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1.
Pediatr Surg Int ; 40(1): 181, 2024 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-38976031

RESUMO

PURPOSE: Acquired rectovaginal fistulae (RVF) are a complication of paediatric HIV infection. We report our experience with the surgical management of this condition. METHODS: We retrospectively reviewed the records of paediatric patients with HIV-associated RVF managed at Chris Hani Baragwanath Academic Hospital (2011-2023). Information about HIV management, surgical history, and long-term outcomes was collected. RESULTS: Ten patients with HIV-associated RVF were identified. Median age of presentation was 2 years (IQR: 1-3 years). Nine patients (9/10) underwent diverting colostomy, while one demised before the stoma was fashioned. Fistula repair was performed a median of 17 months (IQR: 7.5-55 months) after colostomy. An ischiorectal fat pad was interposed in 5/9 patients. Four (4/9) patients had fistula recurrence, 2/9 patients developed anal stenosis, and 3/9 perineal sepsis. Stoma reversal was performed a median of 16 months (IQR: 3-25 months) after repair. Seven patients (7/9) have good outcomes without soiling, while 2/9 have long-term stomas. Failure to maintain viral suppression after repair was significantly associated with fistula recurrence and complications (φ = 0.8, p < 0.05). CONCLUSION: While HIV-associated RVFs remain a challenging condition, successful surgical treatment is possible. Viral suppression is a necessary condition for good outcomes.


Assuntos
Infecções por HIV , Fístula Retovaginal , Humanos , Fístula Retovaginal/cirurgia , Fístula Retovaginal/etiologia , Feminino , Estudos Retrospectivos , Infecções por HIV/complicações , Pré-Escolar , Lactente , Colostomia/métodos , Resultado do Tratamento
2.
Spinal Cord Ser Cases ; 10(1): 46, 2024 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-38997269

RESUMO

INTRODUCTION: Neurogenic bowel dysfunction is a frequent consequence of spinal cord injury/disease (SCI/D). A colostomy is considered when conservative treatments fail [1, 2]. In the last year we observed several SCI/D persons with colostomy, admitted to our institution with multiple complications. CASE PRESENTATION: We present four cases of SCI/D persons treated with Hartmann's procedure and admitted to our institution for pressure ulcer (PU) treatment. All patients underwent PU surgery with good results. All patients reported a subjective good evacuation setting. No one assumed laxative therapies at home. At admission, all patients underwent abdominal radiography that showed an important constipation, with cases of sub-occlusion or complete occlusion with gastroparesis. One person presented a parastomal, strangulated hernia and underwent hernia reduction and patch positioning around the stoma. During hospital stay, bowel management required an important administration of laxatives and frequent, almost daily, stoma washes. DISCUSSION: Some considerations must be made regarding the use of traditional techniques in SCI/D people, such as Hartmann's, leaving a large part of the colon and the anatomical position of the stoma itself represent limitations to fecal progression and may cause constipation. A specific approach, tailored on the SCI/D patients' characteristics, such as the one described by our group, should be considered. Even if colostomy has been performed, appropriate therapies and health education on how to manage the stoma are fundamental to prevent complications.


Assuntos
Colostomia , Traumatismos da Medula Espinal , Humanos , Colostomia/métodos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/cirurgia , Masculino , Pessoa de Meia-Idade , Feminino , Adulto , Constipação Intestinal/etiologia , Úlcera por Pressão/etiologia , Úlcera por Pressão/cirurgia , Idoso , Intestino Neurogênico/etiologia , Intestino Neurogênico/cirurgia
3.
World J Gastroenterol ; 30(22): 2893-2901, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38947295

RESUMO

BACKGROUND: This study employed a phenomenological research approach within qualitative research to explore the challenges encountered by elderly individuals with temporary colostomies in managing their daily lives and care needs. Protecting the anus surgery combined with temporary colostomy has emerged as a prevalent treatment modality for low rectal cancer. However, the ileostomy is susceptible to peri-stoma skin complications, as well as fluid, electrolyte, and nutritional imbalances, posing challenges to effective management. The successful self-management of patients is intricately linked to their adjustment to temporary colostomy; nonetheless, there remains a dearth of research examining the factors influencing self-care among temporary colostomy patients and the obstacles they confront. AIM: To investigate the lived experiences, perceptions, and care requirements of temporary colostomy patients within their home environment, with the ultimate goal of formulating a standardized management protocol. METHODS: Over the period of June to August 2023, a purposive sampling technique was utilized to select 12 patients with temporary intestinal stomas from a tertiary hospital in Shanghai, China. Employing a phenomenological research approach, a semi-structured interview guide was developed, and qualitative interviews were conducted using in-depth interview techniques. The acquired data underwent coding, analysis, organization, and summarization following Colaizzi's seven-step method. RESULTS: The findings of this study revealed that the experiences and needs of patients with temporary intestinal stomas can be delineated into four principal themes: Firstly, Temporary colostomy patients bear various burdens and concerns about the uncertainty of disease progression; secondly, patients exhibit limited self-care capabilities and face information deficits, resulting in heightened reliance on healthcare professionals; thirdly, patients demonstrate the potential for internal motivation through proactive self-adjustment; and finally, patients express a significant need for emotional and social support. CONCLUSION: Home-living patients with temporary intestinal stomas confront multifaceted challenges encompassing burdens, inadequate self-care abilities, informational deficits, and emotional needs. Identifying factors influencing patients' self-care at home and proposing strategies to mitigate barriers can serve as a foundational framework for developing and implementing nursing interventions tailored to the needs of patients with temporary intestinal stomas.


Assuntos
Colostomia , Pesquisa Qualitativa , Autocuidado , Humanos , Feminino , Idoso , Masculino , Colostomia/psicologia , China/epidemiologia , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Ileostomia/psicologia , Ileostomia/efeitos adversos , Qualidade de Vida , Entrevistas como Assunto , Neoplasias Retais/psicologia , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia , Neoplasias Retais/patologia , Adaptação Psicológica
4.
Br J Hosp Med (Lond) ; 85(7): 1-3, 2024 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-39078916

RESUMO

A 46-year-old man presented with a small bowel prolapsing through the anus after straining on the toilet, which was starting to become ischaemic. He admitted to inserting a plastic object in his rectum about half an hour before straining. The bowel was kept moist by placing an intravenous drip line with saline dripping onto a wet swab. In theatre, the bowel was found to be prolapsing through a hole in the upper rectum and out through the anus. It was reduced back into the abdominal cavity through the same perforation, which was 4 cm long, without needing to extend it. This was sutured with polydioxanone (PDS) 2-0 as there was no contamination with faeces or pus. Due to improvement in the appearance of a small bowel and an extremely bruised mesentery, a re-look was planned in 24 hours. At the re-look the small bowel appeared healthy, therefore no resection was performed. However, a loop colostomy was fashioned to protect the upper rectal perforation repair. This shows that resection is not always required in such cases.


Assuntos
Intestino Delgado , Humanos , Masculino , Pessoa de Meia-Idade , Intestino Delgado/cirurgia , Perfuração Intestinal/cirurgia , Perfuração Intestinal/etiologia , Colostomia/métodos , Reto/cirurgia , Prolapso Retal/cirurgia , Canal Anal/cirurgia
5.
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
6.
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
7.
Tech Coloproctol ; 28(1): 65, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38849668

RESUMO

This case report outlines the intricate management of rectal perforation following laser hemorrhoidoplasty in a 31-year-old female, leading to an acute abdomen, sepsis, and multiorgan failure. Urgent laparoscopic exploration and the establishment of a double-loop colostomy were undertaken, marking the beginning of a complex course characterized by relapsed pelvic sepsis. Laser hemorrhoidoplasty has gained widespread acceptance for its minimally invasive approach in treating hemorrhoids. Remarkably, to our knowledge, the case we present is the first major complication reported after laser hemorrhoidoplasty, likely attributed to collateral thermic and mechanical tissue damage.


Assuntos
Hemorroidectomia , Hemorroidas , Perfuração Intestinal , Terapia a Laser , Complicações Pós-Operatórias , Reto , Humanos , Feminino , Adulto , Hemorroidas/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Reto/cirurgia , Reto/lesões , Hemorroidectomia/efeitos adversos , Hemorroidectomia/métodos , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Colostomia/efeitos adversos , Laparoscopia/efeitos adversos , Laparoscopia/métodos
9.
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
10.
Surg Endosc ; 38(8): 4550-4558, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38942946

RESUMO

BACKGROUND: Despite widespread adoption of robotic-assisted surgery (RAS) in rectal cancer resection, there remains limited knowledge of its clinical advantage over laparoscopic (Lap) and open (OS) surgery. We aimed to compare clinical outcomes of RAS with Lap and OS for rectal cancer. METHODS: We identified all patients aged ≥ 18 years who had elective rectal cancer resection requiring temporary or permanent stoma formation from 1/2013 to 12/2020 from the PINC AI™ Healthcare Database. We completed multivariable logistic regression analysis accounting for hospital clustering to compare ileostomy formation between surgical approaches. Next, we built inverse probability of treatment-weighted analyses to compare outcomes for ileostomy and permanent colostomy separately. Outcomes included postoperative complications, in-hospital mortality, discharge to home, reoperation, and 30-day readmission. RESULTS: A total of 12,787 patients (OS: 5599 [43.8%]; Lap: 2872 [22.5%]; RAS: 4316 [33.7%]) underwent elective rectal cancer resection. Compared to OS, patients who had Lap (OR 1.29, p < 0.001) or RAS (OR 1.53, p < 0.001) were more likely to have an ileostomy rather than permanent colostomy. In those with ileostomy, RAS was associated with fewer ileus (OR 0.71, p < 0.001) and less bleeding (OR 0.50, p < 0.001) compared to Lap. In addition, RAS was associated with lower anastomotic leak (OR 0.25, p < 0.001), less bleeding (OR 0.51, p < 0.001), and fewer blood transfusions (OR 0.70, p = 0.022) when compared to OS. In those patients who had permanent colostomy formation, RAS was associated with fewer ileus (OR 0.72, p < 0.001), less bleeding (OR 0.78, p = 0.021), lower 30-day reoperation (OR 0.49, p < 0.001), and higher discharge to home (OR 1.26, p = 0.013) than Lap, as well as OS. CONCLUSION: Rectal cancer patients treated with RAS were more likely to have an ileostomy rather than a permanent colostomy and more enhanced recovery compared to Lap and OS.


Assuntos
Ileostomia , Laparoscopia , Complicações Pós-Operatórias , Neoplasias Retais , Procedimentos Cirúrgicos Robóticos , Humanos , Neoplasias Retais/cirurgia , Feminino , Masculino , Laparoscopia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Pessoa de Meia-Idade , Idoso , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Ileostomia/métodos , Colostomia/métodos , Protectomia/métodos , Protectomia/efeitos adversos , Mortalidade Hospitalar , Estudos Retrospectivos , Resultado do Tratamento , Reoperação/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Adulto
11.
Colorectal Dis ; 26(6): 1153-1165, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38706109

RESUMO

AIM: Literature on nationwide long-term permanent stoma rates after rectal cancer resection in the minimally invasive era is scarce. The aim of this population-based study was to provide more insight into the permanent stoma rate with interhospital variability (IHV) depending on surgical technique, with pelvic sepsis, unplanned reinterventions and readmissions as secondary outcomes. METHOD: Patients who underwent open or minimally invasive resection of rectal cancer (lower border below the sigmoid take-off) in 67 Dutch centres in 2016 were included in this cross-sectional cohort study. RESULTS: Among 2530 patients, 1470 underwent a restorative resection (58%), 356 a Hartmann's procedure (14%, IHV 0%-42%) and 704 an abdominoperineal resection (28%, IHV 3%-60%). Median follow-up was 51 months. The overall permanent stoma rate at last follow-up was 50% (IHV 13%-79%) and the unintentional permanent stoma rate, permanent stoma after a restorative procedure or an unplanned Hartmann's procedure, was 11% (IHV 0%-29%). A total of 2165 patients (86%) underwent a minimally invasive resection: 1760 conventional (81%), 170 transanal (8%) and 235 robot-assisted (11%). An anastomosis was created in 59%, 80% and 66%, with corresponding unintentional permanent stoma rates of 12%, 24% and 14% (p = 0.001), respectively. When corrected for age, American Society of Anesthesiologists classification, cTNM, distance to the anorectal junction and neoadjuvant (chemo)radiotherapy, the minimally invasive technique was not associated with an unintended permanent stoma (p = 0.071) after a restorative procedure. CONCLUSION: A remarkable IHV in the permanent stoma rate after rectal cancer resection was found. No beneficial influence of transanal or robot-assisted laparoscopy on the unintentional permanent stoma rate was found, although this might be caused by the surgical learning curve. A reduction in IHV and improving preoperative counselling for decision-making for restorative procedures are required.


Assuntos
Protectomia , Neoplasias Retais , Estomas Cirúrgicos , Humanos , Estudos Transversais , Neoplasias Retais/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Países Baixos , Protectomia/métodos , Protectomia/estatística & dados numéricos , Colostomia/métodos , Colostomia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Proctocolectomia Restauradora/métodos , Fatores de Tempo , Readmissão do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Reoperação/estatística & dados numéricos , Reoperação/métodos , Resultado do Tratamento , Idoso de 80 Anos ou mais
12.
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
13.
World J Surg ; 48(7): 1767-1770, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38777763

RESUMO

In this study, we introduce a novel method for stoma closure, aiming to reduce wound infection rates. This method involves creating the common channel of both limbs of a loop stoma extracorporeally, which is particularly beneficial during laparoscopic stoma closure surgery by potentially avoiding contamination of the wound. We applied this technique in 23 patients undergoing laparoscopic stoma reversal surgery, comprising both loop colostomy and ileostomy cases. Notably, postoperative outcomes were promising: only two patients experienced postoperative ileus, and importantly, there were no instances of wound infection. These findings suggest that our laparoscopic stoma reversal surgery approach is not only safe and feasible but also offers a significant advantage in reducing wound infection rates.


Assuntos
Colostomia , Ileostomia , Laparoscopia , Infecção da Ferida Cirúrgica , Humanos , Laparoscopia/métodos , Masculino , Feminino , Colostomia/métodos , Idoso , Pessoa de Meia-Idade , Ileostomia/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Idoso de 80 Anos ou mais , Resultado do Tratamento , Adulto , Estomas Cirúrgicos , Técnicas de Fechamento de Ferimentos
14.
Colorectal Dis ; 26(6): 1250-1257, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38802985

RESUMO

AIM: There is ongoing controversy regarding the extent to which Hartmann's procedure (HP) should be used in rectal cancer treatment. This study was designed to investigate 30-day postoperative morbidity and mortality following HP, anterior resection (AR) and abdominoperineal resection (APR) for rectal cancer using a national registry. METHODS: All patients operated for rectal cancer, tumour height 5-15 cm, between the years 2010 and 2017, were identified through the Swedish colorectal cancer registry. RESULTS: A total of 8476 patients were included: 1210 (14%) undergoing HP, 5406 (64%) AR and 1860 (22%) APR. HP was associated with an increased risk of intra-abdominal infection (OR 1.7, CI 1.26-2.28, P = 0.0004) compared to AR and APR, while APR was related to an increased risk of overall complications (OR 1.18, CI 1.01-1.40, P = 0.040). No significant difference was observed in the rate of reoperations and readmissions between HP, AR and APR, and type of surgical procedure was not a risk factor for 30-day mortality. Findings from a subgroup analysis of patients with a tumour 5-7 cm from the anal verge revealed that HP was not associated with increased risk for complications or 30-day mortality. CONCLUSIONS: For patients where AR is not appropriate HP is a valid alternative with a favourable outcome. APR was associated with the highest overall 30-day complication rate.


Assuntos
Complicações Pós-Operatórias , Protectomia , Neoplasias Retais , Sistema de Registros , Humanos , Neoplasias Retais/cirurgia , Masculino , Feminino , Idoso , Protectomia/efeitos adversos , Protectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pessoa de Meia-Idade , Suécia/epidemiologia , Reoperação/estatística & dados numéricos , Fatores de Risco , Colostomia/efeitos adversos , Colostomia/métodos , Colostomia/estatística & dados numéricos , Idoso de 80 Anos ou mais , Readmissão do Paciente/estatística & dados numéricos , Infecções Intra-Abdominais/etiologia , Infecções Intra-Abdominais/epidemiologia
15.
Colorectal Dis ; 26(6): 1258-1265, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38807266

RESUMO

AIM: Most new ostomy patients are not able to manage ostomy self-care when they are discharged and rely on visiting nurse services for ostomy care. The aim of this study was to determine if a perioperative ostomy educational pathway increases the level of independence and decreases the need for visiting nurse services in new ostomy patients. METHOD: A prospective longitudinal study was conducted between July 2018 and February 2020. Patients who received a colostomy or ileostomy and were treated on the surgery ward were included. Patients who followed a perioperative ostomy educational pathway were compared to a historical control group. The primary outcome measure was the level of independence in ostomy care and the need for visiting nurse services. RESULTS: After discharge, 67.6% of patients in the intervention group (n = 244) were able to independently perform ostomy care and were therefore not relying on visiting nurse services, compared to 15.2% of the patients in the control group (n = 33). The need for visiting nurse services was higher in patients aged ≥70 years (OR 3.20, P < 0.001), those who did not attend the preoperative practice session (OR 3.02, P = 0.002), those with a history of transient ischaemic attack (OR 10.22, P = 0.045) and those with mild cognitive impairment (OR 28.98, P = 0.002). CONCLUSION: A perioperative ostomy educational pathway effectively increased the level of independence and decreased the need for visiting nurse services in new ostomy patients.


Assuntos
Ileostomia , Educação de Pacientes como Assunto , Autocuidado , Humanos , Feminino , Masculino , Idoso , Estudos Prospectivos , Estudos Longitudinais , Pessoa de Meia-Idade , Ileostomia/enfermagem , Educação de Pacientes como Assunto/métodos , Colostomia/enfermagem , Enfermagem em Saúde Comunitária , Assistência Perioperatória/métodos , Idoso de 80 Anos ou mais , Alta do Paciente , Estomia/enfermagem
16.
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
17.
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
18.
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
19.
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
20.
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
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