Advertisement

Optimizing Stoma Function and Quality of Life: Best Practices in Planned and Unplanned Stoma Creation

  • Lisa M. Cannon
  • Dana M. Hayden
Chapter

Abstract

Permanent or temporary intestinal diversion is necessary in the management of a number of colon and rectal disorders. This chapter will cover basic indications for stoma formation and considerations relating to choice of stoma and will review operative setup and approach for the most commonly created ostomies with an additional focus on minimally invasive approach to stoma formation. It will then review best pouching practices, common pitfalls and difficult scenarios, and outcomes including quality of life (QoL).

Keywords

Ileostomy Stoma Colostomy Ostomate minimally invasive surgery Obesity Wound ostomy care nurse 

Notes

Acknowledgments

Special thanks to Jan Colwell, RN, MS, CWOCN, FAAN, Michele Kaplon–Jones, MSN, RN, ANP-BC, CWOCN, and Dr. Yalani Vignaswaran, MD, for their photo contributions.

References

  1. 1.
    Danielsen AK, Christensen BM, Mortensen J, Voergaard LL, Herlufsen P, Balleby L. Establishment of a regional Danish database for patients with a stoma. Color Dis. 2014;17:27–33.CrossRefGoogle Scholar
  2. 2.
    Turnbull G. The ostomy files: ostomy statistics: the $64,000 question. Ostomy Wound Manage. 2003;49:22–3.PubMedGoogle Scholar
  3. 3.
    Warschkow R, Ebinger SM, Brunner W, Schmied BM, Marti L. Survival after abdominoperineal and sphincter-preserving resection in nonmetastatic rectal cancer: a population based time trend and propensity score-matched SEER analysis. Gastroenterol Res Pract. 2017;6058907  https://doi.org/10.1155/2017/6058907; epub ahead of print.
  4. 4.
    Godat L, Kobayashi L, Chang DC, Coimbra R. Do trauma stomas ever get reversed? J Am Coll Surg. 2014;219:70–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Salem L, Anaya DA, Flum DR. Temporal changes in the management of diverticulitis. J Surg Research. 2005;124:318–23.CrossRefGoogle Scholar
  6. 6.
    Singh S, Ding NS, Mathis KL, Dulai PS, Farrell AM, Pemberton JH, et al. Systematic review with meta-analysis: faecal diversion for management of perianal Crohn’s disease. Aliment Pharmacol Ther. 2015;42(7):783–92.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Hendren S, Hammond K, Glasgow SC, Perry WB, Buie WD, Steele SR, et al. Clinical practice guidelines for ostomy surgery. Dis Colon Rectum. 2015;58(4):375–87.CrossRefPubMedGoogle Scholar
  8. 8.
    Gachabayov M, Oberkofler CE, Tuech JJ, Hahnloser D, Bergamaschi R. Resection with primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a systematic review and meta-analysis. Color Dis. 2018 Sep;20(9):753–70.CrossRefGoogle Scholar
  9. 9.
    Schmidt S, Ismail T, Puhan MA, Soll C, Breitenstein S. Meta-analysis of surgical strategies in perforated left colonic diverticulitis with generalized peritonitis. Langenbeck’s Arch Surg. 2018;403(4):425–33.CrossRefGoogle Scholar
  10. 10.
    Gibbons G, Tan CJ, Bartolo DCC, Filgate R, Makin G, Barwood N, et al. Emergency left colonic resection on an acute surgical unit: does subspecialization improve outcomes? ANZ J Surg. 2015;85:739–43.CrossRefGoogle Scholar
  11. 11.
    Cataldo PA. Technical tips for stoma creation in the challenging patient. Clin Colon and Rectal Surg. 2008;21(1):17–22.CrossRefGoogle Scholar
  12. 12.
    Berry K, Carmel J, Gutman N, Link M, Markt B, Metzger B, et al. ASCRS and WOCN joint position statement on the value of preoperative stoma marking for patients undergoing fecal ostomy surgery. J Wound Ostomy Continence Nurs. 2007;34(6):627–8.CrossRefGoogle Scholar
  13. 13.
    Thorson AG. Preoperative considerations. In: Cataldo PA, Mackeigan JM, editors. Intestinal stomas: principles, techniques and management. 2nd ed. New York: Marcel Dekker, Inc; 2004. p. 57–64.CrossRefGoogle Scholar
  14. 14.
    Colwell JC. The role of obesity in the patient undergoing colorectal surgery and fecal diversion: a review of the literature. Ostomy Wound Manage. 2014;60(1):24–8.PubMedGoogle Scholar
  15. 15.
    Hardt J, Meerpohl JJ, Metzendorf MI, Kienle P, Post S, Herrle F. Lateral pararectal versus transrectal stoma placement for prevention of parastomal herniation. Cochrane Database Syst Rev. 2013;(11):CD009487.Google Scholar
  16. 16.
    Cottam J, Richards K, Hasted A, Blackman A. Results of a nationwide prospective audit of stoma complications within 3 weeks of surgery. Color Dis. 2007;9:834–8.CrossRefGoogle Scholar
  17. 17.
    Parmar KL, Zammit M, Smith A, Kenyon D, Lees NP. A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network. Color Dis. 2011;13:935–8.CrossRefGoogle Scholar
  18. 18.
    Cataldo P. Technical tips for the difficult stoma. In: Cataldo PA, Mackeigan JM, editors. Intestinal stomas: principles, techniques and management. 2nd ed. New York: Marcel Dekker, Inc; 2004. p. 411–25.CrossRefGoogle Scholar
  19. 19.
    Hyman NH. End ileostomy. In: Cataldo PA, Mackeigan JM, editors. Intestinal Stomas: Principles, techniques and management. 2nd ed. New York: Marcel Dekker, Inc; 2004. p. 159–64.Google Scholar
  20. 20.
    Ng KH, Ng DC, Cheung HY, Wong JC, Yau KK, Chung CC, et al. Obstructive complications of laparoscopically created defunctioning ileostomy. Dis Colon Rectum. 2008;51:1664–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Hasegawa J, Hirota M, Min Kim H, Mikata S, Shimizu J, Soma Y, et al. Single-incision laparoscopic stoma creation: experience with 31 consecutive cases. Asian J Endosc Surg. 2013;6:181–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Shah A, Moftah M, Hadi Nahar Al-Furaji H, Cahill RA. Standardized technique for single port laparoscopic ileostomy and colostomy. Color Dis. 2014;16:0248–O252.CrossRefGoogle Scholar
  23. 23.
    Subhas G, Kim E, Gupta A, Mittal VK, Mckendrick A. Laparoscopic loop ileostomy with a single-port stab incision technique. Tech Coloproctol. 2011;15:337–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Zaghiyan KN, Murrell Z, Fleshner PR. Scarless single-incision laparoscopic loop ileostomy: a novel technique. Dis Colon Rectum. 2011;54(12):1542–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Baloyiannis I, Christodoulidis G, Symeonidis D, Hatzinikolaou I, Spyridakis M, Tepetes K. Loop stomas with a subcutaneously placed bridge device. Tech Coloproctol. 2010;14(S1):S75–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Branco AM, Saraiva AC. Loop colostomy with a suprafascial bridge device. Dig Surg. 2009;26:282–4.CrossRefPubMedGoogle Scholar
  27. 27.
    Harish K. The loop stoma bridge: a new technique. J Gastrointest Surg. 2008;12:958–61.CrossRefPubMedGoogle Scholar
  28. 28.
    Milner CS, Sutton C, Hemingway D. The skin bridge loop colostomy. Tech Coloproctol. 2006;10:137–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Scarpa M, Sadocchi L, Ruffolo C, Iacobone M, Filosa T, Prando D, et al. Rod in loop ileostomy: just an insignificant detail for ileostomy related complications? Langenbeck’s Arch Surg. 2007;392:149–54.CrossRefGoogle Scholar
  30. 30.
    Franklyn J, Varghese G, Mittal R, Rebekah G, Jesudason MR, Perakath B. A prospective randomized controlled trial comparing early postoperative complications in patients undergoing loop colostomy with and without a stoma rod. Color Dis. 2017;19:675–80.CrossRefGoogle Scholar
  31. 31.
    Tang CL, Seow-Choen F, Fook-Chong S, Eu K-W. Bioresorbable adhesion barrier facilitate early closure of the defunctioning ileostomy after rectal excision: a prospective, randomized trial. Dis Colon Rectum. 2003;46(9):1200–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Kawamura YJ, Kakizawa N, Tan KY, Mizokami K, Sasaki J, Tsujinaka S, et al. Sushi-roll wrap of Seprafilm for ileostomy limb facilitates ileostomy closure. Tech Coloproctol. 2009;13:211–4.CrossRefPubMedGoogle Scholar
  33. 33.
    Bertoni DM, Hammond KL, Beck DE, Hicks TC, Whitlow CB, Vargas HD, et al. Use of sodium hyaluronate/carboxymethylcellulose bioresorbably membrane in loop ileostomy construction facilitates stoma closure. Ochsner Journal. 2017;17:146–9.PubMedGoogle Scholar
  34. 34.
    Salum M, Wexner SD, Nogueras JJ, Weiss E, Koruda M, Behrens K, et al. Does sodium hyaluronate- and carboxymethylcellulose-based bioresorbably membrane (seprafilm) decrease operative time for loop ileostomy closure? Tech Coloproctol. 2006;10:187–91.CrossRefPubMedGoogle Scholar
  35. 35.
    Slater R. Quality of life for ostomates. BJN. 2013;22(9):504.CrossRefPubMedGoogle Scholar
  36. 36.
    Colwell JC. Selection of a pouching system. In: Carmel JE, Colwell JC, Goldberg MT, editors. WOCN society core curriculum: ostomy management. Philadelphia: Wolters Kluwer; 2016. p. 120–30.Google Scholar
  37. 37.
    Lavery IC, Erwin-Toth P. Stoma therapy. In: Cataldo PA, Mackeigan JM, editors. Intestinal stomas: principles, techniques and management. 2nd ed. New York: Marcel Dekker, Inc; 2004. p. 259–66.Google Scholar
  38. 38.
    Krishnamurty DM, Blatnik J, Mutch M. Stoma Complications. Clin Colon Rectal Surg. 2017;30:193–200.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Steinhagen E, Colwell J, Cannon LM. Intestinal stomas: postoperative stoma care and peristomal skin complications. Clin Colon Rectal Surg. 2017;30(3):184–92.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Luchtefeld M. Minimally invasive stomas. In: Cataldo PA, Mackeigan JM, editors. Intestinal stomas: principles, techniques and management. 2nd ed. New York: Marcel Dekker, Inc; 2004. p. 259–66.CrossRefGoogle Scholar
  41. 41.
    Fichera A, Zoccali M, Gullo R. Single incision (“Scarless”) laparoscopic total abdominal colectomy with end ileostomy for ulcerative colitis. J Gastrointest Surg. 2011;15:1247–51.CrossRefPubMedGoogle Scholar
  42. 42.
    Olson CH, Bedros N, Hakiman H, Araghizaheh FY. Single-site laparoscopic surgery for inflammatory bowel disease. JSLS. 2014;18(2):258–64.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Pittman J, Kozell K, Gray M. Should WOC nurses measure health-related quality of life in patients undergoing intestinal ostomy surgery? J Wound Ostomy Continence Nurs. 2009;36(3):254–65.CrossRefPubMedGoogle Scholar
  44. 44.
    Nichols TR. Quality of life in US residents with ostomies as assessed using the SF36v2. J Wound Ostomy Continence. 2015;42(1):71–8.CrossRefGoogle Scholar
  45. 45.
    Baxter NN, Novotny PJ, Jacobson T, Maidl JL, Sloan J, Young-Fadok TM. A stoma quality of life scale. Dis Colon Rectum. 2006;49:205–12.CrossRefPubMedGoogle Scholar
  46. 46.
    Grant M, Ferrell B, Dean G, Uman G, Chu D, Krouse R. Revision and psychometric testing of the city of hope quality of life ostomy questionnaire. Qual Life Res. 2004;13:1445–7.CrossRefPubMedGoogle Scholar
  47. 47.
    Kluka S, Kristjanson LJ. Development and testing of the ostomy concerns scale: Measuring ostomy-related concerns of cancer patients and their partner. J Wound Ostomy Continence Nurs. 1996;23:166–70.PubMedGoogle Scholar
  48. 48.
    Olbrisch ME, Ziegler SW. Psychological adjustment and patient information in inflammatory bowel disease: development of two assessment instruments. J Chronic Dis. 1982;35:649–58.CrossRefPubMedGoogle Scholar
  49. 49.
    Marquis P, Marrel A, Jambon B. Quality of life in patients with stomas: the Montreux study. Ostomy Wound Manage. 2003;49(2):48–55.PubMedGoogle Scholar
  50. 50.
    Coons SJ, Chongpison Y, Wendel CS, Grant M, Krouse RS. Overall quality of life and difficulty paying for ostomy supplies in the veterans affairs ostomy health-related quality of life study: an exploratory analysis. Med Care. 2007;45(9):891–5.CrossRefPubMedGoogle Scholar
  51. 51.
    Cakmak A, Aylaz G, Kuzu A. Permanent stoma not only affects patients’ quality of life but also that of their spouses. World J Surg. 2010;34:2872–6.CrossRefPubMedGoogle Scholar
  52. 52.
    Smith DM, Loewenstein G, Jankovich A, Ubel PA. Happily hopeless: adaptation to a permanent, but not to a temporary, disability. Health Psychol. 2009;28(6):787–91.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Danielsen AK, Soerensen EE, Burchart K, Rosenberg J. Impact of a temporary stoma on patients’ everyday lives: feelings of uncertainty while waiting for closure of the stoma. J Clin Nursing. 2013;22:1343–52.CrossRefGoogle Scholar
  54. 54.
    Lim SH, Chan SWC, He HG. Patients’ experiences of performing self-care of stomas in the initial postoperative period. Cancer Nurs. 2015;38(3):185–93.CrossRefPubMedGoogle Scholar
  55. 55.
    Danielsen AK, Bucharth J, Rosenberg J. Patient education has a positive effect in patients with a stoma: a systematic review. Color Dis. 2013;15:e276–83.CrossRefGoogle Scholar
  56. 56.
    Danielsen AK, Rosenberg J. Health related quality of life may increase when patients with a stoma attend patient education: a case-control study. PLoS One. 2014;9(3):e90354.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Mahjoubi B, Kiani Goodarzi K, Mohammad-Sadeghi H. Quality of life in stoma patients: appropriate and inappropriate stoma sites. World J Surg. 2010;34:147–52.CrossRefPubMedGoogle Scholar
  58. 58.
    McKenna LS, Taggart E, Stoelting J, Kirkbride G, Forbes GB. The impact of preoperative stoma marking on health-related quality of life: a comparison cohort study. J Wound Ostomy Continence Nurs. 2016;43(1):57–61.CrossRefPubMedGoogle Scholar
  59. 59.
    Person B, Ifargan R, Lachter J, Duek SD, Kluger Y, Assalia A. The impact of preoperative stoma site marking on the incidence of complications, quality of life, and the patient’s independence. Dis Colon Rectum. 2012;55:783–7.CrossRefPubMedGoogle Scholar
  60. 60.
    Messaris E, Sehgal R, Deiling S, Koltun WA, Stewart D, McKenna K, et al. Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum. 2012;55:175–80.CrossRefPubMedGoogle Scholar
  61. 61.
    Harris DA, Egbeare D, Jones S, Benjamin H, Woodward A, Foster ME. Complications and mortality following stoma formation. Ann R Coll Surg Engl. 2005;87(6):427–31.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    LI W, Stocchi L, Cherla D, Liu G, Agostinelli A, Delaney CP, et al. Factors associated with hospital readmission following diverting ileostomy creation. Tech Coloproctol. 2017;21:641–8.CrossRefPubMedGoogle Scholar
  63. 63.
    Leong APK, Londono-Schimmer EE, Philips RKS. Life table analysis of stomal complications following ileostomy. Br J Surg. 1994;81:727–9.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Hotouras A, Murphy J, Thaha M, Chan CL. The persistent challenge of parastomal herniation: a review of the literature and future developments. Color Dis. 2013;15(5):e202–e-214.CrossRefGoogle Scholar
  65. 65.
    Lyon CC, Smith AJ, Griffiths CE, Beck MH. The spectrum of skin disorders in abdominal stoma patients. Br J Dermatol. 2000;143:1248–60.CrossRefPubMedGoogle Scholar

Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2020

Authors and Affiliations

  • Lisa M. Cannon
    • 1
  • Dana M. Hayden
    • 2
  1. 1.University of ChicagoChicagoUSA
  2. 2.Division of Colon and Rectal SurgeryRush University Medical Center, Department of General SurgeryChicagoUSA

Personalised recommendations