challenging ostomies
TRANSCRIPT
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Challenging Ostomies: A Colorectal Surgeon’s Perspective
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Peter Hofmann, MD Department of Colon & Rectal Surgery Springfield Clinic, LLP
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Objectives REVIEW WHY PATIENTS MIGHT REQUIRE AN OSTOMY OUTLINE HOW OSTOMIES ARE ACTUALLY CREATED DISCUSS CHALLENGING OSTOMY PATIENTS REVIEW ISSUES WITH STOMAS
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INDICATIONS DIVERSION
OBSTRUCTION INFLAMMATORY BOWEL DISEASE MOBILITY ISSUES CONTINENCE ISSUES
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INDICATIONS: OBSTRUCTION CANCER BENIGN DISEASE
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INFLAMMATORY BOWEL DISEASE CROHN’S AND ULCERATIVE COLITIS PERIANAL CROHN’S DISEASE DIVERSION AFTER SURGERY FOR IBD
RESTORATIVE PROCTOCOLECTOMY
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Total proctocolectomy with end ileostomy Surgical treatment for ulcerative colitis
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MOBILITY ISSUES WHEELCHAIR-BOUND PATIENTS PATIENTS WHO CANNOT PERFORM ACTIVITIES OF
DAILY LIVING
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CONTINENCE ISSUES DUE TO A PHYSICAL IMPAIRMENT FECAL INCONTINENCE WHICH IS REFRACTORY TO
OTHER MEDICAL AND SURGICAL INTERVENTIONS
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OSTOMY CONSTRUCTION YOU NEED A PIECE OF BOWEL AND A “HOLE” BOWEL IS TETHERED BY ITS BLOOD SUPPLY THE “HOLE” CAN BE DIFFICULT TO CREATE
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OSTOMY CONSTRUCTION VARIES WITH COLOSTOMIES VERSUS ILEOSTOMIES MAY HAVE DIFFERING CHALLENGES BASED ON
FUNCTION TEMPORARY VERSUS PERMANENT EMERGENT VERSUS ELECTIVE
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CHALLENGING PATIENTS OBESE CACHECTIC PREVIOUS SURGERIES/SCARS PREVIOUS OSTOMIES OR
CONCURRENT OSTOMY
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OBESITY INCREASINGLY COMMON ISSUE IN SURGERY
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WHAT IT MEANS IN OSTOMY CONSTRUCTION CHALLENGES!
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GENDER DIFFERENCES IN OBESITY
MEN HAVE THIN ABDOMINAL WALLS BUT CAN HAVE VERY THICK, STIFF MESENTERY PRESENTS ITS OWN SET OF CHALLENGES
WOMEN HAVE THICK ABDOMINAL WALLS A LOT OF SUBCUTANEOUS FAT LIES BETWEEN THE
ABDOMINAL WALL AND THE SKIN
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DIAGRAM OF OSTOMY CONSTRUCTION COLOSTOMY
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AGAIN, OBESE PATIENTS ARE A CHALLENGE
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EXTREMELY THIN PATIENTS CAN PRESENT A CHALLENGE, TOO! NEED TO WATCH OUT FOR BONY PROMINENCES!
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PREVIOUS SURGERY YOU DECIDE WHAT’S TOUGH ABOUT THIS…
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Previous surgery Or this…
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STOMA COMPLICATIONS PROLAPSE SKIN ISSUES PARASTOMAL HERNIA
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prolapse
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Skin issues Vexing problem, worse with poorly-positioned stomas
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Parastomal hernias Very common problem
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SUMMARY STOMA FORMATION CAN BE A CHALLENGE
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SUMMARY FIRST SURGERY IS THE TIME TO GET IT RIGHT
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SUMMARY WOUND-OSTOMY SPECIALISTS ARE CRITICAL TO
SUCCESSFUL PLACEMENT AND CARE OF OSTOMIES
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SUMMARY “BAD” OSTOMIES EXACT A TERRIBLE TOLL ON
PATIENTS
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SUMMARY TEAM APPROACH IS ALWAYS BEST
ENTEROSTOMAL THERAPIST COLORECTAL SURGEON PATIENT STAFF AND VISITING NURSES PHARMACIST/HOME HEALTH SUPPLY
SPECIALIST FAMILY/FRIENDS
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QUESTIONS…