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Ostomias

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Ostomias

  1. 1. OSTOMIAS JOSE DOMINGO DIAZ NAJERARESIDENTE DE CIRUGIA GENERAL UNIVERSIDAD DE CARTAGENA
  2. 2. DEFINICIONStoma, palabra griega, bocaEl estoma u ostomía consiste en la apertura, por una intervención quirúrgica, de una víscera hueca al exterior. La mayoría de las veces se localizan en la pared abdominal. Anorectal and Colonic Diseases A Practical Guide to Their Management Third Edition 2010
  3. 3. HISTORIA Y EVOLUCION DE LAS OSTOMIAS DIGESTIVAS Praxágoras Paracelso384-322 a. C. PRAXÁGORAS de COS practicaba fístulas enterocutáneas para alivio de la obstrucción 1491-1541 PARACELSO realizaba anos artificiales frente a otra técnica de manipulación intestinal 1710 LITTRÉ recomendó cecostomía inguinal transperitoneal en paciente con ano imperforado 1793 DURET realizó primera colostomía inguinal del lado izquierdo 1797 FINE (Génova) practicó primera colostomía transversa Siglo XVIII- XIX  1839 AMUSSAT exteriorizó colon sigmoideo en región lumbar izquierda  1879 BAUM (Alemania) realizó la primera ileostomía con resección de colon  1879-1880 GUSSENBAUER Describen la creación de colostomía terminal y muñón distal suturado  1881 SCHITZINGER Técnica precursora del procedimiento de HARTMANN en 1923 1888 MAYDL introdujo la técnica de colostomía en asa sostenida por un tubo Rev Med Hosp Gen Mex 2006; 69 (2): 113-118
  4. 4. HISTORIA Y EVOLUCION DE LAS OSTOMIAS OSTOMIAS DIGESTIVAS Siglo XX1908 ERNEST MILES desarrolló los criterios de la resección abdominoperineal1950 BROOKE y TURNBULL primera ileostomía con eversión y sutura mucocutánea1968 KOCK técnica de ileostomía con reservorio en forma de “U”1975 FEUSTEL Y HENNIG cierre magnético del estoma de Erlangen1978 PARKS Y NICHOLLS reservorio ileal en “S” y “W”1980 UTSUNOMIYA reservorio ileal en “J ”1990 JACOBS (Miami ) resección colónica por vía laparoscópica Dispositivos antiguos Dispositivo hecho a mano por un paciente ileostomizado (1977) ) Rev Med Hosp Gen Mex 2006; 69 (2): 113-118
  5. 5. DEFINICIONOstomia : abocar hacia (comunicación, derivación, anastomosis)colostomía: Derivación temporal o definitiva del intestino grueso a lapiel habitualmenteileostomía: Derivación temporal o definitiva del íleon a la piel. Puedeser derivativa o de protección.Fistula mucosa: porción distal del colon, no funcional, se exteriorizacomo una fístula colomucosa, que sirve para lavar este segmentoterminal. Mastery of Surgery, Nyhus-Baker 1999
  6. 6. D.E. Beck et al. (eds.), The ASCRS Manual of Colon and Rectal Surgery 2009
  7. 7. Anorectal and Colonic DiseasesA Practical Guide to Their Management Third Edition 2010
  8. 8. CLASIFICACION Permanencia •: Transitorias o Definitivas Objetivo •: Descompresiva o Derivativas (CONTROVERSIAS) Localización •: Ubicación + ostomía. •Ej. en el ciego: Cecostomía. Mastery of Surgery, Nyhus-Baker 1999
  9. 9. CLASIFICACIONOSTOMIAS DIGESTIVAS•Ileostomía, ColostomíaOSTOMÍAS DE ALIMENTACIÓN•: Gastrostomía, YeyunostomíaOSTOMÍAS UROLÓGICAS•: Nefrostomía, Cistotomía, Ureterostomía Mastery of Surgery, Nyhus-Baker 1999
  10. 10. FISIOLOGIA DEL ESTOMAPerdida de continenciaReducccion de area de absorcionConsecuencias nutricionales• SALIDA: -Distal izquierdo o sigmoide -Derecho o Transversa -Ileostomia• VOLUMEN Maydó n GHG y cols. Estomas intestinales: Construcción y complicaciones An Med (Mex) 2011; 56 (4): 205-209• FLORA
  11. 11. COLOSTOMÍAS Es la exteriorización de un tramo del colon a la piel. Según la porción abocada puede ser: Ascendente •El estoma se coloca en la parte derecha del abdomen Transversa •El estoma se coloca Indistintamente en la parte derecha o izquierda del abdomen. Descendente •El estoma se coloca en la parte izquierda del abdomen. Sigmoides : FII
  12. 12. COLOSTOMÍAShttp://dc118.4shared.com/doc/RE9hJjHx/preview010.png 12
  13. 13. CLASIFICACION NO SECCIONADA WANGESTEEN• EN ASA GLENN-RAFAL SECCIONADA DENNIS Y FALLISTERMINAL CABOS MIKULICZCIRCUNFERENCIA ADYACENTES RAKINL EN DOBLE ESPERNE CAÑON CABOS DEVINE SEPARADOS MIXTER EN UN CABO HARTMANN OP MILES OP BABCOCK Maingots Abdominal Operations ZINNER-ASHLEY 11ed McGraw-Hill
  14. 14. Anorectal and Colonic DiseasesA Practical Guide to Their Management Third Edition 2010
  15. 15. COLOSTOMIA EN ASADavRichard N Saunders is a Specialist Registrar in Colorectal Surgery at the Leicester Royal Infirmary, Leicester, UKid Hemingway MBChB MD FRCS(gen) is Consultant Colorectal Surgeon at the Leicester Royal Infirmary, Leicester, UK. ELSEVIER 2008 Principles and Practice of Surgery for the Colon, Rectum and Anus, Third Edition
  16. 16. COLOSTOMIA EN ASADavRichard N Saunders is a Specialist Registrar in Colorectal Surgery at the Leicester Royal Infirmary, Leicester, UKid Hemingway MBChB MD FRCS(gen) is Consultant Colorectal Surgeon at the Leicester Royal Infirmary, Leicester, UK. ELSEVIER 2008 Principles and Practice of Surgery for the Colon, Rectum and Anus, Third Edition
  17. 17. COLOSTOMIA DE MIKULIEZ•    Paul Mikuliez (cañón de escopeta): Se realiza después de resecar un segmento del colon, uniendo los dos cabos entre sí a nivel de la cara posterior,quedando un estoma funcionante y una fístula mucosa. 17
  18. 18. COLOSTOMIA DE HARTMAN•    Hartmann: Se realiza en situaciones en las que se considera necesario resecar una parte del colon (descendente osigma) y no practicar la anastomosis en la misma intervención. El colon proximal se aboca al exterior como una colostomíasigmoidea y el distal se cierra suturándolo dentro de la cavidad abdominal. 18
  19. 19. COLOSTOMIA DE DEVINEDevine: Se exteriorizan los dos extremos del colon de forma separada,formando dos estomas diferentes, uno elimina heces y el otro recibe elnombre de fístula mucosa. 19
  20. 20. COLOSTOMIA EN CABOS DIVORCIADOS http://www.sacd.org.ar/tnueve.pdf 20
  21. 21. CECOSTOMIAMaingots Abdominal Operations ZINNER-ASHLEY 11ed McGraw-Hill 21
  22. 22. APENDICECOSTOMIA Urology Journal Vol 8 No 1 Winter 2011 22
  23. 23. Urology Journal Vol 8 No 1 Winter 2011 23
  24. 24. MADURACION• INMEDIATA : COLOSTOMIA TERMINAL• DIFERIDA : SE ESPERA PARA ABRIR LA COLOSTOMIA( ASA) 24
  25. 25. TECNICAS Anorectal and Colonic Diseases A Practical Guide to Their Management Third Edition 2010
  26. 26. PREPARACION DEL SITIO DE OSTOMIAMarcacion del sitioDisco en piel 2 cm de diametroInsicionSeparacion longitudinal fibras muscularesClamp intestinalCierre de pared abdominalSangrado del estomaMaduracion 8 puntos Principles and Practice of Surgery for the Colon, Rectum and Anus, Third Edition
  27. 27. LAPAROTOMIAMaingots Abdominal Operations ZINNER-ASHLEY 11ed McGraw-Hill 27
  28. 28. LAPAROTOMIAMaingots Abdominal Operations ZINNER-ASHLEY 11ed McGraw-Hill
  29. 29. LAPAROTOMIAMaingots Abdominal Operations ZINNER-ASHLEY 11ed McGraw-Hill 29
  30. 30. COLOSTOMIA LAPAROSCOPICA http://www.youtube.com/watch?v=IsagXh99GwI 30
  31. 31. OTRAS TECNICAS COLOSTOMIA LAPAROSCOPICA COLOSTOMIA PERCUTANEA COLOSTOMIA ASISTIDA POR ENDOSCOPIA COLOSTOMIAS DE SCHMIDT-PERINEAL COLOSTOMIA CON CONTINENTE Colostomía con anillo magnético Colostomía continente de Koc Colostomía continente con banda ajustable Maingots Abdominal Operations ZINNER-ASHLEY 11ed McGraw-Hill
  32. 32. COLOSTOMIA ENDOSCOPICA - PERCUTANEA Para ver esta película, debe disponer de QuickTime™ y de un descompresor . http://www.youtube.com/watch?v=dvg87t6C91k
  33. 33. COLOSTOMIA CON BANDA AJUSTABLE Cirugía Digestiva, F. Galindo. www.sacd.org.ar, 2009; III-309, pág. 1- 33 12.
  34. 34. SCHMIDT© 2002, Editions Scientifiques et Médicales Elsevier SAS, París. Todos los derechos reservados. 34
  35. 35. ILEOSTOMIAS• TERMINAL : V.G BROOKE• EN ASA: FIST MUCOSA• CONTINENTE: POUCH , U , J. 35
  36. 36. ILEOSTOMIA DE BROOKE Sleisenger and Fordtrans Gastrointestinal and Liver Disease, 9th ed. Copyright © 2010 Sau 36
  37. 37. LOOP ILEOSTOMYPrinciples and Practice of surgery for the Colon, Rectum and Anus Third Edition 37
  38. 38. ILEOSTOMIA DE KOCKSleisenger and Fordtrans Gastrointestinal and Liver Disease, 9th ed.Copyright © 2010 Sau 38
  39. 39. IPAA “J”Sleisenger and Fordtrans Gastrointestinal and Liver Disease, 9th ed.Copyright © 2010 Sau 39
  40. 40. ILEOSTOMIA VS COLOSTOMIADavRichard N Saunders is a Specialist Registrar in Colorectal Surgery at the Leicester Royal Infirmary, Leicester, UKid Hemingway MBChB MD FRCS(gen) is Consultant Colorectal Surgeon at the Leicester Royal Infirmary, Leicester, UK. ELSEVIER 2008 40
  41. 41. Sleisenger and Fordtrans Gastrointestinal and Liver Disease, 9th ed. 41
  42. 42. PREPARACION PREOPERATORIA APOYO PSICOLOGICO DETERMINACION DEL SITIO DEL ESTOMA -LEJOS DEL OMBLIGO -EVITAR PLIEGUES CUTANEOS CICATRICES PROMINENCIAS OSEAS PIEL CON RECEPCION DE RADIACIONES PACIENTE OBESO Anorectal and Colonic Diseases A Practical Guide to Their Management Third Edition 2010
  43. 43. PREPARACION DEL SITIO DE OSTOMIAMarcacion del sitio *Disco en piel 2 cm de diametroInsicionSeparacion longitudinal fibras muscularesClamp intestinalCierre de pared abdominalSangrado del estomaMaduracion 8 puntos Principles and Practice of Surgery for the Colon, Rectum and Anus, Third Edition
  44. 44. CONSIDERACIONES ESPECIALESOBESIDADASCITISLESIONES POR RADIACION D.E. Beck et al. (eds.), The ASCRS Manual of Colon and Rectal Surgery 2009
  45. 45. CUIDADO POSOPERATORIO• Evaluacion de viabilidad Estoma en ciruela u oscuro * -Trinitrato de glicerina Evaluacion : -Tecnica tubo de ensayo -Fluoresceina 5ml• Dispositivos de ostomias * Proteccion de la piel ‘estandar de oro’ Proteccion con hidrocoloides• Alta hospitalaria Actividad Anorectal and Colonic Diseases A Practical Guide to Their Management Third Edition 2010
  46. 46. Anorectal and Colonic Diseases, A Practical Guide to Their Management Third Edition 2010
  47. 47. ALIMENTACION
  48. 48. BOLSAS DE OSTOMIA
  49. 49. COMPLICACIONES• NECROSIS• ISQUEMIA• PROLAPSO• RETRACCION• ESTENOSIS TEMPRANAS - TARDIAS• HERNIA PARAOSTOMAL• PELVIS SEPSIS MENORES - MAYORES• OBSTRUCCION INTESTINAL• SEPARACION MUCOCUTANEA• POUCHITIS AND COUFFITIS• DEHISCENCIA DE SUTURA• HEMORRAGIA• FISTULA• ABSCESOS 49
  50. 50. ISQUEMIA Y NECROSIS DISTALPrinciples and Practice of surgery for the Colon, Rectum and Anus Third Edition 50
  51. 51. PROLAPSO Y ULCERAPrinciples and Practice of surgery for the Colon, Rectum and Anus Third Edition 51
  52. 52. HERNIA PARAOSTOMALPrinciples and Practice of surgery for the Colon, Rectum and Anus Third Edition 52
  53. 53. CAPUT MEDUSAPrinciples and Practice of surgery for the Colon, Rectum and Anus Third Edition 53
  54. 54. SEPARACION MUCOCUTANEAPrinciples and Practice of surgery for the Colon, Rectum and Anus Third Edition 54
  55. 55. PROLAPSOPrinciples and Practice of surgery for the Colon, Rectum and Anus Third Edition 55
  56. 56. ESTENOSISPrinciples and Practice of surgery for the Colon, Rectum and Anus Third Edition 56
  57. 57. DEHISCENCIA DE SUTURAPrinciples and Practice of surgery for the Colon, Rectum and Anus Third Edition 57
  58. 58. RETRACCIONPrinciples and Practice of surgery for the Colon, Rectum and Anus Third Edition 58
  59. 59. POUCHITIS - COUFFITISSleisenger and Fordtrans Gastrointestinal and Liver Disease, 9th ed. 59
  60. 60. CIERRE DE COLOSTOMIAS 60
  61. 61. CIERRE DE COLOSTOMIAS REGLA DE LOS 6 61
  62. 62. CIERRE DE ILEOSTOMIA 62
  63. 63. CONCLUSIONES• Las técnicas laparoscópicas han mostrado ser eficaces y seguras para la formación de estomas.• Las tecnicas minimanete invasivas en comparacion a las tecnicas abiertas han demostrado ser menos morbidas y de menor costo.• Para evitar las complicaciones relacionadas a los estomas intestinales, es fundamental conocer las in- dicaciones precisas y las técnicas disponibles para su construcción. 63

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