SGO - All Things Ostomies Flashcards
What are indications for ostomy creation?
What are risk factors for anastomotic leak?
Stakes are much higher for gyn onc patients for leaks because of need to start chemotherapy and having an extensive resection in the abdomen.
What’s the Mayo experience of standardized protocols to reduce anastomotic leaks?
What are general considerations for site selection of the stoma?
Why do you select stoma site to be in the rectus muscle?
Reduces risk of prolapse/herniation of the stoma
Discuss ileostoy site creation.
What are some issues with obese patients and stoma creation?
- Sight line impaired (patients cannot see applicance as well)
- Distance bowel needs to traverse in AAW
- Can compromise blood supply especially given it can put pressure on the mesentery
- You’ll usually go higher for your stoma than general when compared to the thin patient (less fat in epigastic region, less movement in AAW, and sight line is better)
- When doing pulling up stoma through AAW, you can traumatize the bowel and its mesentery in obese patients.
- One trick is to use an alexis retractor at the stoma site and use a lot of lubrication
- smooth surface and helps make a shorter path because it helps to temporarily compress the AAW
- One trick is to use an alexis retractor at the stoma site and use a lot of lubrication
How far away should you be from ileocecal valve for your loop ileostomy?
15 - 20 cm
- This ensure that when you need to reverse the ileostomy later, there will not be compromise of the blood supply in this watershed region.
Steps for a laparoscopic loop ileostomy?
Why is stoma eversion so important in ileostomies?
Liquid contents from the stoma can be very irritating to the skn and it’s important that those contents all go into the bag.
- Semi-lunar incision made on the bowel
- Evert the bowel lumen
- Placement of rosebud stitches
- 3 parts
- full thickness through skin
- bite through seromuscular layer ~ 4 cm below mucosa
- mucosal edge
- 3 parts
What are ghost ileostomies?
Principles of site selection for colostomies
Similar to stoma creation/site selection to ileostomies
Colostomy creation tips and tricks?
What do you do if stoma created edges appear blue or cyanotic?
- May not be a sign of necrosis/ischemia
- May be just a sign of congestion of mesentery given prior bowel manipulation
- One way to tell is to look further down into the stoma lumen and see if pink or nice
- Discoloration will go away in a couple days following stoma creation
Why do you avoid dividing along the taeniae coli for loop colostomies?
Dividing along the lumen is better because the lumen will be bigger and less likely to be stenosed.
How do you avoid tunneling of the colostomy?
Placement of kocher on fascia and allis on the skin to line up the skin and intended area to cut for the fascia.
Why would you do a mucous fistula?
- Incidence of ostomy necrosis?
- Prevention methods?
- How to evaluate extent of necrosis?
- How do you manage?
How do you deal with bleeding stomas?
How do you deal with mucocutaneous separation of the stomas?
How do you deal with stoma retraction?
General principles with high output ileostomies?
How do you deal with high output ileostomy?
- Incidence of parastomal herniations?
- Risk factors?
- Management?
- Does bowel edema increase risk of herniation and why?
- Should you use mesh for these hernias?
- Incidence of parastomal herniations?
- see image
- Risk factors?
- see image
- Management?
- see image
- Does bowel edema increase risk of herniation and why?
- Yes, as the bowel edema resolves, there’s a gap that’s created
- Should you use mesh for these hernias?
- No because often patients will have carcinomatosis, need for reoperation, etc
