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Stomas

Stomas. Bruce D George John Radcliffe Hospital. Permanent temporary Colostomy ileostomy End loop Functional mucus fistula Incontinent continent GI urostomy. Classification of Stomas. Anal sphincter failure

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Stomas

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  1. Stomas Bruce D George John Radcliffe Hospital

  2. Permanent temporary Colostomy ileostomy End loop Functional mucus fistula Incontinent continent GI urostomy Classification of Stomas

  3. Anal sphincter failure To “protect” distal anastomosis or when anastomosis not appropriate To reduce disease activity distally Indications for Stoma Formation

  4. Congenital anorectal atresia Surgical removal APER proctocolectomy Destruction by disease Tumour Crohn’s Severe incontinence Anal Sphincter Failure

  5. Post anterior resection Post ileal pouch anal anastomosis Perforated sigmoid diverticulitis Acute fulminant colitis To “protect” distal anastomosis: Anastomosis not appropriate:

  6. To reduce disease activity distally • Severe Crohn’s colitis • Severe perianal Crohn’s disease

  7. Pre-operative Operative Post-operative Stoma management

  8. 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

  9. Consider stoma formation to be like an anastomosis between bowel and skin Healing depends on: Good blood supply No tension General healing ability Surgical technique

  10. Surgical technique

  11. Surgical technique

  12. Surgical technique

  13. ? Close lateral space

  14. End ileostomy End colostomy

  15. Complications of Stoma formation If anything can go wrong it will Captain Edward Murphy 1949

  16. Early complications • Psychological

  17. Early complications • Initial oedema Necrosis Test-tube test at bedside

  18. Stoma not working Ileus Small bowel obstruction Obstruction at abdominal wall Retraction Working too much High output Leaking Poor siting Muco-cutaneous separation Early complications

  19. The Stomatherapy Nurse

  20. Stenosis Prolapse Parastomal herniation Intermediate or late complications

  21. Stenosis

  22. Prolapse

  23. Parastomal herniation

  24. Miscellaneous

  25. Pre-operative care multidisciplinary Meticulous operative technique like an anastomosis between bowel and skin Post-operative care multidisciplinary Summary

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