Challenging Ostomies: A Colorectal Surgeon’s Perspective

Peter Hofmann, MD Department of Colon & Rectal Surgery Springfield Clinic, LLP

Objectives REVIEW WHY PATIENTS MIGHT REQUIRE AN OSTOMY OUTLINE HOW OSTOMIES ARE ACTUALLY CREATED DISCUSS CHALLENGING OSTOMY PATIENTS REVIEW ISSUES WITH STOMAS

INDICATIONS DIVERSION

OBSTRUCTION INFLAMMATORY BOWEL DISEASE MOBILITY ISSUES CONTINENCE ISSUES

INDICATIONS: OBSTRUCTION CANCER BENIGN DISEASE

INFLAMMATORY BOWEL DISEASE CROHN’S AND ULCERATIVE COLITIS PERIANAL CROHN’S DISEASE DIVERSION AFTER SURGERY FOR IBD

RESTORATIVE PROCTOCOLECTOMY

Total proctocolectomy with end ileostomy Surgical treatment for ulcerative colitis

MOBILITY ISSUES WHEELCHAIR-BOUND PATIENTS PATIENTS WHO CANNOT PERFORM ACTIVITIES OF

DAILY LIVING

CONTINENCE ISSUES DUE TO A PHYSICAL IMPAIRMENT FECAL INCONTINENCE WHICH IS REFRACTORY TO

OTHER MEDICAL AND SURGICAL INTERVENTIONS

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

OSTOMY CONSTRUCTION VARIES WITH COLOSTOMIES VERSUS ILEOSTOMIES MAY HAVE DIFFERING CHALLENGES BASED ON

FUNCTION TEMPORARY VERSUS PERMANENT EMERGENT VERSUS ELECTIVE

CHALLENGING PATIENTS OBESE CACHECTIC PREVIOUS SURGERIES/SCARS PREVIOUS OSTOMIES OR

CONCURRENT OSTOMY

OBESITY INCREASINGLY COMMON ISSUE IN SURGERY

WHAT IT MEANS IN OSTOMY CONSTRUCTION CHALLENGES!

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

DIAGRAM OF OSTOMY CONSTRUCTION COLOSTOMY

AGAIN, OBESE PATIENTS ARE A CHALLENGE

EXTREMELY THIN PATIENTS CAN PRESENT A CHALLENGE, TOO! NEED TO WATCH OUT FOR BONY PROMINENCES!

PREVIOUS SURGERY YOU DECIDE WHAT’S TOUGH ABOUT THIS…

Previous surgery Or this…

STOMA COMPLICATIONS PROLAPSE SKIN ISSUES PARASTOMAL HERNIA

prolapse

Skin issues Vexing problem, worse with poorly-positioned stomas

Parastomal hernias Very common problem

SUMMARY STOMA FORMATION CAN BE A CHALLENGE

SUMMARY FIRST SURGERY IS THE TIME TO GET IT RIGHT

SUMMARY WOUND-OSTOMY SPECIALISTS ARE CRITICAL TO

SUCCESSFUL PLACEMENT AND CARE OF OSTOMIES

SUMMARY “BAD” OSTOMIES EXACT A TERRIBLE TOLL ON

PATIENTS

SUMMARY TEAM APPROACH IS ALWAYS BEST

ENTEROSTOMAL THERAPIST COLORECTAL SURGEON PATIENT STAFF AND VISITING NURSES PHARMACIST/HOME HEALTH SUPPLY

SPECIALIST FAMILY/FRIENDS

QUESTIONS…