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)

Perfil de usuários de um serviço de estomaterapia: análise de cluster / Perfil de usuarios de un servicio de estomaterapia: análisis de cluster / Profile of users of a stomatherapy service: cluster analysis

Resumo Objetivo Analisar o perfil das pessoas com estomias intestinais e/ou urinárias acompanhadas em serviço de estomaterapia, conforme variáveis sociodemográficas e clínicas. Método Trata-se de um estudo transversal, realizado com 90 usuários do serviço de estomaterapia. A coleta foi realizada de janeiro a fevereiro de 2020, por meio de dois instrumentos: COH-QOL-Ostomy, adaptado e traduzido para o contexto brasileiro; e City of Hope Quality of Life - Ostomy Questionnaire, instrumento original com questionário elaborado pelas próprias pesquisadoras, contemplando os aspectos sociodemográfico e clínico. Esses dados foram transferidos e organizados no Software Statistical Package for the Social Science, versão 22. Resultados Foram identificados quatro grupos distintos. No cluster 1, o grupo possui de duas a três complicações associadas ao estoma e 52,9% possuem colostomia. No cluster 2, 45% não apresentam nenhuma complicação e 70% têm urostomia. Já no cluster 3, a totalidade do grupo apresenta uma complicação e colostomia. E no cluster 4, nenhum participante do grupo apresenta complicação e todos têm colostomia. Conclusão e implicações para a prática O estudo proporcionou a geração de dados que podem auxiliar no planejamento do trabalho desenvolvido pelas equipes de saúde junto aos pacientes estomizados.

Resumen Objetivo Analizar el perfil de las personas con ostomías intestinales y/o urinarias seguidas en un servicio de estomaterapia, según variables sociodemográficas y clínicas. Método Se trata de un estudio transversal, realizado con 90 usuarios del servicio de Estomaterapia. La recolección de datos se realizó de enero a febrero de 2020, utilizando dos instrumentos: COH-QOL-Ostomy, adaptado y traducido al contexto brasileño; y City of Hope Quality of Life - Ostomy Questionnaire, instrumento original con cuestionario elaborado por las propias investigadoras, considerando aspectos sociodemográficos y clínicos. Estos datos se transfirieron y organizaron en Software Statistical Package for the Social Science, versión 22. Resultados Se identificaron cuatro clústeres distintos. En el clúster 1, el grupo tiene de dos a tres complicaciones asociadas con estoma y el 52,9% tiene una colostomía. En el grupo 2, el 45% no presenta complicaciones y el 70% tiene urostomía. En el clúster 3, todo el grupo presenta complicación y colostomía. Y en el clúster 4, ninguno de los participantes del grupo tiene complicaciones y todos tienen una colostomía. Conclusión e implicaciones para la práctica El estudio generó datos que pueden ayudar a planificar el trabajo que desarrollan los equipos de salud con pacientes ostomizados.

Abstract Objective To analyze the profile of people with intestinal and/or urinary ostomies followed up in a stomatherapy service, according to sociodemographic and clinical variables. Method This is a cross-sectional study, carried out with 90 users of the stomatherapy service. Data collection was carried out from January to February 2020, using two instruments: COH-QOL-Ostomy, adapted and translated to the Brazilian context; and City of Hope Quality of Life - Ostomy Questionnaire, an original instrument with a questionnaire prepared by the researchers themselves, considering the sociodemographic and clinical aspects. These data were transferred and organized in the Statistical Package for Social Science Software, version 22. Results Four distinct clusters were identified. In cluster 1, the group has two to three complications associated with the stoma and 52.9% have a colostomy. In cluster 2, 45% have no complications and 70% have urostomy. In cluster 3, the entire group presents a complication and colostomy. And in cluster 4, none of the participants in the group have complications and all have a colostomy. Conclusion and implications for practice The study provided the generation of data that can help in planning the work developed by the health teams with ostomy patients.

Revising our concepts about stoma covering a low rectal anastomosis

Introduction: There has been conclusive evidence that defunctioning stoma with either transverse colostomy or ileostomy mitigates the serious consequences of anastomotic leakage. However,whether transverse colostomy or ileostomy is preferred for defunctioning a rectal anastomosis remains controversial. The present study was designed to identify the best defunctioning stoma for colorectal anastomosis. Objective: To improve the quality of life in patients with rectal resection and anastomosis and reduce the morbidity before and after closure of the stoma. Patients and Methods The present study included 48 patients with elective colorectal resection who were randomly arranged into 2 equal groups, with 24 patients each. Group I consisted of patients who underwent ileostomy, and group II consisted of patients who underwent colostomy as a defunctioning stoma for a low rectal anastomosis. All surviving patients were readmitted to have their stoma closed and were followed-up for 6 months after closure of their stomas. All data regarding local and general complications of construction and closure of the stoma of the two groups were recorded and blotted against each other to clarify the most safe and tolerable procedure. Results: We found that all nutritional deficiencies, dehydration, electrolytes imbalance, peristomal dermatitis, and frequent change of appliances are statistically more common in the ileostomy group, while stomal retraction and wound infection after closure of the stoma were statistically more common in the colostomy group. There were no statistically significant differences regarding the total hospital stay and mortality between the two groups. Conclusion and Recommendation: Ileostomy has much higher morbidities than colostomy and it also has a potential risk of mortality; therefore, we recommend colostomy as the ideal method for defunctioning a distal colorectal anastomosis. (AU)

Local treatment of colostomy prolapse with the MESH STRIP technique: A novel and highly efficient day hospital technique

OBJECTIVE: Stoma prolapse is an intussusception of the bowel through a mature stoma. It can be caused by increased intra-abdominal pressure, excessively mobile bowel mesentery and/or a large opening in the abdominal wall at the time of stoma formation. It occurs predominantly in loop stomas, and correction methods include conservative modalities, such as local reduction to the prolapsed bowel, or surgical treatment. The purpose of this study was to describe our experience with the treatment of colostomy prolapse using a novel mesh strip technique. METHODS: Between February 2009 and March 2018, ten consecutive male patients underwent correction of colostomy prolapse under local anesthesia by peristomal placement of a polypropylene mesh strip. Operation time, short- and long-term complications, and recurrence rates were recorded and analyzed. RESULTS: No postoperative complications, morbidity or mortality were observed. The median length of the prolapse ranged from 6-20 cm, and the median operative time was 30 minutes. The median duration of follow-up was 25 months (range, 12-89 months). No relapse, mesh strip extrusion, local infection or granuloma formation were found. CONCLUSION: A simple, fast, and low-cost operation under local anesthesia using a mesh strip is a valuable option to treat colostomy prolapse.

Morbidade e mortalidade no fechamento de estomas: revisão de 10 anos / Morbidity and mortality of stoma closure: a 10-year review

Introdução: O fechamento de estomas, embora rotineiramente performado, ainda não pode ser considerado um procedimento simples. Nós reportamos, desta forma, a morbidade, mortalidade e fatores de riscos associados a este procedimento em um período de dez anos. Métodos: Revisão retrospectiva de 252 prontuários (149 homens; 103 mulheres), com uma média de 56 anos de idade (18 a 89 anos), que foram submetidos a fechamento de estomas, com análise de complicações clínicas e cirúrgicas, características relacionadas ao estoma, entre outros. Admissão em UTI, complicações precoces (até 30 dias) (classificação de Clavien-Dindo), e tardias, além de óbito, foram analisados. Os testes T de Student, ANOVA, Qui-Quadrado de Pearson, exato de Fischer e de Mann-Whitney foram utilizados para análise paramétrica e não-paramétrica. Resultados: Tumores colorretais (64%) e diverticulite (10%) foram as principais causas para a confecção do estoma. 112 (44,4%) dos pacientes tiveram pelo menos uma complicação cirúrgica. As complicações precoces foram infecção de ferida operatória (13%), fistula e deiscência anastomótica/intestinal (9%), abscessos de cavidade ou parede abdominais (8,3%); tardiamente houveram 36 casos de hérnia incisional (14,2%) e uma estenose intestinal (0,3%). Comorbidades levaram a 10% maior probabilidade de ter uma ou mais complicações cirúrgicas, e todas as cinco mortes ocorreram nestes pacientes (2%). Estomas de intestino grosso, maior tempo operatório e admissão em UTI estiveram significamente relacionados a aumento da morbidade. Conclusão: Pacientes com comorbidades e estomas de intestino grosso tiveram mais risco de complicações. Cuidados pré e perioperatórios, e melhor seleção de pacientes são importantes na redução da morbimortalidade.(AU)

Introduction: Although routinely performed, stoma closure cannot as yet be considered a simple procedure. We report here the morbidity, mortality and risk factors associated with this procedure over a 10-year period. Methods: The medical records of 252 patients (149 men; 103 women), with a mean age of 56 years (18 to 89 years), who underwent stoma closure were retrospectively reviewed for postoperative clinical and surgical complications, stoma-related features, among others. ICU admission, early surgical complications (within 30 days) according to the Clavien-Dindo classification, late surgical complications, and death were analyzed. Student's t-test, ANOVA, Pearson's chi-square test, Fisher's exact test, and MannWhitney U test were used for parametric and nonparametric data. Results: Colorectal tumors (64%) and diverticulitis (10%) were the main reasons for stoma surgery. Overall, 112 (44.4%) patients had at least one surgical complication. Early complications included surgical wound infection (13%), fistula and anastomotic/ intestinal dehiscence (9%), and abdominal wall or intra-abdominal abscesses (8.3%). Late complications included 36 (14.2%) cases of incisional hernia and one case (0.3%) of stricture. Patients with comorbidities were 10% more likely to have one or more surgical complications, and all 5 deaths occurred in these patients (2%). Large-bowel ostomies, longer operative time and ICU admission were significantly related to increased morbidity. Conclusion: Patients with an increased number of comorbidities and large-bowel ostomies are at higher risk for complications. Pre- and perioperative care and accurate patient selection are important to reduce morbidity and mortality.(AU)

Fatores associados a não reconstrução do trânsito intestinal em pacientes com câncer retal submetidos à ressecção anterior do reto e ileostomia de proteção / Factors preventing restoration of bowel continuity in patients with rectal cancer submitted to anterior rectal resection and protective ileostomy

RESUMO Objetivo: avaliar os fatores associados ao não fechamento de ileostomia protetora após ressecção anterior do reto com excisão total do mesorreto por câncer retal, a morbidade associada ao fechamento destas ileostomias e a taxa de estomia permanente em pacientes com adenocarcinoma retal. Métodos: estudo retrospectivo de 174 pacientes consecutivos com diagnóstico de tumores retais, dos quais 92 foram submetidos à ressecção anterior do reto com intenção curativa, anastomose coloanal ou colorretal e ileostomia de proteção. Foi realizada análise multivariada visando a determinar os fatores associados à permanência definitiva da estomia, assim como o estudo da morbidade nos que se submeteram à reconstrução do trânsito. Resultados: no período de seguimento de 84 meses, 54 dos 92 pacientes avaliados (58,7%) tiveram a ileostomia fechada e 38 (41,3%) permaneceram com a estomia. Entre os 62 pacientes que tiveram a ileostomia fechada, 11 (17,7%) apresentaram algum tipo de complicação pós-operatória: três com deiscência de anastomose ileal, cinco com obstrução intestinal, dois com infecção de ferida operatória e um com pneumonia. Oito destes pacientes necessitaram de um novo estoma. Conclusão: de acordo com a análise multivariada, os fatores associados à permanência da estomia foram fístula de anastomose, presença de metástases e fechamento da ileostomia durante quimioterapia.

ABSTRACT Objective: to evaluate the factors associated with non-closure of protective ileostomy after anterior resection of the rectum with total mesorectum excision for rectal cancer, the morbidity associated with the closure of ileostomies and the rate of permanent ileostomy in patients with rectal adenocarcinoma. Methods: we conducted a retrospective study with 174 consecutive patients diagnosed with rectal tumors, of whom 92 underwent anterior resection of the rectum with coloanal or colorectal anastomosis and protective ileostomy, with curative intent. We carried out a multivariate analysis to determine the factors associated with definite permanence of the stoma, as well as studied the morbidity of patients who underwent bowel continuity restoration. Results: In the 84-month follow-up period, 54 of the 92 patients evaluated (58.7%) had the ileostomy closed and 38 (41.3%) remained with the stoma. Among the 62 patients who had the ileostomy closed, 11 (17.7%) presented some type of postoperative complication: three had ileal anastomosis dehiscence, five had intestinal obstruction, two had surgical wound infection, and one, pneumonia. Eight of these patients required a new stoma. Conclusion: according to the multivariate analysis, the factors associated with stoma permanence were anastomotic fistula, presence of metastases and closure of the ileostomy during chemotherapy.

Health locus of control, body image and self-esteem in individuals with intestinal stoma / Lócus de controle em saúde, imagem corporal e autoestima nos indivíduos com estoma intestinal

Abstract Objective To evaluate the health locus of control, self-esteem, and body image in patients with an intestinal stoma. Method A descriptive, cross-sectional, analytical study conducted at the pole of the ostomates of the city of Pouso Alegre. The study was approved by Research Ethics Committee of Universidade do Vale do Sapucaí. Opinion: 620,459. Patients: 44 patients with an intestinal stoma. Four instruments were used: a questionnaire with demographic and stomatologic data, the Health Locus of Control Scale, the Rosenberg Self-Esteem Scale/UNIFESP-EPM, and the Body Investment Scale. Statistics: Chi-square, Pearson, Mann-Whitney and Kruskal-Wallis tests. p < 0.05 was determined. Results The majority of patients were over 70 years, 16 (36.4%) were female, 30 (68.2%) were married, 31 (70.5%) were retirees, 31 (70.5%) had an income of 1-3 minimum wages, 32 (72.7%) did not practice physical activity, 18 (40.9%) had an incomplete elementary education, and 35 (79.5%) participated in a support or association group. 33 (75%) participants received the stoma because of a neoplasia; and 33 (75%) had a definitive stoma. In 36 (81.8%) participants, the type of stoma used was a colostomy, and 22 (50%) measured 20-40 mm in diameter; 32 (72.7%) participants used a two-piece device. With regard to complications, there were 29 (65.9%) cases of dermatitis. The mean total score for the Health Locus of Control Scale was 62.84; for the Rosenberg Self-Esteem Scale, 27.66; and for the Body Investment Scale, 39.48. The mean scores for the dimensions internal, powerful others, and chance of the Health Locus of Control Scale were 22.68, 20.68, and 19.50, respectively. With respect to the Body Investment Scale, for the dimensions body image, body care, and body touch, the mean scores were 11.64, 11.00, and 13.09, respectively. Conclusion In this study, the participants showed changes in self-esteem and body image and also showed negative feelings about their body. Ostomized individuals believe that they themselves control their state of health and do not believe that other persons or entities (physician, nurse, friends, family, god, etc.) can assist them in their improvement or cure and, in addition, believe that their health is controlled by chance, without personal or other people's interference.

Resumo Objetivo Avaliar o lócus de controle da saúde, autoestima e imagem corporal em portadores de estoma intestinal. Método Estudo descritivo, transversal, analítico; realizado no Polo de ostomizados da cidade de Pouso Alegre, aprovado pelo CEP da Universidade do Vale do Sapucaí. Parecer: 620.459. Casuística: 44 pacientes com estoma intestinal. Foram utilizados quatro instrumentos:questionário com dados demográficos e relacionados ao estoma, Escala de Lócus de Controle da Saúde, Escala de Autoestima de Rosenberg/UNIFESP-EPM e Body Investment Scale. Estatística: Testes do Qui-quadrado, Pearson, Mann-Whitney e de Kruskal-Wallis. Determinou-se p < 0,05. Resultados A maioria tinha idade acima de 70 anos, 16 (36,4%) eram do gênero feminino, 30 (68,2%) eram casados, 31 (70,5%) aposentados, 31 (70,5%) tinham renda de 1 a 3 salários mínimos, 32 (72,7%) não praticavam atividade física, 18 (40,9%) não completaram o ensino fundamental e 35 (79,5%) participavam de grupo de apoio ou associação. 33 (75%) das causas da confecção do estoma foram por neoplasia e em 33 (75%) o estoma era definitivo. Em 36 (81,8%) o estoma era do tipo colostomia, 22 (50%) mediam de 20 a 40 mm de diâmetro e 32 (72,7%) eram dispositivos duas peças. Com relação às complicações, 29 (65,9%) foram dermatite. A média do escore total da Escala para Locus de Controle da Saúde foi de 62,84; Escala de Autoestima de Rosenberg, 27,66; e Body Investment Scale, 39,48. Com relação à média do escore total das dimensões da Escala para Locus de Controle da Saúde, constatamos: Internalidade para saúde, 22,68; Externalidade "outros poderosos", 20,68; e Externalidade para saúde, 19,50. Com relação às dimensões da Body Investment Scale, constatamos: para Imagem corporal, média de 11,64; Cuidado corporal, média de 11,00; e Toque corporal, média de 13,09. Conclusão Os participantes do estudo apresentaram autoestima e imagem corporal alteradas e sentimentos negativos em relação ao corpo. Os ostomizados acreditam que eles próprios controlam o seu estado de saúde e não acreditam que outras pessoas ou entidades (médico, enfermeiro, amigos, familiares, Deus, etc.) possam ajuda-los em sua melhora ou cura e que sua saúde é controlada ao acaso, sem interferência própria ou de outras pessoas.