RESUMO
BACKGROUND: Isolation of the enteroatmospheric fistula (EAF) opening and prevention of contamination of the rest of the wound by effluent are important factors in the management of EAF. OBJECTIVE: The aim of this study is to describe an easily reproducible technique for effluent control in patients with EAF. MATERIALS AND METHODS: A retrospective analysis was conducted on all patients who underwent the present technique between 2013 and 2015. The surgical technique included condom-EAF anastomosis, fistula ring creation, negative pressure wound therapy (NPWT), and adaptation of an ostomy bag. RESULTS: A total of 7 patients with a Björck grade 4 abdomen were included. All fistulas were located in the small bowel with a median number of 2 EAFs (range, 2-3) in each patient, and the majority had moderate output volume. The mean number of NPWT changes was 10 (range, 5-18), the mean time of NPWT use was 75.7 days (range, 60-120 days), and the mean length of stay was 108.2 days (range, 103-160 days). The mean time of ostomy formation to restitution of bowel continuity was 14.3 months (range, 8-20 months). Open anterior component separation was employed in all cases for closure of the abdominal wall. No mortality, ventral herniation, or refistulization was registered in the study. The mean follow-up time was 8.5 months (range, 6-12 months). CONCLUSIONS: This is an easily reproducible and safe technique for effluent control in patients with Björk grade 4 abdomen with established EAF.
Assuntos
Cavidade Abdominal/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais , Enterostomia/métodos , Fístula Intestinal/cirurgia , Cicatrização/fisiologia , Adulto , Idoso , Colostomia/métodos , Feminino , Humanos , Fístula Intestinal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tratamento de Ferimentos com Pressão Negativa , Estudos Retrospectivos , Estomas Cirúrgicos/fisiologia , Técnicas de Sutura , Resultado do TratamentoAssuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Estomas Cirúrgicos/fisiologia , Estomia/enfermagem , Pediatria , Anormalidades Congênitas/cirurgia , Coletores de Urina , Cuidados Pré-Operatórios/enfermagem , Cuidados Pós-Operatórios/enfermagem , Educação de Pacientes como Assunto , Enterostomia/enfermagem , Família , Higiene da Pele/enfermagem , Ureterostomia/enfermagemRESUMO
Background: The acceptance of a colostomy by a patient requires a great amount of psychological resources and social support. Aim: To identify factors that influence the postoperative adaptation to a colostomy. Patients and methods: Sixty patients subjected to a colostomy in 5 hospitals in Santiago were interviewed. The adaptation to the procedure was assessed using the Olsbrisch Ostomy Adjustment Scale. Three regression equations were elaborated to determine the main predictors associated to adaptation. Control variables such as sex, age and the lapse between the interview and the surgical procedure, were included in the model. Results: The model used identified the simultaneous and combined effects of socioeconomic variables such as education and income on the adaptation to colostomy. A generalized detriment of the self image was detected. Patients valued the social support given by the family and friends. Multiple regression analysis determined that the main predictor of the patientÕs adaptation to colostomy was the level of self care developed. Conclusions: The better adaptation to a colostomy could be achieved by training the patient for an adequate self care and providing him with psychological and social support