).Roughly 150,000 stomas are created in the United States annually, equally divided between ileostomies and colostomies.1 When created properly, an ileostomy or colostomy can dramatically improve a patient's quality of life. Patients with a good functioning stoma can expect to live a normal life with very few lifestyle restrictions. In contrast, when a patient develops complications related to their stoma, the impact on their physical and mental health can be irreparable. Stomas can be created for a multitude of diseases such as colorectal cancer, ulcerative colitis, Crohn's disease, diverticulitis, ischemic colitis, radiation injury, and fecal incontinence. The associated morbidity and overall function of a stoma are dependent upon the indication for the stoma, whether it was created electively or emergently, and patient factors such as body habitus and prior surgery. Unfortunately, significant morbidity is associated with stoma creation and these complications can be grouped into early and late-occurring complications. The literature reports the rate of stoma-related complications ranging from 20 to 70%.2-7 Early complications occur within the first 30 days of the stoma creation and include ischemia/necrosis, retraction, mucocutaneous separation, and parastomal abscess. Late complications include parastomal hernia, prolapse, retraction, and varices. All of these complications will be discussed to better understand etiologies and management options. Risk Factors for Stoma-Related ComplicationsAs mentioned previously, stoma creation carries significant morbidity, and disease, patient, clinical, and stoma-specific factors influence the outcomes pertaining to their creation. Harris et al found the most common stoma-related complications in 345 ostomates were herniation, retraction, necrosis, infection, prolapse, stenosis, fistula, and small bowel obstruction (SBO). 4 Complications were more common with colostomies except for SBO, which were more prevalent with ileostomies. The authors also found that loop colostomies had the highest complication rate out of all stoma configurations. Postoperative stoma necrosis was strongly and significantly associated with emergency stoma creation. Parmar et al identified that colostomies, short stoma length, body mass index > 30, emergency surgery, and lack of preoperative marking were associated with increased risks of complications. 7 None of the identified studies was adequately powered to stratify postoperative stoma-related complication rates by specific disease processes. Parastomal HerniaParastomal hernias are incisional hernias at ostomy sites and are believed to be an inevitable consequence of having an Keywords ► parastomal hernia ► stoma prolapse ► colostomy ► ileostomy ► parastomal varices AbstractWhen created properly, an ileostomy or colostomy can dramatically improve a patient's quality of life. Conversely, when a patient develops complications related to their stoma, the impact on physical and mental health can be profound. Unfortunately, significant morbidity is...
TC-325 is safe and highly effective in achieving hemostasis in an anticoagulated severe arterial gastrointestinal bleeding animal model.
Size is the most important determinant in survival following resection. Local excision is common, with resection split between LR and RE. For smaller tumors, LR may be adequate therapy. Preoperative chemotherapy may result in improved survival for large tumors treated with radical resection, but the data are imperfect.
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