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Stomas (Alternatives (3. Total anorectal reconstruction
Indication:…
Stomas
Alternatives
3. Total anorectal reconstruction
Indication: excision of rectum
MOA: construction of new sphincter (electrically stimulated muscle graft or artificial mechanical)
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2. Ileoanal pouch
Indication: pan-colorectal pathology
MOA: colon and rectum removed, piece of ileum joined to upper anal canal; reduced number of bowel movements and less incontinence than simple anastomosis
1. Low/ultralow anterior resection
Indication: proximal rectal pathology
MOA: all/part of rectum excised, prox colon
anastomosed to distal rectum
Types
2) Ileostomy
Protrude from skin, RIF
Frequent, fluid motions
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1. Loop
Indication: temporary, protect a distal anastomosis/obstruction
Known as DEFUNCTIONING stoma
3) Urostomy
Any location, urine
1. Urostomy
Indication: total cystectomy
MOA: ureters fused to abdo wall via ileal conduit, usually
incontinent but can have valve formed to make a catheterisable urostomy
1) Colostomy
Flush to skin, LIF
Solid motions 1-2x/d
2. End
Indication: permenant stoma
MOA: prox end brought out as stoma,
distal end can be resected (taken out, absent anus),
closed (left in abdo, e.g. Hartmann's), or exeriorised (mucocutaneous fistula)
3. Paul Mikulicz
Double barrelled stoma, both ends exteriorised
1. Loop
Indication: temporary, protect a distal anastomosis/obstruction
Known as DEFUNCTIONING stoma
MOA: Loop of colon to exterior with partial division
2 stomas joined together (rod prevents retraction),
prox end passes stool, distal passes mucus, minimises leakage
Complications
Early
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Functional fail
High output: electrolyte imbalaences (e.g. low K)
Tx: codeine, loperamide to slow transit and thicken
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Late
Functional fail
Dermatitis: enzyme irritation
of skin with ileostomies
Fistulae: conduit between two sites
previously not connected e.g. bowel-skin,
bowel-bowel,bowel-bladder, bowel-vagina
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-
Siting
Avoid waistline, bony prominences, skin folds,
old wounds/scars, umbilicus
Pre-op assessment by stoma nurse