Epidemiological characterization of patients with intestinal stomas

Objective: To characterize the sociodemographic and clinical variables of people with intestinal stomas. Materials and Methods: We conducted a cross-sectional study with 47 patients of a Specialized Rehabilitation Center (CER II/APAE) in the municipality of Três Lagoas, state of Mato Grosso do Sul, Midwestern Brazil, from December 2019 to June 2020. Data was analyzed using inferential descriptive statistics (Anderson-Darling, Chi-squared, and Mann-Whitney normality tests). Results: Regarding the patients, 87.23% were from Três Lagoas, 51.06% were female, 40.43% were aged from 60 to 69 years, 59.57% were married, 53.19% were brown, 59.57% were catholic, 36.17% finished elementary school, 46.81% were retired, and 57.45% earned a monthly income below 1 minimum wage. Moreover, 61.70% had undergone terminal colostomy (61.70%), 61.70% had received guidance about its placing, 57.45% had it placed due to situations of urgency, 74.47% had a stoma installed due to a neoplasia, 38.30% were permanent, with 46.81% located in the inferior left quadrant (ILQ), 59.57% presented pasty effluent, 63.83% had a circular diameter, 53.19% had pouches with 2 pieces and 57.45%, with a flexible base, 87.23% had other adjunct equipment, and 95.74% had been trained in self-care. The most common complication was skin/peristomal irritant contact dermatitis (59,57%), and 65,95% of these cases were solved by teaching self-care. The type of stoma was significantly associated with the consistency of the effluent and the size of the protrusion (p> 0.05). Conclusion: The results found can support strategies to implement practices to promote health, develop new public policies, to provide training in self-care, and prevent and treat complications. (AU)

Association of sociodemographic and clinical factors with self-image, self-esteem and locus of health control in patients with an intestinal stoma / Associação dos fatores sociodemográficos e clínicos com a autoimagem, autoestima e Locus de controle em saúde nos indivíduos com estoma intestinal

ABSTRACT Objective: To evaluate the sociodemographic and clinical factors related to patients with an intestinal stoma and to correlate them with locus of health control, self-esteem and self-image. Method: 44 patients with an intestinal stoma participated in the study. The following instruments were used: Scale for Locus of Health Control, Rosenberg Self-Esteem Scale/UNIFESP-EPM and Body Investment Scale. Results: With regard to Locus Health Control variables, sociodemographic variables with alterations were: unemployed (28.13); retirees (27.79); age up to 50 years (28.44); and singles (27.89). Regarding Body Investment Scale, the sociodemographic variables with alterations were: age up to 50 years (21.79); single (19.15) or married (17.53); retired (18.79) or unemployed (19.83); and can read and write (20.13). Regarding Rosenberg-EPM Self-esteem Scale, all sociodemographic variables were altered. Conclusions: Ostomized patients presented alterations in the following variables: unemployed, retired, aged up to 50 years and unmarried. There were also alterations in individuals whose cause of the stoma was neoplasia, a temporary stoma, stoma time <4 years, and ostomized non-participants of an association or support group, and who also did not practice physical activities. We conclude from these findings that ostomized individuals who participated in the study and who were included in these variables showed negative feelings about their body and believed that only they could control their health and that the people involved in their care and rehabilitation did not could contribute to their improvement.

RESUMO Objetivo: Avaliar os fatores sociodemográficos e clínicos relativos aos pacientes com estoma intestinal e correlacioná-los a locus de controle da saúde, autoestima e autoimagem. Método: 44 pacientes com estoma intestinal participaram do estudo. Foram utilizados os seguintes instrumentos: Escala para Locus de Controle da Saúde, Escala de Autoestima de Rosenberg/UNIFESP-EPM e Escala de Investimento no Corpo. Resultados: Com relação às variáveis da Escala Locus de Controle da Saúde, as variáveis sociodemográficas com alteração foram: (28,13) desempregados; (27,79) aposentados; (28,44) idade até 50 anos; e (27,89) solteiros. Com relação à Escala de Investimento no Corpo, as variáveis sociodemográficas com alteração foram: (21,79) idade até 50 anos; (19,15) solteiros ou (17,53) casados; (18,79) aposentados ou (19,83) desempregados; e (20,13) sabem ler e escrever. Com relação à Escala de Autoestima de Rosenberg-EPM, todas as variáveis sociodemográficas estavam alteradas. Conclusões: Os ostomizados apresentaram alterações nas variáveis desempregados, aposentados, idade até 50 anos e solteiros. Também apresentaram alterações indivíduos cuja causa do estoma era neoplasia, caráter temporário do estoma, tempo de estoma <4 anos e ostomizados não participantes de associação ou grupo de apoio e que também não prativavam atividades físicas. Concluímos, por esses achados, que os indivíduos ostomizados que participaram do estudo e que que faziam parte dessas variáveis demonstravam sentimentos negativos com relação a seu corpo e acreditavam que só eles podiam controlar sua saúde, e que as pessoas envolvidas em seus cuidados e reabilitação não podiam contribuir para sua melhora.

De la resección abdominoperineal a las técnicas conservadoras de esfínteres en la cirugía laparoscópica del cáncer del recto / From abdominoperineal resection to conservative techniques of interest in relation to laparoscopic surgery for rectal cancer

Introducción: la principal regla en el manejo del cáncer del recto es la cura oncológica y el mantenimiento de la calidad de vida. El advenimiento de la cirugía laparoscópica ha tenido un impacto en la cirugía gastrointestinal en los últimos 20 años. Tres décadas después de su original descripción por Heald, la escisión total del mesorrecto se ha convertido en la regla de oro para la resección curativa del cáncer del recto. Objetivos: revisar las diferentes opciones técnicas de las que se dispone en la actualidad para el tratamiento laparoscópico del cáncer del recto, mediante la descripción de sus resultados, ventajas y desventajas. Métodos: se realizó una revisión en las bases de datos bibliográficas accesibles por Infomed, que incluyó artículos que trataran el tema en español e inglés, mediante los descriptores de DeCS y MeSH. Resultados: el cáncer del último tercio del recto plantea un cambio significativo para el cirujano. La resección abdominoperineal ha sido considerada como la regla de oro para el tratamiento de los adenocarcinomas situados en el tercio medio y bajo del recto. Sin embargo, con el incremento del conocimiento de la enfermedad, el desarrollo de las técnicas quirúrgicas, la mejor instrumentación, y el uso de la radioquimioterapia preoperatoria, se ha llegado a un cambio en el tratamiento del cáncer de recto que va de la resección abdominoperineal con colostomía permanente a la cirugía preservadora del esfínter mediante las técnicas mínimamente invasivas. Conclusiones: la cirugía conservadora de esfínteres para el cáncer del recto mediante las técnicas mínimamente invasivas es posible en la mayoría de los pacientes con unos resultados a largo plazo iguales a los de la resección abdominoperineal(AU)

Introduction: the main rule for the management of rectal cancer is oncologic cure and the maintenance of quality of life. The advent of laparoscopic surgery has had an impact on gastrointestinal surgery over the last 20 years. Three decades following its original description by Heald, total mesorectal excision has become the gold standard for the curative resection of rectal cancer. Objectives: To review the different technical options currently available for the laparoscopic treatment of rectal cancer, by describing their outcomes, advantages and disadvantages. Methods: A review was performed in the bibliographical databases accessible from Infomed, including articles on the topic written in Spanish and English, using DeCS and MeSH descriptors. Results: Cancer of the lower third of the rectum signifies a fundamental change for the surgeon. Abdominoperineal resection has been considered as the gold standard for the treatment of adenocarcinomas located in the middle and lower rectum. However, with increased knowledge of the disease, the development of surgical techniques, better instrumentation, and the use of preoperative radiochemotherapy, a change has been achieved in treating rectal cancer, which goes from abdominoperineal resection with permanent colostomy to conservative surgery of the sphincter using minimal invasive techniques. Conclusions: The conservative surgery of the sphincters for rectal cancer by minimal invasive techniques is possible to be performed in most patients, with long-term results similar to those of the abdominoperineal resection(AU)

Risk Factors of Permanent Stomas in Patients with Rectal Cancer after Low Anterior Resection with Temporary Stomas

PURPOSE: The aim of this study was to identify risk factors influencing permanent stomas after low anterior resection with temporary stomas for rectal cancer. MATERIALS AND METHODS: A total of 2528 consecutive rectal cancer patients who had undergone low anterior resection were retrospectively reviewed. Risk factors for permanent stomas were evaluated among these patients. RESULTS: Among 2528 cases of rectal cancer, a total of 231 patients had a temporary diverting stoma. Among these cases, 217 (93.9%) received a stoma reversal. The median period between primary surgery and stoma reversal was 7.5 months. The temporary and permanent stoma groups consisted of 203 and 28 patients, respectively. Multivariate analysis showed that independent risk factors for permanent stomas were anastomotic-related complications (p=0.001) and local recurrence (p=0.001). The 5-year overall survival for the temporary and permanent stoma groups were 87.0% and 70.5%, respectively (p<0.001). CONCLUSION: Rectal cancer patients who have temporary stomas after low anterior resection with local recurrence and anastomotic-related complications may be at increased risk for permanent stoma.

Risk Factors of Permanent Stomas in Patients with Rectal Cancer after Low Anterior Resection with Temporary Stomas

PURPOSE: The aim of this study was to identify risk factors influencing permanent stomas after low anterior resection with temporary stomas for rectal cancer. MATERIALS AND METHODS: A total of 2528 consecutive rectal cancer patients who had undergone low anterior resection were retrospectively reviewed. Risk factors for permanent stomas were evaluated among these patients. RESULTS: Among 2528 cases of rectal cancer, a total of 231 patients had a temporary diverting stoma. Among these cases, 217 (93.9%) received a stoma reversal. The median period between primary surgery and stoma reversal was 7.5 months. The temporary and permanent stoma groups consisted of 203 and 28 patients, respectively. Multivariate analysis showed that independent risk factors for permanent stomas were anastomotic-related complications (p=0.001) and local recurrence (p=0.001). The 5-year overall survival for the temporary and permanent stoma groups were 87.0% and 70.5%, respectively (p<0.001). CONCLUSION: Rectal cancer patients who have temporary stomas after low anterior resection with local recurrence and anastomotic-related complications may be at increased risk for permanent stoma.

Characterization of patients with ostomy treated at a public municipal and regional reference center / Caracterização dos usuários com estomia atendidos em um serviço público de referência municipal e regional

OBJECTIVE: to characterize patients with ostomy treated at a municipal and regional reference center in the state of Rio Grande do Sul. METHODS: this is a retrospective and descriptive study, based on the records of patients with ileostomy or colostomy recorded in this service between 2000 and 2010. RESULTS: a total of 273 patients were studied, of which 145 were females. The mean age was 64.5 years. Patients with incomplete elementary education (43.6%) and retirees/pensioners (44.7%) were the most prevalent. The main cause for the stoma was neoplastic disease, with 45.8% of colorectal cancer and 5.5% of cancers at other sites. OTHER CAUSES WERE: diverticular disease (7%), bowel obstruction (7%), functional bowel disorders (4.8%), abdominal trauma (2.9%), non-traumatic bowel perforation (2.6%), inflammatory bowel diseases (1.8%) and intestinal polyposis (0.7%). Regarding the type of ostomy, 85.7% were performed by colostomy and 15.8% by ileostomy. CONCLUSIONS: the study population consisted mainly of patients older than 60 and females. The main intervention performed was permanent colostomy and the most important cause for the procedure performance was colorectal cancer. (AU)

OBJETIVO: caracterizar as pessoas com estomia atendidas em um serviço de referência municipal e regional do Rio Grande do Sul. MÉTODOS : estudo retrospectivo e documental, com consulta aos registros dos usuários com ileostomia ou colostomia cadastrados no referido serviço entre 2000 e 2010. RESULTADOS : foram avaliadas 273 pessoas, sendo 145 mulheres e 128 homens. A média de idade foi de 64,5 anos. Prevaleceram usuários com ensino fundamental incompleto (43,6%) e da classe de aposentados/pensionistas (44,7%). A principal causa motivadora da estomia foi a neoplásica, sendo 45,8% de neoplasia de intestino e 5,5% de neoplasias em outros sítios. Outras causas encontradas foram: doença diverticular (7%), obstrução intestinal (7%), transtornos funcionais do intestino (4,8%), traumatismo abdominal (2,9%), perfuração não traumática do intestino (2,6%), doenças intestinais inflamatórias (1,8%) e polipose intestinal (0,7%). Quanto ao tipo de estomia, 85,7% eram usuários de colostomias, e 15,8% de ileostomia. CONCLUSÕES : a clientela do serviço estudado foi composta principalmente por pessoas acima dos 60 anos de idade e por mulheres. A principal intervenção apresentada foi a colostomia permanente e a mais importante causa motivadora da realização do procedimento foi a neoplasia colorretal. (AU)

Health care service for ostomy patients: profile of the clientele

The study aimed to identify the profile of ostomy patients in a Health Care Service in São José do Rio Preto, São Paulo, Brazil. This is an exploratory, descriptive and retrospective study. Data were obtained by registration forms of patients assisted from January 1st, 2000, to December 31st, 2010. Out of the 252 ostomy patients, 51.1% were females and 48.9% were males; the age group with the highest concentration was from 68 to 78 years old (26.3%) for both genders, with mean age of 73 years old. The main reason for making the stoma was rectal (35.0%) and colon neoplasm (14.1%). The prevalent stoma was temporary colostomy (41.4%) and the period of permanence of the collecting equipment was longer than 36 months. Even though the service provides full assistance to the ostomy patients, it is necessary to review human resources aspects to provide appropriate assistance to its clientele. (AU)

O estudo teve como objetivo identificar o perfil de pacientes estomizados de um Serviço de Atenção ao Estomizado de São José do Rio Preto e Região. A pesquisa é exploratória, descritiva e retrospectiva. Os dados foram obtidos das fichas cadastrais dos pacientes atendidos no período de 1º de janeiro de 2000 a 31 de dezembro de 2010. Dos 252 estomizados, 51,1% eram mulheres e 48,9% homens, a faixa etária de maior concentração encontrou-se, em ambos os sexos, entre 68 a 78 anos (26,3%) com média de idade de 73 anos. O principal motivo da confecção do estoma foi a neoplasia de reto (35,0%) e cólon (14,1%). O estoma prevalente foi a colostomia temporária (41,4%) e o tempo de permanência do equipamento coletor foi superior a 36 meses. O Serviço, embora proporcione assistência integral ao estomizado, necessita rever aspectos de recursos humanos à assistência adequada à clientela. (AU)

Sequelas pós-intubação e traqueostomia cirúrgica aberta: devemos sempre fazer a istmectomia? / Postintubation injuries and open surgical tracheostomy: should we always perform isthmectomy?

OBJETIVO: Avaliar a influência da equipe cirúrgica (cirurgia geral ou cirurgia torácica) e da técnica operatória utilizada (com ou sem istmectomia) sobre a incidência de injúrias pós-intubação nas vias aéreas em pacientes traqueostomizados. MÉTODOS: Foram prospectivamente incluídos neste estudo 164 pacientes admitidos na unidade de terapia intensiva para adultos do Hospital Estadual Sumaré e que ficaram sob intubação traqueal por mais de 24 h, no período entre 1º de janeiro e 31 de agosto de 2007. Quando foi necessária a realização de traqueostomia, os pacientes foram aleatorizados para as equipes de cirurgia geral e torácica. Todos os pacientes foram submetidos à traqueoscopia flexível para a decanulação e/ou a avaliação tardia da via aérea. RESULTADOS: Dos 164 pacientes no estudo, 90 (54,88 por cento) faleceram (sem relação com o procedimento), 67 (40,85 por cento) completaram o seguimento e 7 (4,27 por cento) tiveram seguimento parcial. Dos 67 pacientes com seguimento completo, 32 foram traqueostomizados (21 pela equipe de cirurgia geral e 11 pela equipe de cirurgia torácica). A istmectomia foi realizada em 22 pacientes (11 pela equipe de cirurgia geral e 11 pela equipe de cirurgia torácica). Não houve diferença entre o índice de complicações estomais quando se comparou as equipes, mas sim quando se comparou as técnicas (com e sem istmectomia). CONCLUSÕES: A não realização da istmectomia paralelamente à traqueostomia faz com que o cirurgião realize o óstio traqueal mais distalmente do que supõe. Nestes casos, houve um maior índice de complicações do estoma traqueal.

OBJECTIVE: To evaluate the influence of the surgical team (general surgery or thoracic surgery) and the surgical technique (with or without isthmectomy) on the incidence of postintubation injuries in the airways of tracheostomized patients. METHODS: Between January 1st and August 31st, 2007, 164 patients admitted to the adult intensive care unit and tracheally intubated for more than 24 h were studied prospectively at the Sumaré State Hospital, located at the city of Sumare, Brazil. When tracheostomy was necessary, these patients were randomly assigned to thoracic or general surgery teams. All of the patients were submitted to fiberoptic tracheoscopy for decannulation or late evaluation of the airway. RESULTS: Of the 164 patients in the study, 90 (54.88 percent) died (due to causes unrelated to the procedure), 67 (40.85 percent) completed follow-up, and 7 (4.27 percent) were lost to follow-up. Of the 67 patients who completed follow-up, 32 had undergone tracheostomy (21 by the general surgery team and 11 by the thoracic surgery team), and 22 had been submitted to isthmectomy (11 by the general surgery team and 11 by the thoracic surgery team). There was no difference between the surgical teams in terms of the incidence of stomal complications. However, there was a significant difference when the surgical techniques (with or without isthmectomy) were compared. CONCLUSIONS: Not performing isthmectomy in parallel with tracheostomy leads the surgeon to open the tracheal stoma more distally than expected. In such cases, there were more stomal complications.

Estomias na doença de Crohn / Stomas in Crohn's disease

Foram estudados 232 doentes com diagnóstico de doença de Crohn no período de setembro/84 a março/98. Destes, 143 foram submetidos a 270 operaçöes abdominais. Foram realizadas quer como procedimentos isolados quer associados a ressecçöes intestinais, 82 estomias sendo 20 ileostomias terminais definitivas, 30 temporárias, sendo 17 terminais e 13 em alça; 12 colostomias definitivas e 20 temporárias, sendo oito terminais e 12 em alça. Todos os doentes que foram submetidos estomias, à exceçäo de 4, apresentavam doença perianal. Cinquenta e uma estomias foram realizadas associadamente a ressecçöes intestinais, 17 como tratamento da doença de Crohn näo associada a outro tipo de procedimento, oito para correçäo de complicaçöes da própria estomia e seis para proteçäo de anastomose. Foram indicadas 22 operaçöes com o objetivo de restabelecer o trânsito intestinal, sem êxito em um doente. Dos 57 doentes submetidos a algum tipo de estomia, 45 (78,9 porcento) permanecem com estomia até a presente data, 11 (19,3 porcento) estäo com o trânsito intestinal restabelecido e um (1,8 porcento) faleceu por progressäo da doença de Crohn. Conclusöes: 1. A doença de Crohn foi responsável por número elevado de operaçöes das quais 38,5 porcento associaram-se a estomias; 2. A doença perianal foi o fator mais importante como causa de estomia definitiva; 3. Estomias näo devem ser indicadas como forma isolada de tratamento; 4. A maioria dos doentes (80,7 porcento) em que a estomia foi indicada, mesmo em caráter temporário, permaneceu definitivamente com a mesma; 5. As estomias apresentaram número importante de complicaçöes