Authors: (including presenting author): :
Au TY(1), Lam KK(1), Ho CW(1), Chan KH(1), Li CM(1)
Affiliation: :
(1)Department of Surgery, PYNEH
Keyword 1: :
Stoma Siting
Introduction: :
Preoperative stoma siting is well-known to enhance health-related quality of life and reduce complications such as peristomal skin problems and parastomal hernia. Traditional siting methods primarily rely on physical examinations to locate the marks on rectus muscles. However, there is limited objective data on the thickness of rectus muscles, and it could be challenging for patients with obesity or severe abdominal pain. Despite appropriate stoma siting, complications persist. In 2023, two patients required emergency operations due to parastomal hernias with strangulation, highlighting the need for advanced techniques in stoma siting. Ultrasound (USG) emerges as a non-invasive, cost-effective tool that allows for real-time assessment of rectus muscles, facilitating optimal stoma siting. Literature review has been conducted and revealed that USG is accurate and reliable in evaluating the rectus muscles, which could facilitate stoma siting. To our best knowledge, there are no relevant studies on the effectiveness of USG-guided stoma siting. A pilot study was conducted to study its effectiveness.
Objectives: :
To study the effectiveness of USG-guided stoma siting, compared to standard method.
Methodology: :
This pilot cohort study involved adult patients undergoing elective colorectal surgery requiring stoma siting from 2023 to 2024 in PYNEH. The study consisted of two groups: standard siting group in 2023 (n=21) and USG-guided siting group in 2024 (n=48). Key metrics evaluated included demographic variables, length of hospital stay, and occurrence of complications within one year such as peristomal skin problems, parastomal hernia, and stomal prolapse.
Result & Outcome: :
There was a notable reduction in the length of stay, from a mean of 20 days in the standard group to 17 days in the USG group. Overall complication rates decreased from 81% to 60%. Specifically, there was a statistically significant decrease in the incidence of parastomal hernias from 33% in the standard group to 6% in the USG group (p=0.003). Additionally, the rates of peristomal skin problems and stomal prolapse decreased by 13% and 3%, respectively. Results indicated no statistically significant differences in demographic data, affirming comparable baseline characteristics. While operator dependency poses a challenge, the findings suggested that USG guidance not only improves the precision of stoma siting through an objective tool, but also contributes to a higher quality of life for patients through reduced complications.
