Stoma related morbidity in adults and young children

Research output: PhD ThesisPhd-Thesis - Research and graduation internal

Abstract

Stoma related morbidity is high. In adults, dehydration is the most common reason for readmissions within 30 days, occurring in 6%. In young children, high output stomas are the most frequent reason for high grade complications within 30 days, also occurring in 6%. The loss of fluids seems to be a huge disadvantage for both generations.
For patients with rectal cancer, the formation of an ileostomy after a Low Anterior Resection(LAR) is standard practice in many institutions worldwide. These diverting stomas often require a reintervention and a significant proportion becomes unintentend permanent. This has led to an institutional shift from routine to highly selective diversion in the Netherlands, the first 99 cases are presented in this thesis.
When bowel continuity is restored, Low Anterior Resection Syndrome(LARS) is a frequent problem. A meta-analysis showed that a prolonged time to ileostomy closure seems to reinforce the negative effect on bowel function. Treatment options are not well researched. This thesis describes the POLARiS study protocol; evaluating the feasibility of pelvic floor rehabilitation, transrectal irrigation and sacral neuromodulation in a treatment pathway for LARS.
In young children the formation of an intestinal stoma is rare and literature is scarce. A retrospective cohort study showed that stoma related major morbidity was 39%. In addition, the presence of a stoma result in severe malnourishment in majority of the children.
The formation of a stoma should be a weighed decision, and if a stoma is created, timely closure should be an important part of the patient pathway.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • University of Amsterdam
Supervisors/Advisors
  • Tanis, Pieter, Supervisor
  • Hompes, Roel, Co-supervisor
  • Derikx, Joep, Co-supervisor
Award date7 Oct 2022
Publication statusPublished - 2022

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