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Deciding When to do a Redo Procedure in ARM
Published in Marc A. Levitt, Pediatric Colorectal Surgery, 2023
A redo would entail moving the anoplasty anteriorly and closing the location where the anus is currently located. A colostomy is not needed in such cases. However, keeping the patient on clear liquids only for 5 days postoperatively allows for good perineal healing by reducing pressure of formed stool on the healing perineal incision. Once good perineal healing is ensured, the diet can be advanced. Depending on the age of the patient, placing a Malone at the same time as the redo would give the child a chance to get mechanically clean and to facilitate the achievement of bowel control as they learn how to control their improved anal anatomy.
Assessing and managing pain
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Lindsey Pollard, Harriet Barker
To illustrate pain tolerance, think of two individuals. One has had a formation of a colostomy as part of a curative procedure for bowel cancer. The next person has had a colostomy formed following trauma. The person who has had a curative procedure is feeling positive about their future, which has now been given back to them; the stoma is a small price to pay for their life, and they were prepared for it during clinic appointments. The person who has undergone trauma has had their life changed very quickly; they are likely to be experiencing a great deal emotionally, and are trying to process how their life will change; they would not have undergone a pre-operative work up. In these two very similar procedures, these individuals are likely to have very different levels of pain.
Nursing Considerations in Necrotizing Enterocolitis
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
Margaret Birdsong, Michelle Felix
Ostomy: A surgically formed opening from the inside of an organ to the outside. Stoma: The part of the ostomy that is attached to the skin. It is (usually) constructed from the end of the bowel that has been surgically brought up through the skin and attached to the underlying fascia.Ileostomy: A stoma that is created from the small intestine. The output is liquid and may appear to be undigested.Colostomy: Created from the colon and diverted through the abdomen. The output may initially be meconium, becoming yellow and curdy.Jejunostomy: Created from a more proximal section of the small intestine. The output may be quite watery and corrosive to the neighboring skin.Mucous fistula: The other end of the nonfunctioning bowel, which is delivered through the abdomen—the distal bowel end.High-output stoma: Any stoma that produces greater than or equal to 20 mL/kg of effluent. Management of high-output stomas requires careful replacement of gastrointestinal losses and attention to electrolytes in order to prevent complications.
A giant parastomal hernia in a high risk patient: preparation to make surgery worthwhile
Published in Acta Chirurgica Belgica, 2023
Seda Gunes, Ali Bohlok, Antoine El Asmar, Thibaut Engels, Marie Magdelaine Lefort, Eleonora Farinella, Issam El Nakadi
The first-step surgery started by closing the colostomy. Then, a circular skin incision was made 3 cm above the edge of the hernia’s neck to keep enough skin for the subsequent closure. The hernia sac was opened and 12 liters of ascites aspirated. Exploration of the sac’s cavity revealed the presence of part of the stomach and omentum, along with the small intestins and the tranverse and left colon. After reducing the herniated bowels, the intra-abdominal and intra-thoracic pressures were measured by the anesthesiologist, in order to estimate the amount of bowels to be resected, to achieve the appropriate level of pressures tolerated by the patient’s respiratory system. Subsequently, the left part of the transverse colon, along with the descending colon were resected to reach this adaptation. A terminal colostomy was created in the right abdominal quadrant. The hernia sac was resected and closed. A preperitoneal polypropylene mesh repair was performed (Figure 2).
Surgical flap delay to allow primary transabdominal transplantation of extended rectus abdominis myocutaneous flaps in increasingly complex pelvic wound reconstructions
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Maurits Lange, J. Joris Hage, Arend Aalbers, Esther M. K. Wit, Frédéric Amant, Marije J. Hoornweg
Midline laparotomy APR (n = 42), pelvic exenteration (n = 58), resection of presacral metastasis (n = 2), pelvic reduction of perineal hernia (n = 2), or sole debridement of a chronic presacral abscess (n = 1) was performed by a mostly multidisciplinary team of ablative oncologists (Table 2) and occasionally combined with intra-operative additional radiotherapy (n = 10) or HIPEC (n = 2) [11]. The anus was resected as part of this procedure in 76 of the 105 patients (0.72), and newly made or revised colostomies (n = 40), urostomies (n = 20), or both (n = 24) were brought through and fixed in the abdominal wall. Consequently, 58 patients had a colostomy or a urostomy whereas the remaining 47 patients had both a colostomy and a urostomy at the end of the combined procedure. Ureteral re-anastomosis (n = 4), (partial) bladder resection (n = 3), or unilateral ureteronephrectomy (n = 1) was performed in eight patients.
Risk factors and pooled incidence of intestinal stoma complications: systematic review and Meta-analysis
Published in Current Medical Research and Opinion, 2022
Federica Dellafiore, Rosario Caruso, Luigi Bonavina, Nathasha Samali Udugampolage, Giulia Villa, Sara Russo, Ida Vangone, Irene BaronI, Cristina Di Pasquale, Tiziana Nania, Duilio F. Manara, Cristina Arrigoni
In the context of ostomy care, the risk of several complications has been described as frequent5. These complications are classified in the literature as surgical, psychological, and social6. Complications, which determine an important deterioration of patients’ quality of life, might require redosurgery, delays in dismissions, prolonged convalescence, increased consumption of medical devices7, and additional health care costs8. Edema, intra-, and peri-stomal bleeding, fistula, abscess, ischemia, and ischemia/necrosis of the bowel loop have been described as the most frequent early complications9. In contrast, late complications include peristomal dermatitis, stoma obstruction, retraction, prolapse, peristomal hernia, intestinal obstruction, and granulomas10. Most complications appear within the first year of ostomy surgery and are mainly caused by alterations of the abdominal wall and/or improper ostomy management9. High complication incidences have been previously reported in the literature, ranging between 21 and 70%, and increasing when considering long-term complications after colostomy (58%) and ileostomy surgeries (76%)11,12. Therefore, identifying risk factors involved in ostomy-related complications, which are undoubtedly common and expensive, requiring periodic follow-up, hospitalizations, and surgery affecting healthcare costs, would help professionals prevent complications and provide tailored and direct ostomy counseling and management groups at risk6.