Stomas

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Stomas

• Bruce D George
• John Radcliffe Hospital

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Classification of Stomas

• Permanent temporary
• Colostomy ileostomy
• End loop
• Functional mucus fistula
• Incontinent continent
• GI urostomy

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Indications for Stoma Formation

• Anal sphincter failure
• To protect distal anastomosis or when
  anastomosis not appropriate
• To reduce disease activity distally

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Anal Sphincter Failure

• Congenital anorectal atresia
• Surgical removal
• APER
• proctocolectomy
• Destruction by disease
• Tumour
• Crohns
• Severe incontinence

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To protect distal anastomosis

• Post anterior resection
• Post ileal pouch anal anastomosis
• Perforated sigmoid diverticulitis
• Acute fulminant colitis

Anastomosis not appropriate
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To reduce disease activity distally

• Severe Crohns colitis
• Severe perianal Crohns disease

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Stoma management

• Pre-operative
• Operative
• Post-operative

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Pre-operative management

• Psychological preparation
• Do not frighten inappropriately
• Mark site
• Avoid scars, skin folds, bony prominences
• Consider ability to manage stoma
• Brain, eye or hand failure

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Surgical technique

• Consider stoma formation to be like an
  anastomosis between bowel and skin
• Healing depends on
• Good blood supply
• No tension
• General healing ability

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Surgical technique
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Surgical technique
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Surgical technique
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? Close lateral space
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End ileostomy
End colostomy
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Complications of Stoma formation
If anything can go wrong it will Captain Edward
Murphy 1949
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Early complications

• Psychological

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Early complications

• Initial oedema

Necrosis
Test-tube test at bedside
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Early complications

• Stoma not working
• Ileus
• Small bowel obstruction
• Obstruction at abdominal wall
• Retraction

• Working too much
• High output
• Leaking
• Poor siting
• Muco-cutaneous separation

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The Stomatherapy Nurse
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Intermediate or late complications

• Stenosis
• Prolapse
• Parastomal herniation

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Stenosis
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Prolapse
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Parastomal herniation
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Miscellaneous
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Summary

• Pre-operative care
• multidisciplinary
• Meticulous operative technique
• like an anastomosis between bowel and skin
• Post-operative care
• multidisciplinary