Quality of life and financial impacts of permanent colostomy for rectal cancer

Introduction: Returning to work is an important cancer recovery milestone. Permanent colostomy can be required for rectal cancer treatment and can significantly impact well-being. We aimed to evaluate the impact of permanent colostomy on health-related quality of life and return to work in patients with rectal cancer. Methods: This was a retrospective cohort study on 23 employed patients receiving curative surgery for rectal cancer requiring permanent colostomy. Demographic and health-related quality-of-life questionnaires (the Colostomy Impact Score (CIS), the EORTC Quality of Life Questionnaire (QLQ)-C30, and the EORTC QLQ-CR29) were posted to eligible patients. Results: On average, patients (10 female, 13 male, mean age 61.8 years) were 5.0 ± 3.5 years post-surgery. At the time of questioning, 73.9% had returned to work (21.7% changed their type of work), while 17.4% never returned to work. Of those that returned to work, 11.8% returned within 1 month of surgery, while 23.5% had not returned after 12 months. Comparison of CIS between patients that returned to the same work (14.6 ± 0.93), changed their work (13.0 ± 0.74), and did not return to work (14.3 ± 2.3) revealed no significant differences (p = 0.36). CIS did not correlate with days worked on return, or time to return to work (p > 0.05). Conclusion: Returning to work following rectal cancer treatment with permanent colostomy is challenging, with 17.4% never returning to work. Of those who returned to work, 23.5% required more than 12 months. This was not associated with CIS in our study. (AU)

Quadratus Lumborum block as primary anesthetic technique for colostomy procedure: a case report

Abstract An elderly patient was admitted to the hospital due to an enterovesical fistula and a terminal colostomy was proposed. The patient had a high anesthetic risk and thus a quadratus lumborum block was chosen as the sole anesthetic technique. This block has been described to provide both somatic and visceral analgesia to the abdomen. In fact, it yielded good anesthetic conditions to perform the procedure and allowed the patient to be hemodynamically stable and comfortable throughout the case. The postoperative period was uneventful.

Risk factors associated to incisional hernia in stoma site after stoma closure: A systematic review and meta-analysis.

BACKGROUND: This study aims to identify which risk factors are associated with the appearance of an incisional hernia in a stoma site after its closure. This in the sake of identifying which patients would benefit from a preventative intervention and thus start implementing a cost-effective protocol for prophylactic mesh placement in high-risk patients. METHODS: A systematic review of PubMed, Cochrane library, and ScienceDirect was performed according to PRISMA guidelines. Studies reporting incidence, risk factors, and follow-up time for appearance of incisional hernia after stoma site closure were included. A fixed-effects and random effects models were used to calculate odds ratios' estimates and standardized mean values with their respective grouped 95% confidence interval. This to evaluate the association between possible risk factors and the appearance of incisional hernia after stoma site closure. RESULTS: Seventeen studies totaling 2899 patients were included. Incidence proportion between included studies was of 16.76% (CI95% 12.82; 21.62). Out of the evaluated factors higher BMI (p = 0.0001), presence of parastomal hernia (p = 0.0023), colostomy (p = 0,001), and end stoma (p = 0.0405) were associated with the appearance of incisional hernia in stoma site after stoma closure, while malignant disease (p = 0.0084) and rectum anterior resection (p = 0.0011) were found to be protective factors. CONCLUSIONS: Prophylactic mesh placement should be considered as an effective preventative intervention in high-risk patients (obese patients, patients with parastomal hernia, colostomy, and end stoma patients) with the goal of reducing incisional hernia rates in stoma site after closure while remaining cost-effective.

Sigmoid resection and primary anastomosis for perforated diverticulitis with peritonitis: To divert or not to divert-A systematic review and meta-analysis.

BACKGROUND: The role of proximal diversion in patients undergoing sigmoid resection and primary anastomosis for diverticulitis with generalized peritonitis is unclear. The aim of this study was to compare the clinical outcomes of sigmoid resection and primary anastomosis and sigmoid resection and primary anastomosis with a proximal diversion in perforated diverticulitis with diffuse peritonitis. METHOD: A systematic literature search on sigmoid resection and primary anastomosis and sigmoid resection and primary anastomosis with proximal diversion for diverticulitis with diffuse peritonitis was conducted in the Medline and EMBASE databases. Randomized clinical trials and observational studies reporting the primary outcome of interest (30-day mortality) were included. Secondary outcomes were major morbidity, anastomotic leak, reoperation, stoma nonreversal rates, and length of hospital stay. A meta-analysis of proportions and linear regression models were used to assess the effect of each procedure on the different outcomes. RESULTS: A total of 17 studies involving 544 patients (sigmoid resection and primary anastomosis: 287 versus sigmoid resection and primary anastomosis with proximal diversion: 257) were included. Thirty-day mortality (odds ratio 1.12, 95% confidence interval 0.53-2.40, P = .76), major morbidity (odds ratio 1.40, 95% confidence interval 0.80-2.44, P = .24), anastomotic leak (odds ratio 0.34, 95% confidence interval 0.099-1.20, P = .10), reoperation (odds ratio 0.49, 95% confidence interval 0.17-1.46, P = .20), and length of stay (sigmoid resection and primary anastomosis: 12.1 vs resection and primary anastomosis with diverting ileostomy: 15 days, P = .44) were similar between groups. The risk of definitive stoma was significantly lower after sigmoid resection and primary anastomosis (odds ratio 0.05, 95% confidence interval 0.006-0.35, P = .003). CONCLUSION: Sigmoid resection and primary anastomosis with or without proximal diversion have similar postoperative outcomes in selected patients with diverticulitis and diffuse peritonitis. However, further randomized controlled trials are needed to confirm these results.

[Comparison of protective colostomy vs. ileostomy in rectal cancer surgery]. / Comparación de colostomía frente a ileostomía de protección en cirugía de cáncer rectal.

Background: Rectal cancer (RC) is the 3rd most frequent one in Mexico. Protective stoma in resection and anastomosis is controversial. Objective: To compare quality of life (QoL), functional capacity (FC) and complications in rectal cancer (RC) patients with low and ultralow anterior resection (LAR and ULAR) with loop transverse colostomy (LTC) versus protective ileostomy (IP). Material and methods: Comparative, observational study in patients with RC and LTC (Group 1) or IP (Group 2) from 2018-2021. FC pre and postoperative, complications, hospital readmission (HR) and assessment by other specialty (AS) were assessed; QoL was assessed with EQ-5D by telephone. Student-t test, Chi-squared test, Mann-Whitney-U test were used. Results: Group 1: 12 patients: mean preoperative FC: ECOG 0.83, Karnofsky 91.66%; postoperative: ECOG 1, Karnofsky 89.17%. Mean postoperative QoL: index value 0.76 and health status 82.5%; HR: 25%; AS: 42%. Group 2: 10 patients: mean preoperative FC: ECOG 0.80, Karnofsky 90%; postoperative: ECOG 1.5, Karnofsky 84%. Mean postoperative QoL: index value 0.68 and health status 74%; HR: 50%; AS: 80%. Complications: 100% of sample. Conclusion: The differences in QoL, FC and complications between LTC and IP in RC patients operated with LAR/ULAR were not significant.

Introducción: el cáncer rectal (CR) es el tercero más frecuente en México. El estoma de protección en la resección y anastomosis es controversial. Objetivo: comparar calidad de vida (CV), capacidad funcional (CF) y complicaciones (COMP) en pacientes con CR con resección anterior baja (RAB) y ultrabaja (RAUB) con colostomía de transverso en asa (CTA) frente a ileostomía de protección (IP). Material y métodos: estudio comparativo, observacional, en pacientes con CR con CTA (Grupo 1) o IP (Grupo 2) atendidos en 2018-2021. Se evaluó CF (escalas ECOG y Karnofsky) pre y posquirúrgicas, COMP, reingreso hospitalario (RH) y valoración por otra especialidad (VE). Se evaluó CV con la encuesta EQ-5D vía telefónica. Se utilizó t de Student, Chi cuadrada y U de Mann-Whitney. Resultados: grupo1: 12 pacientes; CF media prequirúrgica ECOG: 0.83, Karnofsky: 91.66%; posquirúrgica ECOG: 1, Karnofsky: 89.17%. CV posquirúrgica medias valor índice: 0.76 y estado funcional: 82.5%; RH: 25%, VE: 42%. Grupo 2: 10 pacientes; CF media prequirúrgica ECOG: 0.80, Karnofsky: 90%; CF media postquirúrgica ECOG: 1.5, Karnofsky: 84%; CV medias valor índice: 0.68, estado funcional: 74%; RH: 50%, VE: 80%. COMP: 100% de la muestra. Conclusiones: las diferencias en CV, CF y COMP entre CTA e IP en pacientes con CR con RAB/RAUB no fueron significativas.

Quadratus Lumborum block as primary anesthetic technique for colostomy procedure: a case report.

An elderly patient was admitted to the hospital due to an enterovesical fistula and a terminal colostomy was proposed. The patient had a high anesthetic risk and thus a quadratus lumborum block was chosen as the sole anesthetic technique. This block has been described to provide both somatic and visceral analgesia to the abdomen. In fact, it yielded good anesthetic conditions to perform the procedure and allowed the patient to be hemodynamically stable and comfortable throughout the case. The postoperative period was uneventful.

Primary adenocarcinoma at colostomy site: report of a clinical case

Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer in the United States and it is found in 17% of patients thought to have complicated diverticular disease. However, primary adenocarcinoma rarely occur in the colostomy site and the risk of developing malignancy is similar to that of any other colonic segment. Polyps found in CRC screenings can be divided into the following types: hyperplastic polyps, polyps with no malignant potential, adenomatous polyps, polyps with malignant potential, and malignancies. Local complications of the colostomy can appear in the immediate, early, or late postoperative period, with an incidence ranging from 15 to 30%; neoplasia is even less common. (AU)

The colostomy complications in anorectal malformation: a retrospective study

Background: A colostomy is a surgical approach that creates an opening for the colon, or/and large intestine through the abdomen. Anorectal malformations are a group of abnormalities of the rectum and anus that are present at birth. Objective: To analyze the common complications of colostomy in anorectal formations. Methods: This was a retrospective study conducted on 50 temporary colostomies performed in children at the Surgical Department of the Abu Ghraib General Hospital in the period from January 2018 to January 2020. Information was collected regarding the patients' age, sex, body weight, associated anomalies, colostomy types and sites, and the indications and complications of colostomies. Results: A total of 44 (88%) cases were reported in the children's 1st month of life. The ratio of male to female was 1:1. Pelvic colostomy was performed in 48 (96%) patients, as 40 (80%) children underwent a loop-type, and 8 (16%) patients underwent doublebarrel colostomy. Transverse colostomy was performed on two patients. Prolapse occurred in 50% of the patients, and skin excoriations occurred in 22% . A total of 10% of the children developed sepsis. Bleeding was seen in 4% of the children after colostomy performance. Stenosis presented in 6% of the children, and this was corrected by repeated dilatation and re-fashioning. Obstruction of intestines was observed in one patient. The retraction developed in 6% of patients. Conclusions: Imperforate anus was themost common indication for stoma formation in the pediatric age group. Loop colostomy was the most common type used, and it had the highest rate of complications. Prolapses and skin excoriation were the most common complications found. (AU)

Absceso periostomal secundario a perforación intestinal por cuerpo extraño: presentación de un caso / Periostomal abscess secondary to bowel perforation due to foreign body ingestion: a case report

Resumen Objetivo: Reportar un caso de absceso periostomal, su diagnóstico clínico e imagenológico y manejo. Materiales y Método: Paciente de 77 años usuaria de colostomía con dolor abdominal asociado a aumento de volumen y enrojecimiento de la piel alrededor de la colostomía. Una tomografía computada de abdomen muestra un cuerpo extraño perforante de la pared colónica ostomizada, asociado a formación de un absceso. Resultados: Se practica una incisión de la colección, dando salida a gran cantidad de pus y cuerpo extraño correspondiente a tibia de ave. Se inicia cobertura antibiótica y se instala drenaje Penrose. Controles posteriores muestran regresión del absceso y drenaje sin débito. Discusión: 80%-90% de los cuerpos extraños ingeridos son eliminados sin complicación y < 1% producen perforación. Esto es más común en segmentos intestinales angulados o intervenidos quirúrgicamente. La clínica es inespecífica y el diagnóstico requiere una imagen que identifique signos sugerentes. Conclusión: Un absceso periostomal y la perforación intestinal por cuerpo extraño son cuadros infrecuentes. La alta sospecha diagnóstica y una evaluación imagenológica pueden dar una respuesta precisa. Además del manejo quirúrgico, debe asociarse cobertura antibiótica para enteropatógenos y generalmente un sistema de drenaje.

Aim: To report a case of periostomal abscess, its clinical and imaging diagnosis and management. Materials and Method: 77-year-old patient, user of a colostomy with abdominal pain associated to swelling and redness of the skin next to the colostomy. A computed tomography of the abdomen showed a foreign body perforating the ostomized bowel associated to the formation of an abscess. Results: An incision of the gathering was performed, giving out a great quantity of pus and the foreign body, which corresponded to a bird's tibia. Antibiotic therapy was given, and a Penrose drainage installed. Further controls showed regression of the abscess and no flux from drainage. Discussion: 80%-90% of ingested foreign bodies are eliminated without complications and < 1% produce perforation. This is more common in angled intestinal segments or surgically intervened ones. Clinical features are unspecific, and diagnosis requires suggesting imaging signs. Conclusion: Periostomal abscesses and bowel perforation due to foreign body are infrequent. High diagnostic suspicion and an imaging evaluation may give a precise answer. Besides surgical management, antibiotic coverage for enteropathogens must be associated and a drainage system too in most cases.

HARTMANN PROCEDURE OR RESECTION WITH PRIMARY ANASTOMOSIS FOR TREATMENT OF PERFORATED DIVERTICULITIS? SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: Mortality after emergency surgery in randomized controlled trials. The Hartmann procedure remains the treatment of choice for most surgeons for the urgent surgical treatment of perforated diverticulitis; however, it is associated with high rates of ostomy non-reversion and postoperative morbidity. AIM: To study the results after the Hartmann vs. resection with primary anastomosis, with or without ileostomy, for the treatment of perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV), and to compare the advantages between the two forms of treatment. METHOD: Systematic search in the literature of observational and randomized articles comparing resection with primary anastomosis vs. Hartmann's procedure in the emergency treatment of perforated diverticulitis. Analyze as primary outcomes the mortality after the emergency operation and the general morbidity after it. As secondary outcomes, severe morbidity after emergency surgery, rates of non-reversion of the ostomy, general and severe morbidity after reversion. RESULTS: There were no significant differences between surgical procedures for mortality, general morbidity and severe morbidity. However, the differences were statistically significant, favoring primary anastomosis in comparison with the Hartmann procedure in the outcome rates of stoma non-reversion, general morbidity and severe morbidity after reversion. CONCLUSION: Primary anastomosis is a good alternative to the Hartmann procedure, with no increase in mortality and morbidity, and with better results in the operation for intestinal transit reconstruction.

The Other Double Bubble Sign: Gastric Parastomal Hernia.

Introduction: A parastomal hernia (PSH) is an abnormal herniation of an intra-abdominal organ or other tissue through an intentionally created fascial defect at an ostomy site. PSHs commonly involve reducible mobile segments of omentum, intra-abdominal fat, and bowel. However, PSHs may rarely involve fixed intra-abdominal organs such as the stomach. Case Description: A 68-year-old female underwent emergent Hartmann procedure for Hinchey III diverticulitis and subsequently developed a large reducible parastomal hernia. She was scheduled for an elective laparoscopic colostomy reversal. Prior to her scheduled reversal, the patient presented to the ED with anorexia, lack of colostomy output, emesis, and pain localized to her left lower quadrant. She was found to have gastric outlet obstruction secondary to herniation of the stomach through the left lower quadrant colostomy site. The patient was admitted and treated conservatively with resolution of her symptoms, but due to the high likelihood of recurrence, the decision was made to proceed with laparoscopic Hartmann colostomy reversal with coloproctostomy and primary closure of the fascia without mesh. Conclusion: The contents of a PSH can become incarcerated causing obstruction, strangulation, necrosis and even perforation over time. Fortunately, in this case, herniation of the stomach was recognized early. The patient underwent repair of the hernia defect in order to prevent recurrence of gastric herniation and its potential detrimental complications. The decision regarding the technical aspects of ostomy reversal in terms of mesh selection require further study. In our case, mesh was not used due to patient-specific factors and comorbidities.

Time after ostomy surgery and type of treatment are associated with quality of life changes in colorectal cancer patients with colostomy.

PURPOSE: Quality of life in colorectal cancer patients may be affected by colostomy and treatment, but relevant studies are still scarce and contradictory. The present study aimed to evaluate the association between colostomy time and treatment type with quality of life in colorectal cancer patients. METHODS: A prospective observational study of 41 patients with colorectal cancer was conducted on three occasions T0, T1 and T2 (0-2; 3-5 and 6-8 months after ostomy surgery, respectively). The treatments prescribed were: surgery alone, chemotherapy or radiotherapy, or chemoradiotherapy. European Organization for Research and Treatment of Cancer questionnaires were used to evaluate quality of life. Worsening clinical changes were evaluated considering difference in scores between times of surgery ≥±9 points. RESULTS: Regarding ostomy surgery, scores in physical function improved between T0 and T1 and these better scores were maintained at T1 to T2. The same was observed for urinary frequency, appetite loss and dry mouth. Chemoradiotherapy was associated with worse scores for global health status, nausea and vomiting, bloating and dry mouth. Although significant differences were not observed in some domains in the Generalized Estimating Equations analysis, patients showed noticeable changes for the worse in the pain, anxiety, weight concern, flatulence and embarrassment domains during these periods. CONCLUSIONS: Colostomy improved quality of life at 3-5 months in most domains of quality of life and remained better at 6-8 months after surgery. Chemoradiotherapy had a late negative influence on quality of life. Health teams could use these results to reassure patients that this procedure will improve their quality of life in many functional and symptomatic aspects.

Parastomal Hernia Following Abdominoperineal Resection / Hérnia paraestomal após ressecc¸ão abdominoperineal

ABSTRACT Parastomal Hernia (PSH) is a common complication of patient who undergone ostomy especially end colostomy. Presence of hernia defect is associated with the risk of strangulation and obstruction so understanding the potential risk factor such as patient's factor and technical issues is important. This study is evaluating the incidence of PSH hernia in patients who undergone end colostomy due to Abdominoperineal Resection (APR) in a tertiary colorectal surgery referral center and explore the possible risk factors of this complication. The study was designed as a retrospective cross sectional study on 41 patients who undergone end colostomy due to APR. Three patient lost the follow up and 13 patients died and 25 patients were enrolled in study. Demographic data, history of smoking, steroid administration, Diabetes, obstructive pulmonary disease, transfusion, Neoadjuvant therapy, wound infection and Body mass Index (BMI) were gathered. The mean age of participants was 58.8 and the mean BMI was 25.04 kg/m2. The incidence of PSH was 40% and 68% of operations were done with Laparoscopy. This study could not find statistically significant risk factor for PSH. The 40% incidence of PSH is noticeable and specific strategies should be applied to reduce such complications. Larger studies is essential to investigate the possible etiologies of this complication.

RESUMO A hérnia paraestomal é uma complicação comum em pacientes submetidos a estomia, especialmente a colostomia terminal. A presença de defeito de hérnia está associada ao risco de estrangulamento e obstrução, portanto, é importante compreender o potencial fator de risco, como o fator do paciente e questões técnicas. Este estudo avalia a incidência de hérnia paraestomal em pacientes submetidos à colostomia terminal devido à ressecção abdominoperineal em um centro terciário de referência em cirurgia colorretal e explorar os possíveis fatores de risco dessa complicação. O desenho do estudo foi transversal retrospectivo de 41 pacientes submetidos à colostomia terminal devido à ressecção abdominoperineal. Três pacientes foram perdidos no seguimento, 13 pacientes morreram, e 25 pacientes foram incluídos no estudo. Dados demográficos, história de tabagismo, administração de esteroides, diabetes, doença pulmonar obstrutiva, transfusão, terapia neoadjuvante, infecção de ferida operatória e Índice de Massa Corporal foram coletados. A média de idade dos participantes foi 58,8 e o índice de massa corporal médio foi 25,04 kg/m2. A incidência de hérnia paraestomal foi de 40% e 68% das cirurgias foram realizadas por laparoscopia. Este estudo não encontrou fator de risco estatisticamente significativo para hérnia paraestomal. A incidência de 40% de hérnia paraestomal é perceptível e estratégias específicas devem ser aplicadas para reduzir tais complicações. Estudos maiores são essenciais para investigar as possíveis etiologias dessa complicação.

Postsurgical intestinal occlusion ileum-ileum double intussusception in eleven-month girl.

BACKGROUND: Postoperative intussusception is an unusual complication in children; the incidence is 0.01-0.25%. CLINICAL CASE: Female of 11 months who underwent colostomy, 48 h later presents abdominal pain, vomiting gastrobiliar and abdominal distension. A laparotomy was performed, finding a double ileo-ileal invagination 60 cm from the ileocecal valve. DISCUSSION: The postoperative intestinal invaginations are extremely rare and most of them occur within the first 7 days. The etiology of postoperative intussusception is unknown. CONCLUSIONS: Postoperative children with intestinal occlusion, intussusception should be suspected and an immediate laparotomy should be performed.

ANTECEDENTES: La invaginación posoperatoria es una complicación inusual en niños. Su incidencia es del 0.01-0.25%. CASO CLÍNICO: Niña de 11 meses a quien se realizó colostomía y 48 horas después presentó dolor abdominal, vómito gastrobiliar y distensión abdominal. Se realizó laparotomía y se encontró una doble invaginación íleo-ileal a 60 cm de la válvula ileocecal. DISCUSIÓN: Las invaginaciones intestinales posoperatorias son extremadamente raras y la mayoría se presentan dentro de los primeros 7 días. La etiología de la invaginación posoperatoria es desconocida. CONCLUSIONES: En niños operados con oclusión intestinal debe sospecharse invaginación intestinal y realizar una laparotomía inmediata.

Hartmann procedure or resection with primary anastomosis for treatment of perforated diverticulitis? systematic review and meta-analysis / Procedimento de hartmann ou ressecção com anastomose primária para tratamento da diverticulite perfurada? revisão sistematizada e metanálise

ABSTRACT Background: The Hartmann procedure remains the treatment of choice for most surgeons for the urgent surgical treatment of perforated diverticulitis; however, it is associated with high rates of ostomy non-reversion and postoperative morbidity. Aim: To study the results after the Hartmann vs. resection with primary anastomosis, with or without ileostomy, for the treatment of perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV), and to compare the advantages between the two forms of treatment. Method: Systematic search in the literature of observational and randomized articles comparing resection with primary anastomosis vs. Hartmann's procedure in the emergency treatment of perforated diverticulitis. Analyze as primary outcomes the mortality after the emergency operation and the general morbidity after it. As secondary outcomes, severe morbidity after emergency surgery, rates of non-reversion of the ostomy, general and severe morbidity after reversion. Results: There were no significant differences between surgical procedures for mortality, general morbidity and severe morbidity. However, the differences were statistically significant, favoring primary anastomosis in comparison with the Hartmann procedure in the outcome rates of stoma non-reversion, general morbidity and severe morbidity after reversion. Conclusion: Primary anastomosis is a good alternative to the Hartmann procedure, with no increase in mortality and morbidity, and with better results in the operation for intestinal transit reconstruction.

RESUMO Racional: O procedimento a Hartmann permanece sendo o tratamento de escolha da maioria dos cirurgiões para o tratamento cirúrgico de urgência da diverticulite perfurada, entretanto está associado com altas taxas de não reversão da ostomia e de morbidade pós-operatória. Objetivo: Estudar os resultados após o procedimento de Hartmann vs. ressecção com anastomose primária, com ou sem ileostomia, para o tratamento da diverticulite perfurada com peritonite purulenta ou fecal (grau de Hinchey III ou IV), e comparar as vantagens entre as duas formas de tratamento. Método: Busca sistemática na literatura de artigos observacionais e randomizados comparando ressecção com anastomose primária vs. procedimento de Hartmann no tratamento de urgência da diverticulite perfurada. Analisar como desfechos primários a mortalidade após a operação de urgência e a morbidade geral após ela; como desfechos secundários, a morbidade severa após a operação de urgência, as taxas de não reversão da ostomia, a morbidade geral e severa após a reversão. Resultados: Não houve diferenças significativas entre os procedimentos cirúrgicos para mortalidade, morbidade geral e morbidade severa. Contudo, as diferenças foram significativas estatisticamente favorecendo anastomose primária na comparação com procedimento de Hartmann nos desfechos taxas de não reversão do estoma, morbidade geral e morbidade severa após reversão. Conclusão: A anastomose primária apresenta-se como boa alternativa ao procedimento de Hartmann, sem aumento de mortalidade e morbidade, e com melhores resultados na operação de reconstrução do trânsito intestinal.

[Prospective study of digestive stomas complications]. / Estudio prospectivo sobre las complicaciones de los estomas digestivos.

The surgical treatment of colorectal pathology can often lead to the need for a stoma, either colostomy or ileostomy. This surgery is associated with a high rate of complications. OBJECTIVE: The objective of this study is to describe the frequency of stomas complications, identify associated risk factors as well as new prevention strategies. MATERIALS AND METHODS: Prospective observational cohort study on patients who underwent an ileostomy or colostomy at the Hospital U. Infanta Leonor between April 2016 and October 2017. RESULTS: A total of 87 stomas were performed in 83 patients, of which 77.01% had at least one complication. The most presented complication was dermatitis (54.02%), followed by detachment (40.23%) and flat stoma (21.84%). The greatest number of complications occurred in the second week of the postoperative period. The average height of the stomas made was 10.6 mm. BMI was associated as a risk factor for the development of stoma complications. Of all the patients, 55 had follow-up until 6 months. CONCLUSION: Although our complication rate is high, this outcome is similar to others studies previously published. BMI was the unique risk factor associated with the development of stoma complications. New strategies related to the surgical technique can be developed to decrease our complication rate.

Disability Among Adults in Brazil With a Colostomy: A Cross-sectional, Descriptive Study.

People with an ostomy need care appropriate to their needs and should be encouraged to adapt to their situation. In Brazil, persons with a stoma meet the legal definition of being disabled, enabling them to access comprehensive health care services. PURPOSE: The objective of this study was to evaluate the degree of disability experienced by persons with a colostomy. METHODS: A cross-sectional study was conducted among people with a colostomy in one Brazilian public health service. Between May 2017 and January 2018, persons at least 18 years of age who had a colostomy for at least 3 months were eligible to participate. Sociodemographic and stoma characteristic variables were collected, and the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 was used to assesses perceived levels of disability. Higher scores indicated greater degree of difficulty. All persons with a WHODAS score ⟩0 were classified as disabled. Descriptive statistics, chi-squared, and Fisher's exact tests were used for data analysis, with a significance level of 5%. RESULTS: Among the 58 predominantly elderly participants (29 women, 29 men; mean age 64 ± 12 years), the overall mean WHODAS score suggested a small degree of impairment (3.1 ± 7.1). The highest scores were observed in the domains participation (6.3 ± 16.1), mobility (5.6 ± 17.3), and life activities (5.3 ± 15.6). The majority of participants (41, 70.7%) had a disability score of 0 (no disability). The proportion of persons who did or did not perceive any level of disability did not differ significantly by the stoma variables assessed. CONCLUSION: Based on the WHODAS scores, the majority of study participants did not perceive themselves as being physically disabled. Other clinical studies should advance this discussion in order to better understand the perception and reality of disability among ostomates.