Authors (including presenting author) :
To KY, Cheung NT, Ngan HL
Affiliation :
Stoma & Wound Care, Nursing Service Division, United Christian Hospital
Keyword 2: :
Convexity pouch
Keyword 3: :
Pouch Leakage
Keyword 4: :
Peristomal Effluent Dermatitis
Introduction :
Pouch leakage is one of the major challenges for ostomates and can lead to peristomal skin complications (PSCs), particularly peristomal effluent dermatitis (PED), and negatively impact patients’ quality of life (QoL). The presence of skin creases around the stoma is a common cause of pouch leakage and may be minimized with a convex pouching system. However, evidence on the early post-operative use of convex pouches to prevent pouch leakage and PED, as well as improving patients’ QoL remains limited.
Objectives :
To evaluate the incidence of PED early postoperatively in a local hospital and describe the post-operative implementation of the convex pouches system to prevent pouch leakage.
Methodology :
This project included 164 patients who underwent surgical stoma creation from 2024 to 1Q 2025. Data collected included gender, preoperative stoma siting, type of surgery (elective or emergency), type of stoma, and the incidence of pouch leakage and PED.
Result & Outcome :
Among 164 patients, 43.3% (n = 71) required conversion to convex pouch due to leakage. Of these, 34 were males and 37 were females. Most had an ileostomy (60.6%), followed by colostomy (33.8%) and urostomy (5.6%). Elective surgery accounted for 53.5% of cases and emergency procedures for 46.5%. Preoperative stoma siting was performed in 60.6% of patients, whereas 39.4% had no siting.
Within these 71 patients with pouch leakage, 67.6% were changed to a convex pouch upon stoma clinic visit (from post-operative day 28 to day 42) and 32.4% during their in-patient stay. Nearly all patients (98.6%) conversions were due to skin creases with leakage; the remainder were related to severe granulomas. Overall, 46.5% of patients with leakage developed PED. The results revealed that many patients did not receive convexity pouch until after stoma clinic review, by which time leakage and PED had already occurred. Therefore, early prevention of leakage in post-operative patients with peristomal skin creases is essential. Concerns that early post-operative convexity may precipitate mucocutaneous separation may delay its use, although current literature does not support a direct association. Further study is needed to explore the effectiveness and safety of early convex pouch use in this population, with the aim of reducing PED and improving QoL.
