Intestinal Stomas. Indications, Management, and Complications.

Department of Colorectal Surgery, Digestive Disease Institute, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Advances in Surgery 09/2012; 46(1):19-49. DOI: 10.1016/j.yasu.2012.04.005
Source: PubMed


The ability to appropriately construct and care for an ostomy is crucial to good colorectal surgical practice. Enterostomal therapy is critical to the successful management of ostomies and their complications. Although associated with morbidity, a well-constructed ostomy can provide our patients with a good, durable QoL.

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    • "When compared with open techniques the laparoscopic approach carries several potential advantages including a rapid post-operative recovery, less post-operative pain, earlier restoration of bowel function, less morbidity and shorter hospital stay with a short delay to normal activities. The overall morbidity of laparoscopic colostomy is low but complications such as small bowel obstruction can be significant [10] [11] [12] and contributing factors such as obesity and a redundant colon. "
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    ABSTRACT: The colostomy is often necessary in complicated divertcular disease. The laparoscopic colostomy is not widely used for the treatment of complicated diverticular disease. Its use in patients with high operative risk is still on debate. The aim of this case report was to present the benefits of laparoscopic colostomy in patients with high peri-and postoperative risk factors. We present a case of 76-year-old female admitted to emergency unit for left colonic obstruction. The patient had a past history of liver cirrhosis HCV-related with a severe malnutrition, hypertrophic cardiomyopathy, diverticular disease, hiatal ernia, previous appendectomy. Patient was classified according to their preoperative risk ASA 3 (classification of the American society of Anestesia-ASA score). Contrast-enhanced abdominal CT revealed a marked thickening in the sigmoid colon and a marked circumferential stenosis in the sigmoid colon in absence of neoplasm, and/or abscess. The laparoscopic procedure is proposed as first intention. The operation time was 50min, and the hospital stay was 4 days. Post operative complications grade I according to the Clavien Dindo Classification. Laparoscopic colostomy is safe and feasible procedure in experienced hands. It is associated with low morbidity and short stay in hospital and should be considered a good alternative to a laparotomy. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
    International Journal of Surgery 05/2015; Vol 12(1):78-80. DOI:10.1016/j.ijscr.2015.05.006 · 1.53 Impact Factor
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    ABSTRACT: Large databases provide a wealth of information for researchers, but identifying patient cohorts often relies on the use of current procedural terminology (CPT) codes. In particular, studies of stoma surgery have been limited by the accuracy of CPT codes in identifying and differentiating ileostomy procedures from colostomy procedures. It is important to make this distinction because the prevalence of complications associated with stoma formation and reversal differ dramatically between types of stoma. Natural language processing (NLP) is a process that allows text-based searching. The Automated Retrieval Console is an NLP-based software that allows investigators to design and perform NLP-assisted document classification. In this study, we evaluated the role of CPT codes and NLP in differentiating ileostomy from colostomy procedures. Using CPT codes, we conducted a retrospective study that identified all patients undergoing a stoma-related procedure at a single institution between January 2005 and December 2011. All operative reports during this time were reviewed manually to abstract the following variables: formation or reversal and ileostomy or colostomy. Sensitivity and specificity for validation of the CPT codes against the mastery surgery schedule were calculated. Operative reports were evaluated by use of NLP to differentiate ileostomy- from colostomy-related procedures. Sensitivity and specificity for identifying patients with ileostomy or colostomy procedures were calculated for CPT codes and NLP for the entire cohort. CPT codes performed well in identifying stoma procedures (sensitivity 87.4%, specificity 97.5%). A total of 664 stoma procedures were identified by CPT codes between 2005 and 2011. The CPT codes were adequate in identifying stoma formation (sensitivity 97.7%, specificity 72.4%) and stoma reversal (sensitivity 74.1%, specificity 98.7%), but they were inadequate in identifying ileostomy (sensitivity 35.0%, specificity 88.1%) and colostomy (75.2% and 80.9%). NLP performed with greater sensitivity, specificity, and accuracy than CPT codes in identifying stoma procedures and stoma types. Major differences where NLP outperformed CPT included identifying ileostomy (specificity 95.8%, sensitivity 88.3%, and accuracy 91.5%) and colostomy (97.6%, 90.5%, and 92.8%, respectively). CPT codes can identify effectively patients who have had stoma procedures and are adequate in distinguishing between formation and reversal; however, CPT codes cannot differentiate ileostomy from colostomy. NLP can be used to differentiate between ileostomy- and colostomy-related procedures. The role of NLP in conjunction with electronic medical records in data retrieval warrants further investigation.
    Surgery 06/2013; 154(2). DOI:10.1016/j.surg.2013.05.022 · 3.38 Impact Factor
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    ABSTRACT: Up to 450 000 people in the United States have ostomies, and 120 000 new ostomies are formed each year. The majority of these are fecal diversions. Determining the amount of healthy bowel proximal to the stoma is essential for short-term and lifelong diet and nutrition planning. People with colostomies and distal ileostomies usually require minimal, if any, diet modifications. On the contrary, more proximal ileostomies are likely to result in significant nutritional losses. These stomas and any high-output stomas require a coordinated approach to management of medications, diet and nutrition, and/or oral rehydration solution.
    Topics in clinical nutrition 10/2013; 28(4):373-383. DOI:10.1097/01.TIN.0000437411.43694.eb
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