Autoimagem de clientes com colostomia em relação à bolsa coletora / Self-image of clients with colostomy related to the collecting bag / Auto-imagen de clientes con colostomía en relación con la bolsa colectora

Objetivou-se analisar a percepção do portador de colostomia em relação ao uso da bolsa coletora. Realizou-se uma pesquisa descritiva com abordagem qualitativa, no Centro Integrado de Saúde Lineu Araújo, Teresina-PI. Participaram da pesquisa dez clientes portadores de bolsa de colostomia. Os dados foram produzidos por meio de entrevistas semiestruturadas. A análise de conteúdo permitiu revelar os sentimentos, as mudanças ocorridas e como acontece o processo de adaptação da pessoa portadora da bolsa de colostomia. Constatou-se que a relação entre a pessoa portadora de colostomia e a bolsa coletora é permeada por sentimentos negativos, mudanças significativas de ordem físicas, psicológicas, sexuais, bem como na teia de suas relações sociais.

The study aimed to analyze the perception of patients with colostomy in the use of the collection bag. It was conducted a descriptive qualitative approach, on the Center for Integrated Health Lineu Araujo, Teresina-PI, Brazil. Ten clients with colostomy bag participated in the survey. Data were generated through semi-structured interviews. Content analysis has revealed the feelings, the changes and how the process of adaptation of the person with the colostomy bag occurs. It was found that the relationship between the collection bag and the person with a colostomy is filled with negative feelings, significant changes in physical, psychological and sexual order, and in the web of his/her social relationships.

El estudio objetivó analizar la percepción de los pacientes con colostomía cuanto al uso de la bolsa de recolección. Llevó-se a cabo una pesquisa con enfoque descriptivo cualitativo, en el Centro de Salud Integrado de Lineu Araujo, Teresina-PI. Participaron en la encuesta diez clientes portadores de bolsa de colostomía. Los datos fueron generados a través de entrevistas semi-estructuradas. El análisis de contenido ha puesto de manifiesto los sentimientos, los cambios y cómo funciona el proceso de adaptación de la persona con la bolsa de colostomía. Se encontró que la relación entre la la persona con una colostomía y bolsa de recolección está llena de sentimientos negativos, u de cambios significativos en los aspectos físico, psicológico y sexual; y en la red de relaciones sociales.

[Self-image of clients with colostomy related to the collecting bag]. / Autoimagem de clientes com colostomia em relação à bolsa coletora.

The study aimed to analyze the perception of patients with colostomy in the use of the collection bag. It was conducted a descriptive qualitative approach, on the Center for Integrated Health Lineu Araujo, Teresina-PI, Brazil. Ten clients with colostomy bag participated in the survey. Data were generated through semi-structured interviews. Content analysis has revealed the feelings, the changes and how the process of adaptation of the person with the colostomy bag occurs. It was found that the relationship between the collection bag and the person with a colostomy is filled with negative feelings, significant changes in physical, psychological and sexual order, and in the web of his/her social relationships.

An update on stoma appliance flanges and base-plates.

Coping with a stoma can be difficult for many reasons; leakage and skin breakdown are two common problems faced by ostomates (people with a stoma). A flange or base-plate adheres to the patient's abdomen. A secure and well designed flange is essential to the ostomate when adjusting to their newly formed stoma. Selecting the correct type of appliance and flange is an important part of holistic assessment. This article is the second in a series of three and focuses on the newer flanges that are available. It can be difficult for community nurses to keep abreast of all the new developments within the stoma appliance field; therefore, this article aims to highlight some of the key aspects concerning the functionality of available flanges.

Early experience with the antegrade colonic enema stopper to reduce stomal stenosis.

BACKGROUND: Since the initial description of the antegrade colonic enema (ACE) procedure, stomal stenosis has been recognized as its most common complication. We previously reported that 44% of our patients required a dilatation for stomal stenosis, with 22% requiring surgical revision. We present our findings with the use of an ACE stopper (Medicina, Adlington, Lancashire, UK) as a means of avoiding this problem. METHODS: A retrospective review of the case notes of all patients who underwent an ACE procedure with a follow-up longer than 6 months was carried out over a 3-year period. Two weeks after the ACE procedure, an ACE stopper was sited in the conduit for at least 4 months and removed only for catheterization. RESULTS: Fourteen patients underwent an ACE procedure, 12 of whom received it laparoscopically. All patients received the ACE stopper. The patients' median age at surgery was 10 years (range, 5-16 years). Diagnoses included spinal dysraphism (n = 6) and anorectal malformation (n = 4), with soiling as the presenting complaint among all patients. The patients' median follow-up was 12 months (range, 6-39 months). There was no stomal complication, and 13 patients reported a marked improvement in soiling. CONCLUSIONS: The use of an ACE stopper has abolished stomal stenosis on short-term follow-up. We recommend the stopper as an adjunct to the overall management of concerned patients. Longer follow-up is required to establish the true effectiveness of this simple device.

Randomized crossover comparison of adhesively coupled colostomy pouching systems.

Ostomy pouching systems affect well being and quality of life, making selection of the appropriate system a key element of ostomy care. Several innovative adhesively coupled, two-piece systems are on the market. They feature flexible low profiles, allowing pouch removal/replacement without changing the skin barrier or wafer. This facilitates inspection or pouch changes without disrupting peristomal skin. Because few controlled trials compare pouching system effectiveness, a prospective, randomized open-label, crossover study was conducted. Under the supervision of ostomy care nurses in six outpatient clinics in Germany, clinical performance of and patient preferences for two adhesively coupled, closed-end pouching systems were compared during normal use. One is a gelatin/pectin-based skin barrier sealed to the pouch with a company-specific adhesive coupling technology (System E); the other, a grooved base plate wafer adhesive pouch coupling system (System F). Seventeen attributes and seven end-of-study measures that included comfort, flexibility, wear time, ease of removal, and overall performance were assessed. Informed, consenting participants were randomly assigned to use one system for five skin barrier/wafer changes or up to 15 days and subsequently switched to the alternative system for a similar period. The 39 participants used a total of 1,645 pouches and 342 skin barriers. All were found safe as determined by incidence and nature of the reported peristomal skin problems, subject withdrawals, and adverse events for both systems. However, System E provided longer pouch wear times (P < 0.01). End-phase ratings favored System E on 10 of the 17 attributes (P < 0.04) and System Fon none. More participants preferred System E on all seven end-of-study measures, five significantly (comfort, flexibility, wear time, ease of removal, and overall performance; (P < 0.02). These participant-reported, ostomy-related outcomes underscore the importance of product evaluation and selection for persons with an ostomy.

The Macedo-Malone antegrade continence enema procedure: early experience.

PURPOSE: The successful treatment of fecal incontinence can dramatically improve the quality of life of affected children. The introduction of the Malone antegrade continence enema provides the opportunity to manage previously resistant cases. However, using the to create this catheterizable channel is not always possible, and the duration of these antegrade enemas is a source of concern for the patients. We describe a new approach to create left continent colonic access to shorten the duration of these enemas, and report the experience gained from the first 9 cases managed at our institution. MATERIALS AND METHODS: During a 5-year period 9 patients underwent a Macedo-Malone antegrade continence enema at our institution. Incontinence was associated with myelomeningocele in 7 patients and anorectal malformation in 2. The antegrade continence enema procedure is begun by isolating a 2 cm flap in a tenia on the left colon (spleen flexure). A 12Fr silicone Foley catheter is placed on the mucosal surface of the flap to allow tubularization of the plate with interrupted polyglycolic acid 3-zero transverse sutures, creating an efferent tubular conduit. Antegrade colonic washouts were started 2 weeks after surgery with saline solution or tap water in all patients. RESULTS: Followup of our 9 cases ranged from 8 to 33 months (average 20.7). Enema volume varied from 250 to 800 ml, with administration taking from 45 to 60 minutes, and colonic evacuation occurred within 30 to 60 minutes of enema administration. Of the 9 patients 8 were completely continent and 1 was partially continent. Four patients experienced difficulty with catheterization initially because of stenosis of the stomal track. The affected stomas were dilated, which was successful in 1 case. Three patients subsequently required stomal revision. CONCLUSIONS: The Macedo-Malone procedure is a relatively straightforward operative approach providing an effective washout technique that is acceptable to parents and children.

Therapeutic cecostomy tubes in infants with imperforate anus and caudal agenesis.

BACKGROUND/PURPOSE: Caudal agenesis is indicative of a poor prognosis for achieving normal bowel function in children with high imperforate anus (HIA). Complications with impaction, soiling, megarectosigmoid, and adverse responses to rectal enemas are inevitable and associated with long-term psychosocial dysfunction. In an attempt to avoid these outcomes, the authors began a prospective evaluation in these high-risk patients of skin level cecostomy tubes placed in infancy. METHODS: Between October 1997 and March 2001, 8 infants with variants of caudal agenesis underwent presumptive therapeutic placement of a cecostomy tube in conjunction with colostomy closure (n = 7) and anal transposition (n = 1). Mean age at time of cecostomy placement was 16 months. Efficacy of daily irrigations with individually modified electrolyte solutions has been evaluated over the subsequent 1 to 41 months with a mean follow-up of 22 months. RESULTS: Effective daily colonic evacuation was achieved in 7 infants. Transient episodes of incomplete emptying often associated with soiling were resolved with adjustments in solution contents and volume. No patient has required admission for impaction, and only 1 patient has required rectal enemas. There have been no major complications, and minor problems with cramping, granulation tissue, and site discomfort quickly resolved. One patient with anal anastamotic stricture consistently has not responded to antegrade irrigation and continues to require intermittent rectal enemas and anal dilation. Attempts to wean the irrigations occur as the infants grow older and are able to participate in toilet training; however, in this preschool population, tapering of the frequency has been tolerated only transiently. CONCLUSIONS: Antegrade enemas via a cecostomy device are highly effective for bowel management in infants with HIA and caudal agenesis. They can be placed with minimal morbidity at the time of initial reconstruction or colostomy closure. Consideration of this procedure in all infants with HIA may be indicated.

Sigmoid irrigation tube for the management of chronic evacuation disorders.

BACKGROUND/PURPOSE: Antegrade colonic irrigation, in which the right colon is accessed via appendicostomy or cecostomy, now is an important adjunct in the management of children with chronic evacuation disorders. However, in most children, the major area of dysfunction is the left rather than the right colon. The authors developed a simple, percutaneous endoscopic, laparoscopically controlled sigmoid irrigation tube placement and evaluated the results in 4 children. METHODS: A rigid sigmoidoscope is advanced into the upper sigmoid and the loop brought in contact with the abdominal wall under laparoscopic control. A small skin incision is made and a needle pushed across the abdominal and sigmoid walls into the lumen of the sigmoidoscope. A guide wire is advanced through the needle into the scope and retrieved. After the scope is removed, a PEG-type catheter is attached to the guide wire and pulled back, securing the sigmoid loop to the abdominal wall. The tube is subsequently converted to a skin-level device by simply adding an external port valve. RESULTS: All 4 patients achieved prompt evacuation in the sitting position. CONCLUSIONS: Sigmoid tube for antegrade irrigation is an appealing alternative to conventional cecal access. The procedure is simple and may offer physiologic advantages.

Clinical value of colonic irrigation in patients with continence disturbances.

UNLABELLED: Continence disturbances, especially fecal soiling, are difficult to treat. Irrigation of the distal part of the large bowel might be considered as a nonsurgical alternative for patients with impaired continence. PURPOSE: This study is aimed at evaluating the clinical value of colonic irrigation. METHODS: Thirty-two patients (16 females; median age, 47 (range, 23-72) years) were offered colonic irrigation on an ambulatory basis. Sixteen patients suffered from fecal soiling (Group I), whereas the other 16 patients were treated for fecal incontinence (Group II). Patients were instructed by enterostomal therapists how to use a conventional colostomy irrigation set to obtain sufficient irrigation of the distal part of their large bowel. Patients with continence disturbances during the daytime were instructed to introduce 500 to 1,000 ml of warm (38 degrees C) water within 5 to 10 minutes after they passed their first stool. In addition, they were advised to wait until the urge to defecate was felt. Patients with soiling during overnight sleep were advised to irrigate during the evening. To determine clinical outcome, a detailed questionnaire was used. RESULTS: Median duration of follow-up was 18 months. Ten patients discontinued irrigation within the first month of treatment. Symptoms resolved completely in two patients. They believed that there was no need to continue treatment any longer. Irrigation had no effect in two patients. Despite the fact that symptoms resolved, six patients discontinued treatment because they experienced pain (n = 2) or they considered the irrigation to be too time-consuming (n = 4). Twenty-two patients are still performing irrigations. Most patients irrigated the colon in the morning after the first stool was passed. Time needed for washout varied between 10 and 90 minutes. Frequency of irrigations varied from two times per day to two times per week. In Group I, irrigation was found to be beneficial in 92 percent of patients, whereas 60 percent of patients in Group II considered the treatment as a major improvement to the quality of their lives. If patients who discontinued treatment because of washout-related problems are included in the assessment of final outcome, the success rate is 79 and 38 percent respectively. CONCLUSIONS: Patients with fecal soiling benefit more from colonic irrigation than patients with incontinence for liquid or solid stools. If creation of a stoma is considered, especially in patients with intractable and disabling soiling, it might be worthwhile to treat these patients first by colonic irrigation.

[The AKA-2 sutureless compression anastomosis of the colon and rectum]. / Die nahtlose Kompressionsanastomose AKA-2 am Kolon und Rektum.

According to own experimental studies with anastomoses without any foreign material and based on the first clinical experience with the sutureless compression anastomoses (AKA-2) in colorectal surgery on 140 patients, this anastomotic technique was applied on further 147 patients following resections of the distal colon and rectum. Excluding the 24 patients with primary protective colostomy the leakage rate was 4.0% and out of the 45 patients with an anastomosis of 10 cm or less 2 patients developed fistulae (4.4%). 3 patients showed clinically inapparent fistulae by the routinely performed gastrographin enema. On endoscopy between 2nd and 3rd postoperative week no epithelial defects were found. Due to the biological advantages regarding morphological and functional criterias and a possible oncological advantage the sutureless compression anastomoses (AKA-2) can be recommended.