Abstract
Background and purpose
Despite the advances achieved in surgical techniques in recent years, an intestinal stoma is still needed in many patients undergoing colorectal surgery. However, the intestinal stoma may be associated with serious complications and the need for a second surgical procedure. In extreme cases, when it is not possible to access the abdominal cavity, the management of a complicated stoma is challenging. The purpose of this study was to describe the use of a Dacron vascular prosthesis (DVP) in patients with intestinal stoma complications.
Methods
In patients with a shallow, superficial stoma or mucocutaneous separation (MCS), we sutured the prosthesis in the intestinal loop (at the edge of an intestinal fistula) to create a device to direct the fecal content to the collection bag.
Results
We included 9 patients in this series (colorectal cancer, n = 5; Crohn’s disease, n = 2; giant abdominal hernia and morbid obesity, n = 2). The results obtained were promising since they showed good evolution in patients with severe intestinal complications and an impossibility of surgical correction of the stoma. Five patients presented complete healing, and two patients presented partial healing. There were two deaths caused by sepsis, which were not related to the surgical procedure. With this technique, there was a reduction in the leakage of intestinal contents into the peritoneal cavity and an increase in the healing of the peristomal dermatitis in most of the patients. The DVP could possibly represent a surgical alternative in selected patients with complicated stomas when surgical correction may not be a suitable option.
Conclusions
The authors recommend this technique for selected complex cases of stoma complications after unsuccessful attempts to adapt collecting equipment. The placement of the DVP allowed the peristomal skin to heal and improved the contamination of the peritoneal cavity.
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References
Gilshtein H, Ghuman A, Dawoud M et al (2020) Indications for, and outcomes of, end ileostomy revision procedures. Colorectal Dis. https://doi.org/10.1111/codi.15449
Tsujinaka S, Tan KY, Miyakura Y et al (2020) Current management of intestinal stomas and their complications. J Anus Rectum Colon 4(1):25–33. https://doi.org/10.23922/jarc.2019-032
Kwiatt M, Kawata M (2013) Avoidance and management of stomal complications. Clin Colon Rectal Surg. 26(2):112–121. https://doi.org/10.1055/s-0033-1348050
Stelton S (2019) CE: Stoma and peristomal skin care: a clinical review. Am J Nurs. 119(6):38–45. https://doi.org/10.1097/01.NAJ.0000559781.86311.64
Steinhagen E, Colwell J, Cannon LM (2017) Intestinal stomas-postoperative stoma care and peristomal skin complications. Clin Colon Rectal Surg. 30(3):184–192. https://doi.org/10.1055/s-0037-1598159
Nagano M, Ogata Y, Ikeda M, Tsukada K, Tokunaga K, Iida S (2019) Peristomal moisture-associated skin damage and independence in pouching system changes in persons with new fecal ostomies. J Wound Ostomy Continence Nurs. 46(2):137–142. https://doi.org/10.1097/WON.0000000000000491
Krishnamurty DM, Blatnik J, Mutch M (2017) Stoma Complications. Clin Colon Rectal Surg. 30(3):193–200. https://doi.org/10.1055/s-0037-1598160
Miyo M, Takemasa I, Ikeda M, Tujie M, Hasegawa J, Ohue M, Kato T, Mizushima T, Doki Y, Mori M (2017) The influence of specific technical maneuvers utilized in the creation of diverting loop-ileostomies on stoma-related morbidity. Surg Today. 47(8):940–950. https://doi.org/10.1007/s00595-017-1481-2
Rivet EB (2019) Ostomy management: a model of interdisciplinary care. Surg Clin North Am. 99(5):885–898. https://doi.org/10.1016/j.suc.2019.06.007
de Donato G, Setacci F, Galzerano G, Ruzzi U, Borrelli MP, Mazzitelli G, Setacci C (2014) Prosthesis infection: prevention and treatment. J Cardiovasc Surg (Torino). 55(6):779–792
Féres O, Feitosa MR, Parra RS, da Rocha JJR (2020) Dacron vascular prosthesis for superficially complicated stomas. Tech Coloproctol. https://doi.org/10.1007/s10151-020-02344-0
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OF, MRF, RSP, and JJRR designed, planned, and conducted the study. All authors contributed to data collection, analysis, and interpretation of data. RSP and MRF wrote the final draft, and OF and JJRR critically revised the manuscript. The final manuscript was approved by all authors. All authors made a substantial contribution to the concept or design of the work; acquisition, analysis, or interpretation of data; drafted the article or revised it critically for important intellectual content; and approved the version to be published.
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Féres, O., da Rocha, J.J.R., Feitosa, M.R. et al. A novel technique for superficial complicated stomas using the Dacron vascular prosthesis. Langenbecks Arch Surg 406, 1239–1244 (2021). https://doi.org/10.1007/s00423-021-02194-w
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DOI: https://doi.org/10.1007/s00423-021-02194-w