Challenging Ostomies: AColorectal Surgeon’sPerspective
Peter Hofmann, MD Department of Colon & Rectal Surgery Springfield Clinic, LLP
Objectives REVIEW WHY PATIENTS MIGHT REQUIRE AN OSTOMY OUTLINE HOW OSTOMIES ARE ACTUALLY CREATED DISCUSS CHALLENGING OS...
INDICATIONS DIVERSION    OBSTRUCTION    INFLAMMATORY BOWEL DISEASE    MOBILITY ISSUES    CONTINENCE ISSUES
INDICATIONS: OBSTRUCTION CANCER BENIGN DISEASE
INFLAMMATORY BOWELDISEASE CROHN’S AND ULCERATIVE COLITIS PERIANAL CROHN’S DISEASE DIVERSION AFTER SURGERY FOR IBD  RES...
Total proctocolectomy with endileostomy Surgical treatment for ulcerative colitis
MOBILITY ISSUES WHEELCHAIR-BOUND PATIENTS PATIENTS WHO CANNOT PERFORM ACTIVITIES OF  DAILY LIVING
CONTINENCE ISSUES DUE TO A PHYSICAL IMPAIRMENT FECAL INCONTINENCE WHICH IS REFRACTORY TO  OTHER MEDICAL AND SURGICAL INT...
OSTOMY CONSTRUCTION YOU NEED A PIECE OF BOWEL AND A “HOLE” BOWEL IS TETHERED BY ITS BLOOD SUPPLY THE “HOLE” CAN BE DIFF...
OSTOMY CONSTRUCTION VARIES WITH COLOSTOMIES VERSUS ILEOSTOMIES MAY HAVE DIFFERING CHALLENGES BASED ON  FUNCTION  TEMPOR...
CHALLENGING PATIENTS OBESE CACHECTIC PREVIOUS SURGERIES/SCARS PREVIOUS OSTOMIES OR  CONCURRENT OSTOMY
OBESITY INCREASINGLY COMMON ISSUE IN SURGERY
WHAT IT MEANS IN OSTOMYCONSTRUCTION CHALLENGES!
GENDER DIFFERENCES IN   OBESITY MEN HAVE THIN ABDOMINAL WALLS  BUT CAN HAVE VERY THICK, STIFF MESENTERY  PRESENTS ITS O...
DIAGRAM OF OSTOMYCONSTRUCTION COLOSTOMY
AGAIN, OBESE PATIENTS ARE ACHALLENGE
EXTREMELY THIN PATIENTSCAN PRESENT A CHALLENGE,TOO! NEED TO WATCH OUT FOR BONY PROMINENCES!
PREVIOUS SURGERY YOU DECIDE WHAT’S TOUGH ABOUT THIS…
Previous surgery Or this…
STOMA COMPLICATIONS PROLAPSE SKIN ISSUES PARASTOMAL HERNIA
prolapse
Skin issues Vexing problem, worse with poorly-positioned stomas
Parastomal hernias Very common problem
SUMMARY STOMA FORMATION CAN BE A CHALLENGE
SUMMARY FIRST SURGERY IS THE TIME TO GET IT RIGHT
SUMMARY WOUND-OSTOMY SPECIALISTS ARE CRITICAL TO  SUCCESSFUL PLACEMENT AND CARE OF OSTOMIES
SUMMARY “BAD” OSTOMIES EXACT A TERRIBLE TOLL ON  PATIENTS
SUMMARY TEAM APPROACH IS ALWAYS BEST  ENTEROSTOMAL THERAPIST  COLORECTAL SURGEON  PATIENT  STAFF AND VISITING NURSES ...
QUESTIONS…
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Challenging ostomies

  1. 1. Challenging Ostomies: AColorectal Surgeon’sPerspective
  2. 2. Peter Hofmann, MD Department of Colon & Rectal Surgery Springfield Clinic, LLP
  3. 3. Objectives REVIEW WHY PATIENTS MIGHT REQUIRE AN OSTOMY OUTLINE HOW OSTOMIES ARE ACTUALLY CREATED DISCUSS CHALLENGING OSTOMY PATIENTS REVIEW ISSUES WITH STOMAS
  4. 4. INDICATIONS DIVERSION  OBSTRUCTION  INFLAMMATORY BOWEL DISEASE  MOBILITY ISSUES  CONTINENCE ISSUES
  5. 5. INDICATIONS: OBSTRUCTION CANCER BENIGN DISEASE
  6. 6. INFLAMMATORY BOWELDISEASE CROHN’S AND ULCERATIVE COLITIS PERIANAL CROHN’S DISEASE DIVERSION AFTER SURGERY FOR IBD  RESTORATIVE PROCTOCOLECTOMY
  7. 7. Total proctocolectomy with endileostomy Surgical treatment for ulcerative colitis
  8. 8. MOBILITY ISSUES WHEELCHAIR-BOUND PATIENTS PATIENTS WHO CANNOT PERFORM ACTIVITIES OF DAILY LIVING
  9. 9. CONTINENCE ISSUES DUE TO A PHYSICAL IMPAIRMENT FECAL INCONTINENCE WHICH IS REFRACTORY TO OTHER MEDICAL AND SURGICAL INTERVENTIONS
  10. 10. OSTOMY CONSTRUCTION YOU NEED A PIECE OF BOWEL AND A “HOLE” BOWEL IS TETHERED BY ITS BLOOD SUPPLY THE “HOLE” CAN BE DIFFICULT TO CREATE
  11. 11. OSTOMY CONSTRUCTION VARIES WITH COLOSTOMIES VERSUS ILEOSTOMIES MAY HAVE DIFFERING CHALLENGES BASED ON FUNCTION  TEMPORARY VERSUS PERMANENT  EMERGENT VERSUS ELECTIVE
  12. 12. CHALLENGING PATIENTS OBESE CACHECTIC PREVIOUS SURGERIES/SCARS PREVIOUS OSTOMIES OR CONCURRENT OSTOMY
  13. 13. OBESITY INCREASINGLY COMMON ISSUE IN SURGERY
  14. 14. WHAT IT MEANS IN OSTOMYCONSTRUCTION CHALLENGES!
  15. 15. GENDER DIFFERENCES IN OBESITY MEN HAVE THIN ABDOMINAL WALLS  BUT CAN HAVE VERY THICK, STIFF MESENTERY  PRESENTS ITS OWN SET OF CHALLENGES WOMEN HAVE THICK ABDOMINAL WALLS  A LOT OF SUBCUTANEOUS FAT LIES BETWEEN THE ABDOMINAL WALL AND THE SKIN
  16. 16. DIAGRAM OF OSTOMYCONSTRUCTION COLOSTOMY
  17. 17. AGAIN, OBESE PATIENTS ARE ACHALLENGE
  18. 18. EXTREMELY THIN PATIENTSCAN PRESENT A CHALLENGE,TOO! NEED TO WATCH OUT FOR BONY PROMINENCES!
  19. 19. PREVIOUS SURGERY YOU DECIDE WHAT’S TOUGH ABOUT THIS…
  20. 20. Previous surgery Or this…
  21. 21. STOMA COMPLICATIONS PROLAPSE SKIN ISSUES PARASTOMAL HERNIA
  22. 22. prolapse
  23. 23. Skin issues Vexing problem, worse with poorly-positioned stomas
  24. 24. Parastomal hernias Very common problem
  25. 25. SUMMARY STOMA FORMATION CAN BE A CHALLENGE
  26. 26. SUMMARY FIRST SURGERY IS THE TIME TO GET IT RIGHT
  27. 27. SUMMARY WOUND-OSTOMY SPECIALISTS ARE CRITICAL TO SUCCESSFUL PLACEMENT AND CARE OF OSTOMIES
  28. 28. SUMMARY “BAD” OSTOMIES EXACT A TERRIBLE TOLL ON PATIENTS
  29. 29. SUMMARY TEAM APPROACH IS ALWAYS BEST  ENTEROSTOMAL THERAPIST  COLORECTAL SURGEON  PATIENT  STAFF AND VISITING NURSES  PHARMACIST/HOME HEALTH SUPPLY SPECIALIST  FAMILY/FRIENDS
  30. 30. QUESTIONS…
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