Complicated or not complicated: Stoma site marking before emergency abdominal surgery

BACKGROUND: Marking a stoma site preoperatively decreases the possibility of experiencing later stoma-related problems and improves the quality of life of patients in the postoperative period. Those best equipped to perform this procedure are ostomy nurses and colorectal surgeons, as they receive the stoma therapy education during their training programs. The aim of this study was to compare the rate of stoma problems and quality of life of patients who underwent an operation that included stoma creation (elective or urgent) with and without preoperative stoma siting. The approach and behavior of surgical residents regarding stoma creation was also assessed.

METHODS: Patients who had undergone gastrointestinal surgery between January 2012 and December 2013 were assessed. A total of 116 of those patients who had a stoma created during the initial operation were followed by a stoma therapy nurse in the postoperative period and were enrolled in the current study. In addition, a survey of the residents was conducted to evaluate their knowledge about stoma creation and stoma care.

RESULTS: A total of 67 (58%) of the 116 patients included were male. The median age was 57±16 years (range: 17–87 years). A body mass index above 30 kg/m2 was detected in 16 patients (14%). The reason for surgery was malignant disease in 93 (80%) patients, and 97 cases (84%) were elective operations. Preoperative stoma marking was performed in 72 patients (62%). The stoma type was an ileostomy in 87 patients (75%). Stoma-related complications were observed in 40 patients (35%). Emergency surgery (p=0.02), preoperative stoma marking (p<0.0005), adjuvant therapy (p=0.004), and the stoma caretaker (patient or relatives) (p=0.05) were associated with stoma-related complications. Logistic regression analysis revealed that only the type of surgery (emergency or elective), preoperative stoma marking, and the stoma caretaker increased the rate of stoma-related complications.

CONCLUSION: Marking the stoma location before surgery reduces the risk of stoma-related complications and has a positive effect on the patient’s quality of life. Multivariable analysis indicated that marking the stoma site before the operation was the only factor that affected the rate of stoma-related complications, regardless of emergency or elective surgical conditions. Since surgeons will encounter the need for a stoma procedure during their professional career and they will not always have the opportunity to work with stoma therapy nurse, stoma care education should be provided during their residency (internship) education, and ascertaining a stoma localization before surgery for all potential stoma cases should be encouraged in emergency shifts.

Komplike ya da deðil: Acil abdominal cerrahi öncesinde stoma yeri iþaretlenmesi

AMAÇ: Stoma bölgesinin ameliyat öncesi iþaretlenmesi stomada problem olma olasýlýðýný azaltýr ve ameliyat sonrasý dönemde hastalarýn yaþam kalitesini arttýrýr. Bu prosedür için en iyi uygulayýcýlar ostomi hemþireleri ve kolorektal cerrahlardýr, çünkü eðitim programlarý sýrasýnda stoma tedavisi alýrlar. Bu çalýþmada, stoma oluþturulan hastalarda (elektif veya acil) ameliyat öncesi stoma yeri iþaretlemesi yapýlan ve yapýlmayan hastalar arasýndaki stoma problemi oranýný ve ameliyat sonrasý yaþam kalitesini karþýlaþtýrmayý amaçladýk. Ayrýca cerrahi asistanlarýnýn nöbet þartlarýnda stoma oluþturma konusundaki yaklaþým ve davranýþlarýný deðerlendirdik.

GEREÇ VE YÖNTEM: Ocak 2012–Aralýk 2013 tarihleri arasýnda gastrointestinal cerrahi geçiren hastalar deðerlendirildi. Ameliyat sonrasý stoma oluþturulan toplam 116 hasta ameliyat sonrasý dönemde stoma tedavisi hemþiresi tarafýndan takip edildi ve bu çalýþmaya alýndý. Ayrýca asistanlara stoma oluþturma ve stoma bakýmý hakkýndaki bilgilerini deðerlendirmek üzere bir anket yapýldý.

BULGULAR: Yüz on altý hastanýn 67’si (%58) erkekti. Ortanca yaþ 57±16 yýldý (daðýlým 17–87). On altý hastada (%14) beden kitle indeksi 30 kg/ m2’nin üzerinde tespit edildi. Ameliyat nedeni 93 hastada (%80) malign hastalýk idi. Doksan yedi hasta (%84) elektif olarak ameliyat edildi. Ameliyat öncesi stoma iþareti 72 hastaya (%62) yapýldý. Stoma 87 hastada (%75) ileostomi idi. Stoma ile ilgili komplikasyonlar 40 hastada (%35) gözlendi. Acil cerrahi (p=0.02), ameliyat öncesi stoma iþaretlenmesi (p<0.0005), adjuvan tedavi (p=0.004) ve stoma bakýmýný yapan kiþi ya da kiþiler (hastanýn kendisi veya akrabalarý) (p=0.05) stomaya baðlý komplikasyonlarla iliþkiliydi. Lojistik regresyon analizinde sadece cerrahi tip (acil veya elektif ), ameliyat öncesi stoma iþaretlemesi ve stoma bakýmýný yapan kiþinin stomaya baðlý komplikasyonlarý arttýrdýðýný ortaya koydu.

TARTIÞMA: Stoma yerinin ameliyattan önce iþaretlenmesi, stomaya baðlý komplikasyon riskini azaltýr ve hastalarýn yaþam kalitesini olumlu yönde etkiler. Çok deðiþkenli analiz, stoma bölgesini ameliyattan önce iþaretlemenin, acil bir durumda veya elektif bir ameliyatta yapýlmasýna raðmen stomaya baðlý komplikasyonlarý deðiþtirebilecek tek faktör olduðunu göstermektedir. Cerrahlarýn profesyonel kariyerleri sýrasýnda her zaman stoma prosedürü ile karþýlaþacaklarý ve stoma terapi hemþiresi ile çalýþma fýrsatlarýna her zaman sahip olamayacaklarý göz önüne alýndýðýnda, asistanlýk eðitimi sýrasýnda stoma bakým eðitimi verilmeli ve teþvik edilmelidir. Nöbetlerde tüm potansiyel stoma vakalarýnýn ameliyat öncesi stoma lokalizasyonunun belirlenmesi için asistanlar teþvik edilmelidirler.