No abstract

Enhanced recovery can be seen as the use of evidence and research that when used for patients undergoing stoma-forming surgery (and other surgery) leads to a better recovery (Lassen et al, 2009; Ahmed et al, 2010). Moving patients towards adopting an opinion that 'up and mobile' immediately after surgery is the pathway to success, and is an essential element in implementing enhanced recovery after surgery. It can lead to several clinical benefits, including fewer complications (e.g. infection) and a shorter length of time in hospital (Faiz et al, 2008). While having a shorter length of stay is positive, it does result in less time being available to the ostomate (person with a stoma) to become proficient with their stoma care. Changes need to be made to nursing services to encompass this new challenge; for example, the use of preoperative training tools. These changes can result in satisfied ostomates (Bryan and Dukes, 2010) who have fewer post-discharge problems with their stoma. This article outlines the concept of enhanced recovery after surgery and its benefits for patients with a stoma.

The aim of this article is to discuss the care of patients with enterocutaneous fistula (ECF) requiring long-term support in the community. The discussion of what ECF are and aspects of nutrition will support the knowledge required to care for this group of patients effectively in their homes. This article focuses on the management of ECF appliances and gives a basic guide of skin care and how to reduce the prevalence of appliance leaks.

Undergoing surgery and having the formation of a stoma may be required for a number of reasons and how a patient accepts their new body image and changes to their lifestyle can be greatly determined by the support and care they receive from their stoma nurse and other health professionals involved in their recovery after stoma formation. Preparing a patient pre-operatively and taking time to listen to their individual needs will enhance their perception of living with a stoma and accepting their stoma, thus not negatively impacting on what they perceive to be their quality of life. Acknowledging the quality of life of an individual and taking measures to maintain a person's quality of life at an early stage within the surgical pathway will have a positive impact on a patient's recovery from surgery and ability to cope with the daily routine involved when living with a stoma. Nurses need to understand what their patient perceives as a good quality of life and how to alter any negative factors that may inhibit a patient's ability to care for and accept their stoma.

Enterocutaneous fistulas (ECF) may be challenging to manage due to the large volume of fluid losses, that may result in severe dehydration, electrolyte imbalances, malnutrition and sepsis. It is imperative that this group of patients receive adequate nutrition, as malnutrition and sepsis are the leading cause of death. ECF treatment is complex and based on various assessments, treatment can be medical/conservative management or surgical. Depending on the site of the fistula and the nutritional status of the patient, clinicians have to decide whether parenteral nutrition or enteral nutrition should be established. Fistuloclysis is a relatively novel procedure in which nutrition is provided via an enteral feeding tube placed directly into the distal lumen of a high output fistula. Although fistuloclysis is not feasible for all patients with ECF, for those that are eligible, the method appears to be an acceptable and safe method of maintaining and improving nutritional status.