclusion, suggesting that the results were robust and credible. Funnel diagram analysis suggested a small published bias. Conclusions: Chronic RLRI patients with late severe complications undergoing diseased bowel resection have higher risk of complication, while their long-term mortality is comparable to those undergoing diversion enterostomy. Diseased bowel resection is better in postoperative improvement of symptoms and stoma reduction rate.

Dificuldades e Facilidades do processo educativo desenvolvido por enfermeiros às pessoas com estomias / What nurses find difficult and helpful when educating people with ostomies / Dificultades y facilidades del proceso educativo desarrollado por enfermeras para personas con estomas

Objetivo: descrever e analisar as dificuldades e facilidades percebidas por enfermeiros para implementação do processo educativo dirigido às pessoas com estomia. Método: estudo qualitativo e exploratório, apoiada no materialismo histórico e no método dialético. A coleta ocorreu em um Centro de Reabilitação no Rio de Janeiro, com seis enfermeiros, por meio da triangulação de métodos (observação participante, entrevista e análise de registros de enfermagem), entre dezembro de 2014 e março de 2015. Resultados: os fatores dificultadores do processo educativo foram: estrutura física inadequada, escassez de recursos financeiro e humano. Além disso, apreendeu-se déficit na formação e qualificação dos enfermeiros. Os fatores facilitadores incluíram: fornecimento de equipamentos e adjuvantes para as pessoas com estomia e criação de grupos de apoio para esta clientela. Conclusão: concluiu-se que existem contradições e discrepâncias na execução do processo educativo relacionadas à organização laboral, à formação e aos aspectos legais.

Objective: to describe and analyze what nurses perceive to be difficult and simple to implement in the process of educating people with ostomies Method: this qualitative, exploratory study was supported by historical materialism and the dialectical method. Data were collected from six nurses at a Rehabilitation Center in Rio de Janeiro, using a triangulation of methods (participant observation, interview, and analysis of nursing records), between December 2014 and March 2015. Results: the factors that hampered the educational process were inappropriate physical structure, and scarcity of financial and human resources. There was also found to be a deficit in the nurses' training and qualification. Enabling factors included: provision of equipment and adjuvants for people with ostomies, and creation of support groups for this clientele. Conclusion: it was concluded that execution of the educational process suffers from contradictions and discrepancies relating to work organization, training, and legal aspects.

Objetivo: describir y analizar lo que las enfermeras perciben como difícil y simple de implementar en el proceso de educación de las personas con ostomías Método: este estudio cualitativo, exploratorio, se sustenta en el materialismo histórico y el método dialéctico. Se recolectaron datos de seis enfermeras en un Centro de Rehabilitación de Río de Janeiro, mediante una triangulación de métodos (observación participante, entrevista y análisis de registros de enfermería), entre diciembre de 2014 y marzo de 2015. Resultados: los factores que obstaculizaron el proceso educativo fueron estructura física inadecuada y escasez de recursos financieros y humanos. También se constató un déficit en la formación y calificación de las enfermeras. Los factores habilitantes incluyeron: provisión de equipo y adyuvantes para personas con ostomías y creación de grupos de apoyo para esta clientela. Conclusión: se concluyó que la ejecución del proceso educativo adolece de contradicciones y discrepancias relacionadas con la organización del trabajo, la formación y los aspectos legales.

Criança com estoma nos estudos de Pós-Graduação Stricto Sensu em Enfermagem: destacando aspectos epistemológicos / Child with stoma in Nursing post-graduation studies: epistemological aspects / Niño con estoma en estudios de Postgrado en Enfermería: destacando aspectos

Objetivo: analisar as dissertações e teses defendidas nos cursos de Pós-Graduação Stricto Sensu em Enfermagem, no Brasil, relativas ao tema criança com estoma, destacando seus aspectos epistemológicos. Método: estudo documental, descritivo, considerando o recorte temporal entre 2009 e 2019. Utilizou-se a Metodologia de Categorização Epistemológica para a Pesquisa na Enfermagem. Resultados: selecionaram-se doze estudos: dez dissertações de mestrado e duas teses de doutorado. Nota-se o predomínio de estudos na área/campo epistêmico assistencial, na linha de pesquisa: Processo de Cuidar em Saúde e Enfermagem. Identificou-se um maior interesse de estudos no contexto domiciliar e ambulatorial. Há predomínio da abordagem qualitativa e uso da entrevista para coleta de dados. Conclusão: os aspectos epistemológicos destacados possibilitam afirmar que as dissertações e teses relacionadas ao tema estão predominantemente orientadas para um pragmatismo epistemológico da assistência de enfermagem à criança com estoma e sua família, com objetos científicos delimitados para alcançar a compreensão desse fenômeno.

Objective: to examine postgraduate Nursing dissertations and theses defended in Brazil on the subject of children with stoma, highlighting their epistemological aspects. Method: this descriptive study considered studies published between 2009 and 2019 using the Epistemological Categorization methodology for research in Nursing. Results: twelve studies were selected: ten master's dissertations and two doctoral theses. The predominant epistemic area/field was "care", in the research line: "care process in health, and nursing". Studies were found to show greater interest in the home and outpatient context. The qualitative approach and data collection by interview predominated. Conclusion: from the epistemological aspects highlighted, it can be said that the dissertations and theses on the subject of children with stomata were predominantly oriented towards an epistemological pragmatism in nursing care for children with stoma and their families, with scientific objects delimited to achieve an understanding of this phenomenon.

Objetivo: analizar las disertaciones y tesis de posgrado en Enfermería defendidas en Brazil sobre el tema de niños con estoma, destacando sus aspectos epistemológicos. Método: este estudio descriptivo consideró estudios publicados entre 2009 y 2019 utilizando la metodología de Categorización Epistemológica para la investigación en Enfermería. Resultados: se seleccionaron doce estudios: diez tesis de maestría y dos tesis doctorales. El área / campo epistémico predominante fue el "cuidado", en la línea de investigación: "proceso de cuidado en salud y enfermería". Se encontró que los estudios muestran un mayor interés en el contexto domiciliario y ambulatorio. Predominó el enfoque cualitativo y la recolección de datos por entrevista. Conclusión: a partir de los aspectos epistemológicos destacados, se puede decir que las disertaciones y tesis sobre el tema de los niños con estoma estuvieron orientadas predominantemente hacia un pragmatismo epistemológico en la atención de enfermería al niño con estoma y sus familias, con objetos científicos delimitados para lograr un entendimiento. de este fenómeno.