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Ronald L Hrebinko - One of the best experts on this subject based on the ideXlab platform.
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novel creation of a noneverted Stoma during ileal conduit urinary diversion technique and short term outcomes
Urology, 2020Co-Authors: David T Miller, Avinash Maganty, Katherine Theisen, Ronald L HrebinkoAbstract:Objective To report our experience with a noneverted Stoma technique used in ileal conduit urinary diversion. We successfully utilize this technique in patients when traditional everted Stoma maturation is difficult due to a thick abdominal wall, bulky mesentery, and poor bowel compliance. Methods We retrospectively reviewed all patients who underwent surgical creation of ileal conduit using a noneverted Stoma technique between 2009 and 2018. We recorded demographic and perioperative information, including 30-day postoperative complications, and Stoma appearance at last follow-up visit. Using R software, chi-square testing of the distribution of Stoma outcomes for obese and nonobese patients was performed. Results There were a total of 42 patients who underwent noneverted Stoma maturation technique by a single surgeon. Our cohort meets obese criteria with a mean body mass index (BMI) of 30.2. Mean length of follow-up was 16.6 months (1-62). On follow-up, 35 (83.3%) of Stomas were pink and everted appearing, 4 (9.5%) were flush, small, or noneverted, 1 (2.3%) had an eschar or area of granulation tissue around the Stoma, and 2 (4.7%) did not have a Stoma description documented. There were 9 (21%) Stoma-related complications in our cohort. There was no statistical difference in Stoma outcomes between obese (BMI > 30) and nonobese (BMI Conclusion Ileal conduit creation with a noneverted Stoma provides good Stoma protuberance in patients with a thick abdominal wall, bulky mesentery, and poor bowel compliance. This technique is safe and should be considered in patients in whom Stoma maturation is difficult.
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technique of paraStomal hernia repair using synthetic mesh
Urology, 2001Co-Authors: Michael E Franks, Ronald L HrebinkoAbstract:We describe a reliable and simple technique of paraStomal hernia repair using primary fascial repair with synthetic mesh that minimizes the known complications of infection and Stomal stenosis while eliminating the need for peritoneal exploration, lysis of adhesions, and relocation of the Stoma. We applied this technique to 6 patients (aged 65 to 83 years) with symptomatic, first-time paraStomal hernias. The results are discussed.
Goran T. Rudic - One of the best experts on this subject based on the ideXlab platform.
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weight gain after bariatric surgery as a result of a large gastric Stoma endotherapy with sodium morrhuate may prevent the need for surgical revision
Gastrointestinal Endoscopy, 2007Co-Authors: Marc F. Catalano, Goran T. Rudic, Alfred J Anderson, Thomas Y. ChuaAbstract:Background Obesity affects more than 30% of the U.S. population and is associated with the development of life-threatening complications. Numerous therapeutic approaches to the problem have been advocated, including low-calorie diets, anoretic drugs, behavior modifications, and exercise therapy. The only treatment proven to be effective in the long-term management of morbid obesity is surgical intervention. Complications of bariatric surgery include Stomal stenosis and/or ulcer and Stomal dilation (secondary to overeating). The latter complication can result in a gain of previously lost weight. Objective To determine the effect of endoscopic injection by using a sclerosant (sodium morrhuate) to induce Stomal stenosis in patients who present with Stomal dilatation complicated by weight gain. Design Bariatric patients with a large gastric Stoma were treated with sodium morrhuate Stomal injection. Diameters of the Stoma were followed at repeat endoscopy. Weight loss at scheduled clinic visits were compared with pretherapy weights. Patients Twenty-eight patients (10 men, 18 women; age range, 27-58 years), after bariatric surgery with GI bypass, were referred with weight gain after initial weight loss. Weight gain was believed to be the result of a large gastric Stoma. Interventions Treatment included injection of sodium morrhuate (1-2 mL circumferentially) surrounding the Stoma. A total of 1 to 3 injection sessions were performed in an attempt to achieve a Stoma diameter of 1.2 cm or smaller. Main Outcome Measurements Treatment success was defined as a decrease of Stoma size to ≤12 mm and weight loss ≥75% of the weight the patient gained after establishing a steady state post bariatric surgery weight. Results A total of 2.3 injection sessions were performed. Successful endotherapy was achieved in 18 of 28 patients (64%). One patient developed symptoms of Stomal stenosis, which required 2 separate balloon dilating sessions. No other complications were encountered. Limitations Retrospective case series. Conclusions Endoscopic injection of sodium morrhuate surrounding the dilated gastric Stoma complicating bariatric surgery appears to be a successful, less-invasive therapeutic alternative to surgical revision.
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Weight Gain Following Bariatric Surgery As a Result of Large Gastric Stoma: Endotherapy Using Sodium Morrhuate (SM) to Induce Stomal Stenosis May Prevent Need for Surgical Revision
Gastrointestinal Endoscopy, 2006Co-Authors: Marc F. Catalano, Thomas Y. Chua, Oscar Batista, Goran T. RudicAbstract:Weight Gain Following Bariatric Surgery As a Result of Large Gastric Stoma: Endotherapy Using Sodium Morrhuate (SM) to Induce Stomal Stenosis May Prevent Need for Surgical Revision Marc F. Catalano, Thomas Y. Chua, Oscar A. Batista, Goran T. Rudic Obesity is a chronic medical condition associated with increased morbidity & mortality. Affects 250 million world-wide & 300 thousand deaths/yr. Surgery appears to be the best long-term Rx option, with high success. The most popular procedure is the Roux-Y gastric bypass (RYGB) which takes advantage of both restrictive (small pouch) & malabsorptive surgery. Complications following RYGB have been well described. Those which may be amenable to endotherapy include dilation of gastric Stoma. These pts present with wt gain following initial wt loss. Aim: Determine efficacy of SM injection of large gastric Stoma in pts with RYGB presenting with wt gain. Methods: Over 4-yrs, 31 pts (10 M, 21 F, age 27-58) with morbid obesity & recent RYGB presented with wt gain following initial wt loss, all with large gastric Stoma (Stoma size S15 mm) by EGD or x-ray. Rx included injection of SM circumferentially along the dilated Stoma to induce tissue retraction and scarring. A total of 1-3 injection sessions were performed. Amount of SM injected per session ranged 8-20 cc (mean 14.5). Successful endotherapy was defined: Stoma size S1.2 cm, loss of &75% of wt that was regained following initial wt loss. F/U range 6-25 mo (mean 18). F/U visits were at 4-8 wks. Wt was recorded and compared to historical wt. Results: A mean of 2.3 sessions were performed in 31 RYGB pts. Successful endotherapy as defined at entry, was seen in 19/31 (61%). Mean pre surg wt was 322 lbs, mean post surg wt of 179 lbs. In this group, wt gain was a mean 65 lbs. Following completion of SM endotherapy, wt loss was a mean of 49 lbs at 18 mo F/U. Estimated mean Stoma diameter at study entry was 17 mm (range 14-20). Following Sclerotherapy, mean Stoma diameter was 10 mm (range 5-16). Of the 12 pts with unsuccessful endotherapy, 5 had revision of their RYGB. Remaining 7 pts continued post bariatric diet & life modification. At subsequent endoscopy, 11 pts had shallow circumferential Stomal ulcers & were treated with PPI. All ulcers healed at 8 wks. Presence of ulcer formation resulted in higher success of endotherapy 82% (9/11) compared to those w/o ulcer 50% (10/20). Conclusions: Endoscopic injection of SM surrounding a dilated gastric Stoma complicating RYGB surgery appears to be a successful, less invasive therapeutic alternative to surgical revision. The presence of a Stomal ulcer, following endotherapy, is a positive predictor for successful outcome.
Thomas Y. Chua - One of the best experts on this subject based on the ideXlab platform.
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weight gain after bariatric surgery as a result of a large gastric Stoma endotherapy with sodium morrhuate may prevent the need for surgical revision
Gastrointestinal Endoscopy, 2007Co-Authors: Marc F. Catalano, Goran T. Rudic, Alfred J Anderson, Thomas Y. ChuaAbstract:Background Obesity affects more than 30% of the U.S. population and is associated with the development of life-threatening complications. Numerous therapeutic approaches to the problem have been advocated, including low-calorie diets, anoretic drugs, behavior modifications, and exercise therapy. The only treatment proven to be effective in the long-term management of morbid obesity is surgical intervention. Complications of bariatric surgery include Stomal stenosis and/or ulcer and Stomal dilation (secondary to overeating). The latter complication can result in a gain of previously lost weight. Objective To determine the effect of endoscopic injection by using a sclerosant (sodium morrhuate) to induce Stomal stenosis in patients who present with Stomal dilatation complicated by weight gain. Design Bariatric patients with a large gastric Stoma were treated with sodium morrhuate Stomal injection. Diameters of the Stoma were followed at repeat endoscopy. Weight loss at scheduled clinic visits were compared with pretherapy weights. Patients Twenty-eight patients (10 men, 18 women; age range, 27-58 years), after bariatric surgery with GI bypass, were referred with weight gain after initial weight loss. Weight gain was believed to be the result of a large gastric Stoma. Interventions Treatment included injection of sodium morrhuate (1-2 mL circumferentially) surrounding the Stoma. A total of 1 to 3 injection sessions were performed in an attempt to achieve a Stoma diameter of 1.2 cm or smaller. Main Outcome Measurements Treatment success was defined as a decrease of Stoma size to ≤12 mm and weight loss ≥75% of the weight the patient gained after establishing a steady state post bariatric surgery weight. Results A total of 2.3 injection sessions were performed. Successful endotherapy was achieved in 18 of 28 patients (64%). One patient developed symptoms of Stomal stenosis, which required 2 separate balloon dilating sessions. No other complications were encountered. Limitations Retrospective case series. Conclusions Endoscopic injection of sodium morrhuate surrounding the dilated gastric Stoma complicating bariatric surgery appears to be a successful, less-invasive therapeutic alternative to surgical revision.
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Weight Gain Following Bariatric Surgery As a Result of Large Gastric Stoma: Endotherapy Using Sodium Morrhuate (SM) to Induce Stomal Stenosis May Prevent Need for Surgical Revision
Gastrointestinal Endoscopy, 2006Co-Authors: Marc F. Catalano, Thomas Y. Chua, Oscar Batista, Goran T. RudicAbstract:Weight Gain Following Bariatric Surgery As a Result of Large Gastric Stoma: Endotherapy Using Sodium Morrhuate (SM) to Induce Stomal Stenosis May Prevent Need for Surgical Revision Marc F. Catalano, Thomas Y. Chua, Oscar A. Batista, Goran T. Rudic Obesity is a chronic medical condition associated with increased morbidity & mortality. Affects 250 million world-wide & 300 thousand deaths/yr. Surgery appears to be the best long-term Rx option, with high success. The most popular procedure is the Roux-Y gastric bypass (RYGB) which takes advantage of both restrictive (small pouch) & malabsorptive surgery. Complications following RYGB have been well described. Those which may be amenable to endotherapy include dilation of gastric Stoma. These pts present with wt gain following initial wt loss. Aim: Determine efficacy of SM injection of large gastric Stoma in pts with RYGB presenting with wt gain. Methods: Over 4-yrs, 31 pts (10 M, 21 F, age 27-58) with morbid obesity & recent RYGB presented with wt gain following initial wt loss, all with large gastric Stoma (Stoma size S15 mm) by EGD or x-ray. Rx included injection of SM circumferentially along the dilated Stoma to induce tissue retraction and scarring. A total of 1-3 injection sessions were performed. Amount of SM injected per session ranged 8-20 cc (mean 14.5). Successful endotherapy was defined: Stoma size S1.2 cm, loss of &75% of wt that was regained following initial wt loss. F/U range 6-25 mo (mean 18). F/U visits were at 4-8 wks. Wt was recorded and compared to historical wt. Results: A mean of 2.3 sessions were performed in 31 RYGB pts. Successful endotherapy as defined at entry, was seen in 19/31 (61%). Mean pre surg wt was 322 lbs, mean post surg wt of 179 lbs. In this group, wt gain was a mean 65 lbs. Following completion of SM endotherapy, wt loss was a mean of 49 lbs at 18 mo F/U. Estimated mean Stoma diameter at study entry was 17 mm (range 14-20). Following Sclerotherapy, mean Stoma diameter was 10 mm (range 5-16). Of the 12 pts with unsuccessful endotherapy, 5 had revision of their RYGB. Remaining 7 pts continued post bariatric diet & life modification. At subsequent endoscopy, 11 pts had shallow circumferential Stomal ulcers & were treated with PPI. All ulcers healed at 8 wks. Presence of ulcer formation resulted in higher success of endotherapy 82% (9/11) compared to those w/o ulcer 50% (10/20). Conclusions: Endoscopic injection of SM surrounding a dilated gastric Stoma complicating RYGB surgery appears to be a successful, less invasive therapeutic alternative to surgical revision. The presence of a Stomal ulcer, following endotherapy, is a positive predictor for successful outcome.
Raj S Pruthi - One of the best experts on this subject based on the ideXlab platform.
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incidence and risk factors of Stomal complications in patients undergoing cystectomy with ileal conduit urinary diversion for bladder cancer
The Journal of Urology, 2007Co-Authors: Erik Kouba, Matt Sands, Aaron C Lentz, Eric M Wallen, Raj S PruthiAbstract:Purpose: In this study we examined the incidence and associated factors of Stomal complications in patients undergoing radical cystectomy with ileal conduit urinary diversion for bladder cancer. In addition, we evaluated the treatment and outcomes of surgical procedures in patients in whom Stoma related complications developed.Materials and Methods: From 2001 to 2005 a total of 137 patients underwent ileal conduit diversion after cystectomy or exploration for bladder cancer, had complete clinical followup and were followed for at least 12 months after surgery. The incidence of Stomal complications (including paraStomal hernia, Stomal stenosis and Stomal prolapse) is reported with correlations made to age, race, gender, body mass index, smoking history, alcohol consumption, preoperative laboratory values (creatinine, hematocrit), operative estimated blood loss and surgical complications. In addition, management of Stomal complications is reported.Results: Of the 137 patients 21 Stomal complications (15.3%)...
Sally Waichi Chan - One of the best experts on this subject based on the ideXlab platform.
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patients experiences of performing self care of Stomas in the initial postoperative period
Cancer Nursing, 2015Co-Authors: Sally Waichi Chan, Honggu HeAbstract:Abstract With the loss of an important bodily function and the distortion in body image, a Stoma patient experiences physical, psychological, and social changes. With limited current studies exploring experiences of patients in the management of their Stoma, there is a need to explore their experiences, their needs, and factors that influence their self-management. The aim of this study was to investigate patients' experiences of performing self-care of Stomas in the initial postoperative period. This study adopted a descriptive qualitative approach from the interpretive paradigm. Semistructured interviews were conducted with 12 patients 1 month postoperatively in a colorectal ward in a hospital in Singapore. Thematic analysis was applied to the interview data. Five themes were identified: process of acceptance and self-management of Stoma, physical limitations, psychological reactions, social support, and need for timely and sufficient Stoma preparation and education. This study highlights the importance of health professionals' role in helping patients adjust preoperatively and postoperatively and accept the presence of a Stoma. Health professionals need to be aware of the physical, psychological, and social impact of Stoma on patients in the initial 30-day postoperative period. Research findings informed the type and level of assistance and support to be offered to patients by nurses and the importance of encouraging patients to be involved in Stoma care at an early stage, which will ultimately contribute to effective and independent self-management. Patients can be prepared preoperatively to reduce the psychological and social impact of Stoma after creation of their Stoma.
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patients experiences of performing self care of Stomas in the initial postoperative period
Cancer Nursing, 2015Co-Authors: Siew Hoon Lim, Sally Waichi ChanAbstract:Background With the loss of an important bodily function and the distortion in body image, a Stoma patient experiences physical, psychological, and social changes. With limited current studies exploring experiences of patients in the management of their Stoma, there is a need to explore their experiences, their needs, and factors that influence their self-management. Objective The aim of this study was to investigate patients' experiences of performing self-care of Stomas in the initial postoperative period. Methods This study adopted a descriptive qualitative approach from the interpretive paradigm. Semistructured interviews were conducted with 12 patients 1 month postoperatively in a colorectal ward in a hospital in Singapore. Thematic analysis was applied to the interview data. Results Five themes were identified: process of acceptance and self-management of Stoma, physical limitations, psychological reactions, social support, and need for timely and sufficient Stoma preparation and education. Conclusions This study highlights the importance of health professionals' role in helping patients adjust preoperatively and postoperatively and accept the presence of a Stoma. Health professionals need to be aware of the physical, psychological, and social impact of Stoma on patients in the initial 30-day postoperative period. Implications for practice Research findings informed the type and level of assistance and support to be offered to patients by nurses and the importance of encouraging patients to be involved in Stoma care at an early stage, which will ultimately contribute to effective and independent self-management. Patients can be prepared preoperatively to reduce the psychological and social impact of Stoma after creation of their Stoma.