Failure of Stoma Acceptance in Functional Bowel Patients

ABSTRACT NUMBER: NESTAC_03

 

AUTHORS
A. Bean, A. Read, A. Sharpe, S. Plusa

AFFILIATIONS
Colorectal Surgical Unit, Royal Victoria Infirmary, Newcastle upon Tyne
Newcastle University, Newcastle upon Tyne

CORRESPONDING AUTHOR CONTACT EMAIL
ku.ca.eltsacwen@1naeb.a

MAIN ABSTRACT TEXT

Introduction
Stoma formation can be necessary to treat severe constipation and incontinence, but failure of stoma acceptance means reversal, a high-risk procedure, is sometimes requested. Pre-operative stoma counselling is provided to optimise patient acceptance and can include an optional referral to psychology and the opportunity to meet a patient with a stoma. The audit aimed to assess the frequency of stoma reversal, indications and pre-operative counselling.

Methods
Patients undergoing stoma formation for bowel dysfunction at the Royal Victoria Infirmary over a ten-year period were identified using a specialist nurse database and post-operative outcomes were assessed using medical and nursing records.

Results
Ninety-five stomas were formed (82% female, mean age 51, range 23 – 89) for incontinence (50%), constipation (41%) and mixed (9%) and nine were reversed (9.5%).
Eight were reversed due to failure of stoma acceptance and one after healing of a solitary rectal ulcer. All nine patients who underwent reversal attended at least two pre-operative counselling sessions. Prior to surgery one met a patient with a stoma, and four accepted a psychology referral. Two patients went on to have their stomas re-formed, one of whom underwent a second reversal procedure.

Conclusions
A significant number of patients are undergoing unplanned stoma reversal, which exposes them to significant morbidity and risk of mortality. Patient acceptance may be improved by enhanced pre-operative counselling and psychology input to identify patients who may struggle with acceptance.