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1.
J Wound Care ; 33(Sup6): S8-S12, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38843047

RESUMO

OBJECTIVE: Fournier's gangrene (FG) is a rare and serious disorder which is associated with high mortality. In the literature, there is no study evaluating clinician-, patient- and disease-related factors affecting disease outcomes according to aetiological variation in FG. In our study, laboratory results and Uludag Fournier's Gangrene Severity Index (UFGSI) score, clinical characteristics and mortality rates were compared between FG originating from perianal or from urogenital regions. METHOD: Platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) and UFGSI risk scores were calculated in patients with FG at presentation to the emergency department. The patients were assigned to two groups according to FG aetiology. RESULTS: It was observed that the number of debridement interventions and the need for colostomy were significantly greater in the perianal FG group, while the need for flap or reconstruction was significantly (p=0.002) higher in the genitourinary FG group. No significant difference was detected in mortality between groups and the difference in aetiology had no significant effect on the results of the neutrophil-to-lymphocyte ratio, LRINEC or UFGSI scores. CONCLUSION: Laboratory results and UFGSI score were helpful in assessing disease severity independently from aetiology. The higher number of debridement interventions to protect anal function in the perianal group and the greater need for reconstructive surgery in the urogenital group were identified as factors that prolonged length of hospital stay.


Assuntos
Desbridamento , Gangrena de Fournier , Humanos , Gangrena de Fournier/terapia , Gangrena de Fournier/mortalidade , Masculino , Pessoa de Meia-Idade , Feminino , Idoso , Índice de Gravidade de Doença , Adulto , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Colostomia
2.
PLoS One ; 19(6): e0305047, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38843261

RESUMO

BACKGROUND: Ostomy surgery is a common procedure that poses various challenges for patients and healthcare professionals. There are numerous guidelines addressing different ostomy-related problems (ORPs) and supporting an interdisciplinary approach for ostomy care, but evidence-based literature for optimizing drug therapy after ostomy surgery is lacking. AIM: To investigate and characterize typical ORPs in relation to drug therapy and provide best practice recommendations from a pharmaceutical point of view. METHODS: Patients with an ileo- or colostomy were consecutively enrolled in a prospective, interventional monocentric cohort study during hospitalization, with particular attention to medication. A clinical pharmacist assessed DRPs by performing level 3 medication reviews and patient interviews. Pharmacists' interventions (PIs) were evaluated by two senior clinical pharmacists and documented in DokuPIK (Documentation of Pharmacists' Interventions in the Hospital). Following interdisciplinary discussions, physicians either accepted or rejected the proposed changes in drug therapy. Comparisons were made between ileostomy and colostomy patients regarding type and extent of PIs. RESULTS: Out of the 80 patients included in the cohort, 54 (67.5%) had an ileostomy and 26 (32.5%) a colostomy. In this study, 288 PIs were documented (234 ileostomy vs. 54 colostomy), of wich 94.0% were accepted and implemented by the physicians. The most common reason for PIs in both subgroups (29.6% ileostomy vs. 26.1% colostomy) was a missing drug although indicated (e.g. no loperamide, but high stoma output). The proportion of PIs associated with the ostomy was higher in ileostomy patients (48.3% ileostomy vs. 31.5% colostomy; p = 0.025). Typical ORPs were extracted and analyzed as case studies including recommendations for their respective management and prevention. CONCLUSION: This study highlights the importance of clinical pharmacists being a part of interdisciplinary teams to collaboratively improve ostomy care and patient safety. Especially ileostomy patients are more vulnerable for ORPs in the context of drug therapy and need to be monitored carefully.


Assuntos
Farmacêuticos , Humanos , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Estudos Prospectivos , Colostomia , Ileostomia , Idoso de 80 Anos ou mais , Conduta do Tratamento Medicamentoso/normas , Estomia , Guias de Prática Clínica como Assunto , Adulto
3.
BMC Gastroenterol ; 24(1): 194, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38840108

RESUMO

BACKGROUND: This study aimed to compare low Hartmann's procedure (LHP) with abdominoperineal resection (APR) for rectal cancer (RC) regarding postoperative complications. METHOD: RC patients receiving radical LHP or APR from 2015 to 2019 in our center were retrospectively enrolled. Patients' demographic and surgical information was collected and analyzed. Propensity score matching (PSM) was used to balance the baseline information. The primary outcome was the incidence of major complications. All the statistical analysis was performed by SPSS 22.0 and R. RESULTS: 342 individuals were primarily included and 134 remained after PSM with a 1:2 ratio (50 in LHP and 84 in APR). Patients in the LHP group were associated with higher tumor height (P < 0.001). No significant difference was observed between the two groups for the incidence of major complications (6.0% vs. 1.2%, P = 0.290), and severe pelvic abscess (2% vs. 0%, P = 0.373). However, the occurrence rate of minor complications was significantly higher in the LHP group (52% vs. 21.4%, P < 0.001), and the difference mainly lay in abdominal wound infection (10% vs. 0%, P = 0.006) and bowel obstruction (16% vs. 4.8%, P = 0.028). LHP was not the independent risk factor of pelvic abscess in the multivariate analysis. CONCLUSION: Our data demonstrated a comparable incidence of major complications between LHP and APR. LHP was still a reliable alternative in selected RC patients when primary anastomosis was not recommended.


Assuntos
Complicações Pós-Operatórias , Protectomia , Pontuação de Propensão , Neoplasias Retais , Humanos , Neoplasias Retais/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Protectomia/métodos , Protectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Idoso , Colostomia/métodos , Colostomia/efeitos adversos , Incidência
4.
Int J Colorectal Dis ; 39(1): 68, 2024 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-38714581

RESUMO

PURPOSE: Anastomotic leakage is a serious complication of colorectal cancer surgery, prolonging hospital stays and impacting patient prognosis. Preventive colostomy is required in patients at risk of anastomotic fistulas. However, it remains unclear whether the commonly used loop colostomy(LC) or loop ileostomy(LI) can reduce the complications of colorectal surgery. This study aims to compare perioperative morbidities associated with LC and LI following anterior rectal cancer resection, including LC and LI reversal. METHODS: In this meta-analysis, the Embase, Web of Science, Scopus, PubMed, and Cochrane Library databases were searched for prospective cohort studies, retrospective cohort studies, and randomized controlled trials (RCTs) on perioperative morbidity during stoma development and reversal up to July 2023, The meta-analysis included 10 trials with 2036 individuals (2 RCTs and 8 cohorts). RESULTS: No significant differences in morbidity, mortality, or stoma-related issues were found between the LI and LC groups after anterior resection surgery. However, patients in the LC group exhibited higher rates of stoma prolapse (RR: 0.39; 95%CI: 0.19-0.82; P = 0.01), retraction (RR: 0.45; 95%CI: 0.29-0.71; P < 0.01), surgical site infection (RR: 0.52; 95%CI: 0.27-1.00; P = 0.05) and incisional hernias (RR: 0.53; 95%CI: 0.32-0.89; P = 0.02) after stoma closure compared to those in the LI group. Conversely, the LI group showed higher rates of dehydration or electrolyte imbalances(RR: 2.98; 95%CI: 1.51-5.89; P < 0.01), high-output(RR: 6.17; 95%CI: 1.24-30.64; P = 0.03), and renal insufficiency post-surgery(RR: 2.51; 95%CI: 1.01-6.27; P = 0.05). CONCLUSION: Our study strongly recommends a preventive LI for anterior resection due to rectal cancer. However, ileostomy is more likely to result in dehydration, renal insufficiency, and intestinal obstruction. More multicenter RCTs are needed to corroborate this.


Assuntos
Colostomia , Ileostomia , Complicações Pós-Operatórias , Neoplasias Retais , Humanos , Neoplasias Retais/cirurgia , Ileostomia/efeitos adversos , Colostomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Masculino , Fístula Anastomótica/etiologia , Fístula Anastomótica/prevenção & controle , Feminino , Pessoa de Meia-Idade
5.
Chirurgia (Bucur) ; 119(2): 156-170, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38743829

RESUMO

Introduction: Globally, cancer is the leading cause of mortality, with colorectal neoplasia ranking third in terms of incidence and mortality worldwide. Patients face disease- and treatment-specific impacts, which can significantly influence their quality of life (QoL). Aim: This study aimed to propose a protocol to measure in-hospital and long-term QoL in patients with complicated colorectal cancer (CRC). Material and Methods: multicenter prospective observational cohort study. Results: QoL is a multidimensional concept that includes criteria for physical, mental, emotional, and social functionality as perceived by the patient. Periodically evaluating QoL offers measurable and objective tools to intervene at the appropriate time to decrease the Years of Life Lost and Years Lived with Disabilities for CRC patients. However, a structured and functional system requires dedicated and common institutional effort. A pilot study using this protocol included 69 patients, 65.12+-10.92 years, M:F ratio = 56.5:43.5%. Surgical procedure was right hemicolectomy, left colectomy, transverse colectomy, sigmoidectomy, total colectomy, rectal resection, and colorectal resection with stoma (ileostomy or colostomy) in 21.7%, 11.6%, 2.9%, 11.6%, 1.4%, 23.2%, and 27.5% of the cases, respectively. The mean Global Health Status Score, Symptom Score, and Functional Score was 82.36+-18.60, 11.89+-10.27, and 86.27, 74.50-94.11, respectively. Conclusions: CRC diagnosis has major effects on patients physical and psychological status, and concentrated efforts should be made by the involved medical team and healthcare systems to improve QoL throughout the treatment pathway.


Assuntos
Colectomia , Neoplasias Colorretais , Estadiamento de Neoplasias , Qualidade de Vida , Humanos , Masculino , Feminino , Estudos Prospectivos , Idoso , Colectomia/métodos , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/psicologia , Neoplasias Colorretais/patologia , Pessoa de Meia-Idade , Resultado do Tratamento , Projetos Piloto , Colostomia/psicologia , Estudos de Coortes
6.
Int J Colorectal Dis ; 39(1): 81, 2024 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-38809269

RESUMO

BACKGROUND: Clostridium difficile infection (CDI) has been described in the early post-operative phase after stoma reversal. This systematic review aimed to describe the incidence of CDI after stoma reversal and to identify pre-operative variables correlated with an increased risk of infection. METHODS: A systematic review of the literature was conducted according to the PRISMA guidelines in March 2024. Manuscripts were included if reported at least one patient with CDI-associated diarrhoea following stoma reversal (colostomy/ileostomy). The primary outcome of interest was the incidence of CDI; the secondary outcome was the comparison of clinical variables (age, sex, time to stoma reversal, neo-adjuvant and adjuvant therapies after index colorectal procedure) in CDI-positive versus CDI-negative patients. A meta-analysis was performed when at least three studies reported on those variables. RESULTS: Out of 43 eligible manuscripts, 1 randomized controlled trial and 10 retrospective studies were selected, including 17,857 patients (2.1% CDI). Overall, the mean age was 64.3 ± 11.6 years in the CDI group and 61.5 ± 12.6 years in the CDI-negative group (p = 0.51), with no significant difference in sex (p = 0.34). Univariable analyses documented that the mean time to stoma reversal was 53.9 ± 19.1 weeks in CDI patients and 39.8 ± 15.0 weeks in CDI-negative patients (p = 0.40) and a correlation between neo-adjuvant and adjuvant treatments with CDI (p < 0.001). A meta-analysis was performed for time to stoma reversal, age, sex, and neo-adjuvant therapies disclosing no significant differences for CDI (stoma delay, MD 11.59; 95%CI  24.32-1.13; age, MD 0.97; 95%CI 2.08-4.03; sex, OR1.11; 95%CI 0.88-1.41; neo-adjuvant, OR0.81; 95%CI 0.49-1.35). Meta-analysis including patients who underwent adjuvant therapy evidenced a higher risk of CDI (OR 2.88; 95%CI 1.01-8.17, p = 0.11). CONCLUSION: CDI occurs in approximately 2.1% of patients after stoma reversal. Although a trend of increased delay in stoma reversal and a correlation with chemotherapy were documented in CDI patients, the use of adjuvant therapy was the only possible risk factor documented on meta-analysis. PROSPERO REGISTRATION NUMBER: CRD42023484704.


Assuntos
Clostridioides difficile , Infecções por Clostridium , Estomas Cirúrgicos , Humanos , Infecções por Clostridium/etiologia , Infecções por Clostridium/microbiologia , Estomas Cirúrgicos/efeitos adversos , Estomas Cirúrgicos/microbiologia , Clostridioides difficile/isolamento & purificação , Pessoa de Meia-Idade , Masculino , Feminino , Incidência , Fatores de Risco , Idoso , Ileostomia/efeitos adversos , Colostomia/efeitos adversos
7.
BMJ Case Rep ; 17(5)2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38821566

RESUMO

This case highlights a rare presentation of diverticulitis of the sigmoid colon with perforation into the retroperitoneum complicated by abscess, vertebral osteomyelitis and acute lower extremity ischemia. A late 40-year-old man presented to an emergency department with acute ischemia of his left lower extremity. He was tachycardic with a leucocytosis, an unremarkable abdominal exam and a pulseless, insensate and paralysed left lower extremity. Imaging revealed sigmoid thickening, an abscess adjacent to iliac vasculature and occlusion of the left popliteal artery. The abscess came in contact with prior spine anterior lumbar interbody fusion (ALIF) hardware at L5-S1 vertebrae. The patient was taken urgently to the operating room for embolectomy, thrombectomy and fasciotomy. He was started on antibiotics and later underwent operative drainage with debridement for osteomyelitis. Non-operative management of the complicated diverticulitis failed, necessitating open sigmoidectomy with colostomy. 1 year later, he was symptom-free and the colostomy was reversed.


Assuntos
Isquemia , Humanos , Masculino , Adulto , Isquemia/etiologia , Isquemia/diagnóstico , Espaço Retroperitoneal , Osteomielite/complicações , Osteomielite/diagnóstico , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/cirurgia , Extremidade Inferior/irrigação sanguínea , Antibacterianos/uso terapêutico , Abscesso Abdominal/cirurgia , Abscesso Abdominal/etiologia , Embolectomia/métodos , Colostomia , Abscesso/complicações , Abscesso/terapia , Abscesso/diagnóstico
8.
BMC Pregnancy Childbirth ; 24(1): 374, 2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38755532

RESUMO

Colorectal cancer (CRC) in pregnancy is sporadic. We reported a case of a woman at 23 + 4 weeks of gestation who presented with abdominal pain. The patient underwent an ultrasound and MRI, during which a colonic mass was noted. Considering a probable incomplete intestinal obstruction, a colonoscopy, biopsy, and colonic stenting were performed by a multidisciplinary team. However, sudden hyperthermia and CT demonstrated intestinal perforation, and an emergency caesarean section and colostomy were conducted. The histological analysis confirmed moderately high-grade adenocarcinoma.


Assuntos
Adenocarcinoma , Cesárea , Neoplasias Colorretais , Perfuração Intestinal , Complicações Neoplásicas na Gravidez , Humanos , Feminino , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Gravidez , Neoplasias Colorretais/cirurgia , Complicações Neoplásicas na Gravidez/cirurgia , Cesárea/efeitos adversos , Adulto , Adenocarcinoma/complicações , Adenocarcinoma/cirurgia , Colostomia , Dor Abdominal/etiologia
9.
Adv Skin Wound Care ; 37(6): 312-318, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38767423

RESUMO

OBJECTIVE: To identify the lived experiences, quality of life (QoL), and level of ostomy adjustment (OA) in patients after colorectal cancer with a permanent colostomy (PC). METHODS: In this parallel-design mixed-methods study, the researchers interviewed 14 patients after colorectal cancer whose PC was created more than 1 year prior. Qualitative data were interpreted using hermeneutic interpretive phenomenological design. Quantitative data were collected with the Stoma QoL Scale and OA Inventory-23. RESULTS: The mean age of the participants was 61.5 (SD, 10.0) years, and the mean PC duration was 7.7 (SD, 5.0) years. Mean QoL and OA scores were just above the median. Three superordinate themes consisting of nine themes emerged from the analysis: (1) early experiences (acceptance, medical problems, and emotional changes); (2) long-term experiences (physiologic experiences, psychosocial experiences, economic experiences, and coping strategies); (3) feelings and expectations about the future (worries and expectations). CONCLUSIONS: Even individuals who have been living with a PC for a long time may not be fully adapted to the process and may not have internalized lifestyle changes. Nurses should provide support to individuals with a PC through routine follow-ups, social support, and facilitative healthcare strategies regardless of the length of time since PC creation.


Assuntos
Adaptação Psicológica , Neoplasias Colorretais , Colostomia , Pesquisa Qualitativa , Qualidade de Vida , Humanos , Colostomia/psicologia , Neoplasias Colorretais/psicologia , Neoplasias Colorretais/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Qualidade de Vida/psicologia , Idoso
10.
BMC Surg ; 24(1): 111, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38622633

RESUMO

BACKGROUND: Hartmann's reversal, a complex elective surgery, reverses and closes the colostomy in individuals who previously underwent a Hartmann's procedure due to colonic pathology like cancer or diverticulitis. It demands careful planning and patient optimisation to help reduce postoperative complications. Preoperative evaluation of body composition has been useful in identifying patients at high risk of short-term postoperative outcomes following colorectal cancer surgery. We sought to explore the use of our in-house derived Artificial Intelligence (AI) algorithm to measure body composition within patients undergoing Hartmann's reversal procedure in the prediction of short-term postoperative complications. METHODS: A retrospective study of all patients who underwent Hartmann's reversal within a single tertiary referral centre (Western) in Melbourne, Australia and who had a preoperative Computerised Tomography (CT) scan performed. Body composition was measured using our previously validated AI algorithm for body segmentation developed by the Department of Surgery, Western Precinct, University of Melbourne. Sarcopenia in our study was defined as a skeletal muscle index (SMI), calculated as Skeletal Muscle Area (SMA) /height2 < 38.5 cm2/m2 in women and < 52.4 cm2/m2 in men. RESULTS: Between 2010 and 2020, 47 patients (mean age 63.1 ± 12.3 years; male, n = 28 (59.6%) underwent body composition analysis. Twenty-one patients (44.7%) were sarcopenic, and 12 (25.5%) had evidence of sarcopenic obesity. The most common postoperative complication was surgical site infection (SSI) (n = 8, 17%). Sarcopenia (n = 7, 87.5%, p = 0.02) and sarcopenic obesity (n = 5, 62.5%, p = 0.02) were significantly associated with SSIs. The risks of developing an SSI were 8.7 times greater when sarcopenia was present. CONCLUSION: Sarcopenia and sarcopenic obesity were related to postoperative complications following Hartmann's reversal. Body composition measured by a validated AI algorithm may be a beneficial tool for predicting short-term surgical outcomes for these patients.


Assuntos
Proctocolectomia Restauradora , Sarcopenia , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Sarcopenia/complicações , Sarcopenia/diagnóstico , Estudos Retrospectivos , Inteligência Artificial , Anastomose Cirúrgica/métodos , Resultado do Tratamento , Colostomia/efeitos adversos , Proctocolectomia Restauradora/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Obesidade/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia
11.
Br J Community Nurs ; 29(4): 195-198, 2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38564441

RESUMO

Community nurses are often the common link with people in the community with healthcare services. Community nurses are involved in the care of people living with a temporary or permanent stoma and might be asked specialist questions of which they may feel uncertain of appropriate responses. This article describes some basic facts about stoma as well as specialist dietary considerations; which can be used to improve symptoms such as constipation as well as how to prevent issues such as a food bolus obstruction. An increased understanding of stoma-related dietary needs among community nurses will likely improve care outcomes, as they will feel more equipped to offer tailored guidance and support.


Assuntos
Colostomia , Estomas Cirúrgicos , Humanos , Ileostomia , Dieta
12.
Br J Community Nurs ; 29(4): 184-188, 2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38564443

RESUMO

Each year an estimated 13 500 stoma surgeries are carried out in the UK (Kettle, 2019). Stoma surgery may involve the formation of a colostomy or an ileostomy. The person with a stoma may require help and support from the community nurse. This article aims to update readers on the indications for colostomy and ileostomy surgery and to enable them to support ostomates to reduce the risks of complications.


Assuntos
Colostomia , Estomas Cirúrgicos , Humanos , Ileostomia , Complicações Pós-Operatórias
13.
Surg Clin North Am ; 104(3): 579-593, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38677822

RESUMO

Fecal ostomy creation is a commonly performed procedure with many indications. Better outcomes occur when preoperative patient education and stoma site marking are provided. Despite a seemingly simple operation, ostomy creation is often difficult and complications are common. Certain risk factors, particularly obesity, are strongly associated with stoma-related complications. The ability to optimize the ostomy and stoma in the operating room and to troubleshoot frequently encountered post-operative stoma-related issues are critical skills for surgeons and ostomy nurses alike.


Assuntos
Colostomia , Humanos , Colostomia/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estomas Cirúrgicos/efeitos adversos , Ileostomia/métodos , Ileostomia/efeitos adversos , Fatores de Risco
14.
Surg Endosc ; 38(5): 2777-2787, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38580758

RESUMO

BACKGROUND: Current guidelines recommend resection with primary anastomosis with diverting loop ileostomy over Hartmann's procedure if deemed safe for acute diverticulitis. The primary objective of the current study was to compare the utilization of these strategies and describe nationwide ostomy closure patterns and readmission outcomes within 1 year of discharge. METHODS: This was a retrospective, population-based, cohort study of United States Hospitals reporting to the Nationwide Readmissions Database from January 2011 to December 2019. There were 35,774 patients identified undergoing non-elective primary anastomosis with diverting loop ileostomy or Hartmann's procedure for acute diverticulitis. Rates of ostomy closure, unplanned readmissions, and complications were compared. Cox proportional hazards and logistic regression models were used to control for patient and hospital-level confounders as well as severity of disease. RESULTS: Of the 35,774 patients identified, 93.5% underwent Hartmann's procedure. Half (47.2%) were aged 46-65 years, 50.8% female, 41.2% publicly insured, and 91.7% underwent open surgery. Primary anastomosis was associated with higher rates of 1-year ostomy closure (83.6% vs. 53.4%, p < 0.001) and shorter time-to-closure [median 72 days (Interquartile range 49-103) vs. 115 (86-160); p < 0.001]. Primary anastomosis was associated with increased unplanned readmissions [Hazard Ratio = 2.83 (95% Confidence Interval 2.83-3.37); p < 0.001], but fewer complications upon stoma closure [Odds Ratio 0.51 (95% 0.42-0.63); p < 0.001]. There were no differences in complications between primary anastomosis and Hartmann's procedure during index admission [Odds Ratio = 1.13 (95% Confidence Interval 0.96-1.33); p = 0.137]. CONCLUSION: Patients who undergo primary anastomosis for acute diverticulitis are more likely to undergo ostomy reversal and experience fewer postoperative complications upon stoma reversal. These data support the current national guidelines that recommend primary anastomosis in appropriate cases of acute diverticulitis requiring operative treatment.


Assuntos
Anastomose Cirúrgica , Colostomia , Ileostomia , Readmissão do Paciente , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Ileostomia/métodos , Anastomose Cirúrgica/métodos , Estudos Retrospectivos , Idoso , Readmissão do Paciente/estatística & dados numéricos , Estados Unidos , Colostomia/métodos , Colostomia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Doença Aguda , Alta do Paciente/estatística & dados numéricos , Doença Diverticular do Colo/cirurgia , Diverticulite/cirurgia , Adulto
15.
Surg Endosc ; 38(5): 2834-2841, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38605169

RESUMO

BACKGROUND: Stoma prolapse (SP) is a common stoma-related complication, particularly in loop colostomies. This study aimed to investigate potential risk factors for SP development after laparoscopic loop colostomy. METHODS: In total, data from 140 patients who underwent laparoscopic loop colostomy were analyzed between September 2016 and March 2022. Risk factors for SP were investigated retrospectively. RESULTS: The median follow-up duration after colostomy was 12.5 months, and SP occurred in 33 (23.6%) patients. Multivariate analysis showed that being overweight (body mass index ≥ 25; odds ratio [OR], 8.69; 95% confidential interval [CI], 1.61-46.72; p = 0.012) and having a thin rectus abdominis penetration of the stoma (< 8.9 mm; OR, 8.22; 95% CI, 2.50-27.05; p < 0.001) were independent risk factors for SP. Other patient characteristics and surgical factors associated with stoma construction were unrelated to SP development. CONCLUSIONS: Being overweight and the route penetrating the thinner rectus abdominis during stoma construction was associated with a significantly higher incidence of SP after laparoscopic loop colostomy. Selecting a construction site that penetrates the thicker rectus abdominis muscle may be crucial for preventing SP.


Assuntos
Colostomia , Laparoscopia , Estomas Cirúrgicos , Humanos , Colostomia/efeitos adversos , Colostomia/métodos , Feminino , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Masculino , Fatores de Risco , Pessoa de Meia-Idade , Estudos Retrospectivos , Estomas Cirúrgicos/efeitos adversos , Prolapso , Idoso , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Adulto , Incidência , Reto do Abdome , Sobrepeso/epidemiologia , Idoso de 80 Anos ou mais
17.
Eur J Oncol Nurs ; 70: 102590, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38677217

RESUMO

PURPOSE: With the prolonged survival time of patients with permanent colostomy for colorectal cancer, they and their spouses face tremendous pressure and development dilemmas that can easily lead to family adaptation crises. This qualitative study amid to explore the dyadic experiences of family resilience among Chinese patients with permanent colostomy and their spouses. METHODS: A phenomenological research method was adopted. Semi-structured, in-depth, face-to-face interviews with 10 dyads of patients with permanent colostomy and their spouses were recruited through purposive sampling from a public tertiary hospital in China from March 2023 to July 2023.The Dyadic interview analysis and Colaizzi methods were used to analyze the interview data. RESULTS: Three themes and nine subthemes were developed. (1) family crisis and dichotomous coping with stress-family crisis and coping pressure caused by enterostomy; (2) Adjustment and adaptation within the family-Joint adjustment and adaptation within the couple's family; and (3) integration and utilization of multi-dimensional social external resources (micro-level, meso-level, and macro-level). CONCLUSIONS: Couples living with permanent colostomy often undergo a complex emotional journey, experiencing varied levels of individual stress as they navigate social interactions and daily activities, which can contribute to a decline in family adaptation. With the help of the perspective of family advantage, health practitioners should pay attention to the evaluation of individual factors and family environmental resources, to fully mobilize advantage resources and give effective interventions to improve the family and social adaptation level of patients and their spouses.


Assuntos
Adaptação Psicológica , Neoplasias Colorretais , Colostomia , Pesquisa Qualitativa , Resiliência Psicológica , Cônjuges , Humanos , Feminino , Masculino , Colostomia/psicologia , Pessoa de Meia-Idade , Cônjuges/psicologia , China , Idoso , Neoplasias Colorretais/psicologia , Neoplasias Colorretais/cirurgia , Adulto , Estresse Psicológico , Família/psicologia
18.
BMC Pediatr ; 24(1): 207, 2024 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-38521911

RESUMO

BACKGROUND: Anorectal malformations (ARMs) are the most common congenital anomaly of the digestive tract. And colostomy should be performed as the first-stage procedure in neonates diagnosed with intermediate- or high-type ARMs. However, the most classic Pe˜na's colostomy still has some disadvantages such as complicated operation procedure, susceptibility to infection, a greater possibility of postoperative incision dehiscence, difficulty of nursing and large surgical trauma and incision scarring when closing the stoma. We aimed to explore the effectiveness of middle descending colon-double lumen ostomy (MDCDLO) in the treatment of high and intermediate types of anorectal malformations. METHODS: We retrospectively reviewed the data of patients who underwent MDCDLO for high or intermediate types of ARMs between June 2016 and December 2021 in our hospital. The basic characteristics were recorded. All patients were followed up monthly to determine if any complication happen. RESULTS: There were 17 boys and 6 girls diagnosed with high or intermediate types of ARMs in our hospital between June 2016 and December 2021. All 23 patients were cured without complications such as abdominal incision infection, stoma stenosis, incisional hernia, and urinary tract infection in the postoperative follow-up time of 6 months to 6 years except one case of proximal intestinal prolapse was restored under anesthesia. CONCLUSION: MDCDLO offers the advantages of simplicity, efficiency, safety, mild trauma, and small scarring in the treatment of high and intermediate types of anorectal malformations.


Assuntos
Malformações Anorretais , Recém-Nascido , Masculino , Feminino , Humanos , Malformações Anorretais/cirurgia , Malformações Anorretais/etiologia , Estudos Retrospectivos , Cicatriz/etiologia , Colo Descendente , Colostomia/efeitos adversos , Colostomia/métodos
20.
World J Surg ; 48(5): 1252-1260, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38488859

RESUMO

BACKGROUND: There is limited data to guide decision-making between performing a primary anastomosis and fashioning an end colostomy following emergency sigmoid colectomy for patients with sigmoid volvulus. The aim of this study was to compare the outcomes of these two approaches. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2006 to 2021 was retrospectively analyzed. Missing data were multiply imputed, and coarsened exact matching was performed to generate matched cohorts. Rates of major complications and other postoperative outcomes were evaluated among patients who had a primary anastomosis as compared with matched controls who had an end colostomy following emergency sigmoid colectomy. RESULTS: Overall, 4041 patients who had a primary anastomosis and 1240 who had an end colostomy met the inclusion criteria. After multiple imputation and coarsened exact matching, 895 patients who had a primary anastomosis had a matched control. The rate of major complications was lower in patients who had an end colostomy (33.2% vs. 36.7%), but this difference was not statistically significant (OR 0.86, 95% CI 0.70-1.05). Results were similar in subgroup analyses of higher-risk patients. There were no significant differences in overall complication rate, mortality, length of hospital stay, or readmission rate. Patients with a colostomy were more likely to be discharged to a care facility (OR 1.35, 95% CI 1.09-1.67). CONCLUSION: Differences in rates of major complications and many other outcomes after primary anastomosis as compared with end colostomy were not statistically significant following emergency sigmoid colectomy for sigmoid volvulus.


Assuntos
Anastomose Cirúrgica , Colectomia , Colostomia , Volvo Intestinal , Complicações Pós-Operatórias , Melhoria de Qualidade , Doenças do Colo Sigmoide , Humanos , Colectomia/métodos , Colectomia/efeitos adversos , Volvo Intestinal/cirurgia , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Colostomia/métodos , Anastomose Cirúrgica/métodos , Complicações Pós-Operatórias/epidemiologia , Doenças do Colo Sigmoide/cirurgia , Colo Sigmoide/cirurgia , Estados Unidos , Emergências
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