Stomalar
Özet
Stomalar, gastrointestinal veya üriner sistemin karın duvarına ağızlaştırılmasıyla oluşturulan ve dışkı sapması veya dekompresyon sağlayan cerrahi açıklıklardır. Bu işlem, kolorektal kanserler, inflamatuar bağırsak hastalıkları, travmalar ve doğumsal anomaliler gibi çeşitli endikasyonlarla geçici veya kalıcı olarak uygulanabilir. Başarılı bir stoma yönetimi için ameliyat öncesi yer seçimi kritik öneme sahiptir; ideal konumun rektus kası içinden geçmesi, hastanın görüş alanında olması ve kemik çıkıntılarından uzak düz bir alanda bulunması gerekir. Stomalar, kullanılan bağırsak segmentine göre ileostomi veya kolostomi olarak, cerrahi teknik açısından ise uç veya loop şeklinde sınıflandırılır. İleostomilerde içerik daha sıvı ve tahriş ediciyken, kolostomilerde daha katı bir çıktı gözlenir. Cerrahi sonrası dönemde iskemi, nekroz, prolapsus, darlık ve parastomal herni gibi komplikasyonlar gelişebileceğinden, titiz cerrahi teknik ve düzenli stoma bakımı esastır. Günümüzde laparoskopik yöntemler açık cerrahiye güvenli bir alternatif sunarken, stoma bakımı ve uygun cihaz kullanımı hastaların yaşam kalitesini artırmada kilit rol oynar.
Stomas are surgical openings created by anastomosing a part of the gastrointestinal or urinary system to the abdominal wall to provide fecal diversion or decompression. This procedure can be performed temporarily or permanently for various indications such as colorectal cancers, inflammatory bowel diseases, traumas, and congenital anomalies. For successful stoma management, preoperative site selection is critical; the ideal location should pass through the rectus muscle, be within the patient's field of vision, and be located on a flat area away from bony prominences. Stomas are classified as ileostomy or colostomy according to the intestinal segment used, and as end or loop stomas in terms of surgical technique. While the content is more liquid and irritating in ileostomies, a more solid output is observed in colostomies. Since complications such as ischemia, necrosis, prolapse, stenosis, and parastomal hernia may develop in the postoperative period, meticulous surgical technique and regular stoma care are essential. Today, laparoscopic methods offer a safe alternative to open surgery, while stoma care and the use of appropriate devices play a key role in improving the quality of life of patients.
Referanslar
Merriam-Webster. Online dictionary of the English language. Accessed 5 May 2010.
Truelove SC, Witts LJ. Cortisone in ulcerative colitis. Preliminary report on a therapeutic trial. Br Med J. 1954;2:375–8.
Terrone DG, Lepanto L, Billiard JS, et al. A primer to common major gastrointestinal post-surgical anatomy on CT-a pictorial review. Insights Imaging. 2011;2:631–638. DOI: 10.1007/s13244-011-0121-4.
Weinstein S, Osei-Bonsu S, Aslam R, Yee J. Multidetector CT of the postoperative colon: a review of normal appearances and common complications. Radiographics. 2013;33:515–532. DOI: 10.1148/rg.332125723.
Baykara ZG, Demir SG, Karadag A, et al. A multicenter, retrospective study to evaluate the effect of preoperative stoma site marking on stomal and peristomal complications. Ostomy Wound Manage 2014; 60:16.
Tan WS, Tang CL, Shi L, Eu KW. Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg 2009; 96:462.
Emmanuel A, Chohda E, Lapa C, Miles A, Haji A, Ellul J. Dysfunctional Stomas for Rectal Cancer Resulting in Much Shorter-Term Complications After Low Anterior Resection. World J Surg. 2018; 42:3755–3764.[ PMC free article ] [ PubMed ] [ Google Scholar ]
Cataldo PA. İntestinal stomas, 200 years of digging. Dis Colon Rectum 1999;42:137-42.
Robert, W. Beart, JR. (1996). İleostomy and İts Alternatives. George D. Zuidema (Ed.), Shackelford's Surgery Of The Alimentary Tract (pp. 198-206). Philadelphia, Pennsylvania: W.B. Saunders Company
Gooszen AW, Geelkerken RH, Hermans J, et al. Quality of life with a temporary stoma: ileostomy vs. colostomy. Dis Colon Rectum 2000; 43:650.
Rullier E, Le Toux N, Laurent C, et al. Loop ileostomy versus loop colostomy for defunctioning low anastomosis during rectal cancer surgery. World J Surg 2001; 25:27.
Güenaga KF, Lustosa SA, Saad SS, et al. Ileostomy or colostomy for temporary decompression of colorectal anastomosis. Cochrane Database Syst Rev 2007; :CD004647.
Jugal S, McKain ES, Swarnkar K, et al. Laparoscopic or trephine fecal diversion: is there a preferred approach and why? Colorectal Dis 2005; 7:156.
Liu J, Bruch HP, Farke S, et al. Stoma formation for fecal diversion: a plea for the laparoscopic approach. Tech Coloproctol 2005; 9:9.
Young CJ, Eyers AA, Solomon MJ. Defunctioning of the anorectum: a historically controlled study of laparoscopic vs. open procedures. Dis Colon Rectum 1998; 41:190.
Chunder A, Gachabayov M, Dyatlov A, Lee H, Essani R, Bergamaschi R. The effect of diverting loop ileostomy and colostomy on postoperative morbidity in restorative anterior resection for rectal cancer: a systematic review and meta-analysis. Langenbecks Arch Surg. 2019; 404:129-139.
Mileski WJ, Rege RV, Joehl RJ, Nahrwold DL. Rates of morbidity and mortality after the closure of loop end colostomy. Surg Gynecol Obstet 1990; 171: 17-21.
Miura T, Sakamoto Y, Morohashi H, Yoshida T, Sato K, Hakamada K. Risk factor for permanent stoma and incontinence quality of life after sphincter-sparing surgery for low rectal cancer without directing stoma. Ann Gastroenterol Surgery. 2017; 2:79-86.
Parmar KL, Zammit M, Smith A, Kenyon D, Lees NP.; Greater Manchester and Cheshire Colorectal Cancer Network. A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network. Colorectal Dis 2011; 13 (08) 935-938
Park JJ, Del Pino A, Orsay CP., et al. Stoma complications: the Cook County Hospital experience. Dis Colon Rectum 1999; 42 (12) 1575-1580
Cairns BA, Herbst CA, Sartor BR, Briggaman RA, Koruda MJ. Peristomal pyoderma gangrenosum and inflammatory bowel disease. Arch Surg 1994; 129 (07) 769-772
Rubin MS, Bailey HR. Parastomal Hernias. İn MacKeigan JM, Cataldo PA (Eds) İntestinal Stomas. Principles, Techniques, and Management. pp. 307-308, Quality Medical Publishing. St.Louis, 1993.
Ventham NT, Brady RR, Stewart RG, et al. Prophylactic mesh placement of permanent stomas at index operation for colorectal cancer. Ann R Coll Surg Engl 2012; 94:569.
Serra-Aracil X, Bombardo-Junca J, Moreno-Matias J, et al. Randomized, controlled, prospective trial of the use of a mesh to prevent parastomal hernia. Ann Surg 2009; 249:583.
Pennick MO, Artioukh DY. Management of parastomal varices: who re-bleeds and who does not? A systematic review of the literature. Tech Coloproctol 2013; 17 (02) 163-170
53 Nayar M, Saravanan R, Rowlands PC., et al. TIPSS in the treatment of ectopic variceal bleeding. Hepatogastroenterology 2006; 53 (70) 584-587.
