Spätkomplikationen permanenter intestinaler Stomata

Zusammenfassung

Einführung Komplikationen nach Anlage permanenter intestinaler Stomata sind häufig und führen zu gravierenden Problemen in der Stomaversorgung betroffener Patienten. Ziel dieser prospektiven, unizentrischen Nachbeobachtungsstudie war es, Spätkomplikationen im eigenen Patientenkollektiv zu erfassen und potenzielle Risikofaktoren herauszuarbeiten.

Methoden Sämtliche Patienten unserer Klinik mit einer permanenten intestinalen Stomaanlage im Zeitraum 2006 – 2016 wurden in die Studie eingeschlossen. 50 Patienten haben einer Nachuntersuchung zugestimmt (14 weiblich [28%], 36 männlich [72%]). Es erfolgte die Analyse stomaassoziierter Komplikationen im Rahmen einer systematischen Nachuntersuchung (standardisierter Fragebogen, klinische Untersuchung, Sonografie Bauchdecke).

Ergebnisse Das Indikationsspektrum beinhaltete Malignome (n = 27; 54%), Anastomoseninsuffizienzen (n = 10; 20%), akute Divertikulitiden (n = 7; 14%), chronisch entzündliche Darmerkrankungen (n = 5; 10%) sowie seltenere Indikationen. Die 3 häufigsten Spätkomplikationen waren peristomale Hautirritation (n = 25; 50%), parastomale Hernie (n = 14; 28%) und Stomaprolaps (n = 9; 18%). Akute Divertikulitiden führten zu vermehrten Stomaretraktionen (p = 0,012). Doppelläufige Stomata wiesen vermehrt Hernien (p = 0,044) und Prolabierungen (p = 0,047) auf. Ileostomata sind bezüglich peristomaler Hautirritationen problematisch (p = 0,021). Patientenalter, Geschlecht oder eine Stomaanlage im Rahmen einer Notfalloperation stellten in unserem Kollektiv keine unabhängigen Risikofaktoren für das Auftreten von Spätkomplikationen dar.

Schlussfolgerung Die professionelle prä- und postoperative Stomatherapie/-pflege inklusive präoperativer Stomamarkierung und strukturierter stomaspezifischer Nachsorge durch Stomatherapeuten und Chirurgen sowie Hausärzte, ebenso wie eine stringente und zeitnahe Behandlung struktureller Komplikationen, können Spätkomplikationen permanenter intestinaler Stomata vorbeugen und mildern. Interessanterweise war die Stomaanlage im Rahmen einer Notfalloperation kein unabhängiger Risikofaktor für das Auftreten von Spätkomplikationen.

Abstract

Introduction Complications following the creation of permanent intestinal ostomies are common and lead to serious problems in the stoma care of affected patients. The aim of this prospective, single-centre follow-up study was to record the rate of late complications in our own patient group and to identify potential risk factors.

Methods All patients who received a permanent intestinal ostomy in our clinic within the period 2006 – 2016 were included in the study. 50 patients gave their informed consent and participated in our follow-up (14 female [28%], 36 male [72%]). The analysis of stoma-associated complications was performed by review of medical records and a systematic follow-up (standardised questionnaire, clinical examination, and ultrasound of the abdominal wall).

Results Indications included malignancy (n = 27; 54%), anastomotic leakage (n = 10; 20%), acute diverticulitis (n = 7; 14%), IBD (n = 5; 10%) and rarer indications. The top 3 late complications were peristomal skin irritation (n = 25, 50%), parastomal hernia (n = 14; 28%) and prolapse (n = 9; 18%). Acute diverticulitis resulted in increased stomal retraction (p = 0.012). Double-barreled stomata were associated with increased herniation rates (p = 0.044) and prolapse (p = 0.047). Ileostomies were associated with peristomal skin irritation (p = 0.021). Age, sex or emergency stoma creation did not constitute independent risk factors for the development of late complications in our group of patients.

Conclusion Professional pre- and postoperative stoma therapy and care includes preoperative marking of a stoma site and structured stoma-specific follow-up by stoma therapists, surgeons and general practitioners, as well as stringent and early treatment of structural complications. This can prevent and mitigate late complications of permanent intestinal stomata. Interestingly, stoma placement was not an independent risk factor for late complications in an emergency situation.

Schlüsselwörter

Enterostoma - Komplikation - peristomale Hautirritation - parastomale Hernie - Stomaprolaps

Key words

intestinal stoma - complication - peristomal skin irritation - parastomal hernia - prolapse

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