PubMed · 6915847
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B F Majewski. Cases, problems, and solutions: creative ostomy care.. https://pubmed.ncbi.nlm.nih.gov/6915847/
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Advanced pelvic surgery may result in the formation of a colostomy, ileostomy, urostomy, or multiples of these stomas. Stomas may be created because of a planned therapeutic attack to eradicate cancer or manage complications arising from treatments or they may be constructed to palliate severe symptoms or life-threatening problems. In some instances, fistulae between various organs and the skin may occur. Special skills are required to meet the needs of patients with ostomies or fistulae. The often complex care presents critical challenges to nurses, particularly in today's cost-conscious health care environment where prompt hospital discharges, brief clinic appointments, and valuable but limited home care visits are the norm. The skills of the enterostomal therapy nurse are valuable in all phases of care of these patients, from preoperative to outpatient care.
OBJECTIVES: The objectives of this study were to present a minimal invasive technique of intestinal diversion for selected cases of advanced inoperable ovarian cancer, rectal cancer, and rectovaginal fistulas, and to discuss indications, pitfalls, and potential complications. METHODS: The technical features of laparoscopic colostomy are described. RESULTS: Between August 1995 and July 1997 laparoscopic colostomy was successfully carried out in 12 patients with advanced ovarian cancer, inoperable carcinoma of the rectum, or rectovaginal fistulas. There were no intraoperative or postoperative complications and postoperative recovery was rapid, with all patients having function of the colostomy within 24 h and regaining their preoperative state of mobility on the second postoperative day. CONCLUSION: The laparoscopic approach allows careful selection of the colostomy site and easy mobilization of the colon, causing only little disruption to intestinal function and, hence, improving postoperative recovery. From our experience, laparoscopic colostomy is in most cases a simple and safe operation and can be used as the preferred technique of intestinal diversion.
A modification of the Turnbull technique for a temporary diverting ileostomy, which may be also applied to diverting colostomies, is described herein. According to the technical modification described, a totally diverting ileostomy is performed with the help of a Foley catheter secured in the subcutaneous tissue, and pulled upward and to the right like a sling around the efferent loop. This simple modification allows for better protection of distal anastomosis and an optimal diversion of enteric transit. Furthermore, this technique also permits an easier postoperative handling of the stoma, an easier application of the stomal bags and at the same time, it also more efficiently prevents the eventual subcutaneous infiltration with enteric contaminated fluid. In the authors' preliminary experience with ten cases the procedure was shown to offer advantages in reducing local discomfort and also in achieving the objectives of a totally diverting ileostomy.