Restorative proctocolectomy with ileal pouch reservoir in ulcerative colitis : the first series from Malta

Seventy five to eighty percent of patients with ulcerative colitis are more or less satisfactorily treated medically. Surgery cures the disease, but because proper surgical therapy has until recently necessitated a permanent ileostomy, physicians and patients are understandably reluctant to agree to definitive surgical treatment until absolutely necessary.peer-reviewe

Evaluation of an online educational tool designed to reduce stress and boost well-being for people living with an ileostomy : a framework analysis

Ileostomies, in which the small intestine is re-directed out of a stoma in the stomach so that waste is collected using a bag, are using to treat conditions such as bowel cancer and Inflammatory Bowel Disease. Previous research has shown that life with an ileostomy can be challenging. In our own previous work, we piloted an Online Educational Tool (OET) designed to reduce stress and boost well-being in people living with an ileostomy. The current study utilised the qual-itative method framework analysis in order to evaluate the effectiveness of our OET. We asked nine OET users questions about their experience of using the tool and the impact it may have had on their lives. Feedback was generally positive. Participants described facilitators and barriers for remaining engaged, and discussed a wide range of elements which were successful or unsuccessful. Stress levels were generally reduced and well-being boosted; participants gave examples of how this played out for them. Feelings about whether the impact of the tool would last were mixed. There was one participant who felt the tool was not inclusive enough and too repetitive. Findings from this study add weight to previous findings that the OET was successful in its aims

An online educational tool to promote psychological well-being, optimism, and coping self-efficacy among people living with an ileostomy : a pilot study

We assessed an online educational tool designed for people living with an ileostomy. Thirty-nine participants took part in a 10-week online educational tool, which included elements such as happiness profiling, understanding stress and coping, utilising social support, mindfulness skills, and emotional intelligence training. Participants completed questionnaires to assess the effects of the online educational tool on well-being, optimism, and coping self-efficacy at Time 1 (baseline), Time 2 (after the intervention), and Time 3 (three months after completing the online educational tool). Psychological well-being, optimism, use of problem-focused coping self-efficacy, and stop unpleasant emotions and thoughts coping self-efficacy were significantly higher, with large effect sizes, at both Time 2 and Time 3, than Time 1. The online educational tool appears to be a promising time and cost effective method of promoting positive outcomes, although additional testing is required before it could be used in conjunction with existing healthcare treatment

Laparoscopic peritoneal lavage. Our experience and review of the literature

NTRODUCTION: Over the years various therapeutic techniques for diverticulitis have been developed. Laparoscopic peritoneal lavage (LPL) appears to be a safe and useful treatment, and it could be an effective alternative to colonic resection in emergency surgery. AIM: This prospective observational study aims to assess the safety and benefits of laparoscopic peritoneal lavage in perforated sigmoid diverticulitis. MATERIAL AND METHODS: We surgically treated 70 patients urgently for complicated sigmoid diverticulitis. Thirty-two (45.7%) patients underwent resection of the sigmoid colon and creation of a colostomy (Hartmann technique); 21 (30%) patients underwent peritoneal laparoscopic lavage; 4 (5.7%) patients underwent colostomy by the Mikulicz technique; and the remaining 13 (18.6%) patients underwent resection of the sigmoid colon and creation of a colorectal anastomosis with a protective ileostomy. RESULTS: The 66 patients examined were divided into 3 groups: 32 patients were treated with urgent surgery according to the Hartmann procedure; 13 patients were treated with resection and colorectal anastomosis; 21 patients were treated urgently with laparoscopic peritoneal lavage. We had no intraoperative complications. The overall mortality was 4.3% (3 patients). In the LPL group the morbidity rate was 33.3%. CONCLUSIONS: Currently it cannot be said that LPL is better in terms of mortality and morbidity than colonic resection. These data may, however, be proven wrong by greater attention in the selection of patients to undergo laparoscopic peritoneal lavage

The effect of preoperative stoma site marking on quality of life in patients undergoing ostomy surgery

The purpose of this study was to determine if preoperative stoma site marking by a Wound, Ostomy, Continence (WOC) nurse affects patient quality of life. This study used a descriptive design with a convenience sample of 25 ostomy patients. Sixty-three surveys were mailed to study participants and the response rate was 40%. Ten subjects (40%) had their stoma site marked by a WOC nurse preoperatively and fifteen subjects did not. Eleven participants reported that their ostomy was permanent (44%), while fourteen of the participants (56%) state they had a temporary stoma. Thirteen of the subjects had elective ostomy surgery (52%) and twelve (48%) had an ostomy created under emergent conditions. Overall quality of life scores did not differ between the marked and unmarked subjects. However, subjects who did not have their stoma site marked preoperatively had greater problems with pouch leakage (p=.0055) than those who were marked preoperatively

Low zinc status and absorption exist in infants with jejunostomies or ileostomies which persists after intestinal repair.

There is very little data regarding trace mineral nutrition in infants with small intestinal ostomies. Here we evaluated 14 infants with jejunal or ileal ostomies to measure their zinc absorption and retention and biochemical zinc and copper status. Zinc absorption was measured using a dual-tracer stable isotope technique at two different time points when possible. The first study was conducted when the subject was receiving maximal tolerated feeds enterally while the ostomy remained in place. A second study was performed as soon as feasible after full feeds were achieved after intestinal repair. We found biochemical evidence of deficiencies of both zinc and copper in infants with small intestinal ostomies at both time points. Fractional zinc absorption with an ostomy in place was 10.9% ± 5.3%. After reanastamosis, fractional zinc absorption was 9.4% ± 5.7%. Net zinc balance was negative prior to reanastamosis. In conclusion, our data demonstrate that infants with a jejunostomy or ileostomy are at high risk for zinc and copper deficiency before and after intestinal reanastamosis. Additional supplementation, especially of zinc, should be considered during this time period

Emergency treatment of complicated colorectal cancer

Aim: To find evidence to suggest the best approach in patients admitted as an emergency for complicated colorectal cancer. Methods: The medical records of 131 patients admitted as an emergency with an obstructing, perforated, or bleeding colorectal cancer to Noble’s Hospital, Isle of Man, and the Umberto I University Hospital, Rome, were retrospectively evaluated. Patients were divided in 3 groups on the basis of the emergency treatment they received, namely 1) immediate resection, 2) damage control procedure and elective or semielective resection, and 3) no radical treatment. Demographic variables, clinical data, and treatment data were considered, and formed the basis for the comparison of groups. Primary endpoints were 90-day mortality and morbidity. Secondary endpoints were length of stay, number of lymph nodes analyzed, rate of radical R0 resections, and the number of patients who had chemoradiotherapy. Results: Forty-two patients did not have any radical treatment because the cancer was too advanced or they were too ill to tolerate an operation, 78 patients had immediate resection and 11 had damage control followed by elective resection. There was no statistically significant difference between immediate resections and 2-stage treatment in 90-day mortality and morbidity (mortality: 15.4% vs 0%; morbidity: 26.9% vs 27.3%), number of nodes retrieved (16.6±9.4 vs 14.9±5.7), and rate of R0 resections (84.6% vs 90.9%), but mortality was slightly higher in patients who underwent immediate resection. The patients who underwent staged treatment had a higher possibility of receiving a laparoscopic resection (11.5% vs 36.4%). Conclusion: The present study failed to demonstrate a clear superiority of one treatment with respect to the other, even if there is an interesting trend favoring staged resection