About 100,000 people are bearers of a digestive Ostomy or “artificial anus” in France, largely following surgery for colorectal cancer. What are the indications and the daily lives of Ostomy patients? Reply with Daniele Chaumier of the Hopital Tenon in Paris.
Danièle Chaumier is an enterostoma-therapist (and), a registered nurse of State (IDE) specialized in stomatherapy, i.e., in care and the overall management of patients with Stoma (Ostomates). She has long been involved in the research and teaching of the stomatherapy. Chair of the A.F.. and member of the Scientific Committee of the 42nd Congress of the ECT (European Council of Enterostomal Therapy) held in Paris, from 23 to 26 June 2013, she meets Doctissimo issues on this topic.
Doctissimo: In what circumstances is a digestive stoma necessary?
Daniele HO: The majority of Ostomy are carried out as part of a cancer of the colon or rectum. The other main indications are inflammatory bowel diseases (Crohn’s disease and colitis ulcero-haemorrhagic recto).
Temporary ostomies are carried out in two cases that surgery has been programmed:
After removing a segment of the intestine, the surgeon may not immediately connect both ends that remain in place due to significant inflammation. It Cristina then the end of the intestine to the skin. This Ostomy is closed a few weeks later by joining the two digestive segments (anastomosis). Ostomy are located on the left, transverse colon or ileum, depending on the injury.
The surgeon decides to carry out an Ileostomy (the anastomosis is done at the level of the ileum, the last part of the small intestine before the colon), when the anastomosis at the level of the large intestine appears fragile. One speaks then of protective Ileostomy. This allows the evacuation of stool by a temporary stoma, and therefore the protection of the suture at the level of the colon, the time that the latter was consolidated. This option is most often used because the Ileostomy is technically easier to close than the colostomy. The Ileostomy are placed right below the belt through the muscle right to avoid eventrations (hernia).
When surgery is performed in emergency, it may be a bowel obstruction, such as in advanced cancer. The stoma is performed to remove the barrier and allow the evacuation of stool, waiting to explore and treat the cause of this occlusion secondarily.
The vast majority of the definitive ostomies are colostomies realized in cases of cancer of the rectum located near the anus. All of the rectum is then removed and the anus closed. As the definitive Ileostomy, rare now, they are made when it is necessary to remove the majority or even all of the colon, as it is in haemorrhagic colitis and when it is not possible to make a reservoir.
Doctissimo: What is the appearance of a stoma?
Daniele HO: We inform patients that the stoma will have the appearance of a small strawberry, with a texture that looks inside the mouth because it is from the intestinal mucosa. However, before the operation, many of the patients are more concerned with the results in the aftermath of the operation by the appearance of the stoma. However, information and stomatherapy pre operative consultation are necessary when the stoma is envisaged before the intervention.
Doctissimo: Is that all patients are informed before the operation that they will have a stoma when surgery is programmed?
Daniele HO: Yes, currently all patients are. It is an obligation. In general, they are warned by the surgeon and if the hospital has a service of stomatherapy, one or more consultation with a therapist enterostoma are then programmed.
These consultations have as main objectives to inform the person about the consequences of the stoma in everyday life, to make sure that she understands what a stoma, to answer his questions, reassure and to determine the place where the stoma will be placed, depending on the morphology of the abdomen and physical and mental patient.
But it should be noted that some people are not receptive to information if they are too stressed or very old or with cognitive disorders. Psychological status and age are therefore to be taken into account.
Doctissimo: What are the suites of the operation?
Daniele HO: Always taking into account profile and the status of the patient, the goal is to explain in more detail the stoma care and equipment, to accompany the “ostomate” towards autonomy and guide in the choice of his apparatus.
To do this, the care team chooses a series of equipment among the most suitable to the patient according to the type of stoma, the morphology of the abdomen of his abilities, the type of skin, etc. This selection is then made, and the choice is made by the patient. Schematically, the available equipment are currently presented in ‘a piece’ (the bracket that sticks to the skin around the stoma and the collection Pocket feces are integrated in a single product) or “two pieces” (support and Pocket are presented separately).
The purpose of this postoperative follow-up is to make the autonomous patient so that he realizes the care itself, ideally out of the hospital. But this is not always the case because the length of hospital stay was shortened. In addition, some patients are tired, proven treatments heavy or psychologically fragile, which makes learning difficult. In these cases, the patient is directed towards consultations in a stomatherapy or service in the city, to the Office of graduate nurses of State (IDE) familiar (es) with ostomy care. In this way, education of the patient can continue.
If the patient needs help for a more or less long period, it may request the assistance of a loved one to treat the Ostomy and change the pockets. In some cases, regular consultations and the long courses are necessary but they concern mainly the people with physical or psychological problems.
Doctissimo: What are the main concerns expressed by patients out of hospital Ostomy?
Daniele HO: Patients fear especially leakage of materials at the level of the switchgear, gas problems, odors… They also express the fear that leaks or odors might prevent them out or to see people. Other problems such as physical activity, or even sexuality come later… Quality of life is also a major concern in our specialty.
Doctissimo: What signs should alert the patient to think that its Ostomy is not properly treated? What are the main complications?
Daniele HO: By far the most common sign is the irritation of the skin around the stoma that is the consequence of leakage of equipment support, either because it is not properly applied, either because of the detachment of the pocket or because the equipment is not suitable for the profile of the patient.
Thus, complications main shortly after discharge from the hospital are skin like irritation, erosions, or even a local infection that should be addressed. In practice, some patients don’t worry little or no and try to treat themselves the irritation of the skin with ointments or creams because they are afraid to disturb the care staff. Conversely, there are people who come to doubt… In all cases, we invite patients to consult an enterostoma therapist or surgeon in case of problems.