challenging ostomies

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  • 1.Challenging Ostomies: AColorectal SurgeonsPerspective

2. Peter Hofmann, MD Department of Colon & Rectal Surgery Springfield Clinic, LLP 3. Objectives REVIEW WHY PATIENTS MIGHT REQUIRE AN OSTOMY OUTLINE HOW OSTOMIES ARE ACTUALLY CREATED DISCUSS CHALLENGING OSTOMY PATIENTS REVIEW ISSUES WITH STOMAS 4. INDICATIONS DIVERSION OBSTRUCTION INFLAMMATORY BOWEL DISEASE MOBILITY ISSUES CONTINENCE ISSUES 5. INDICATIONS: OBSTRUCTION CANCER BENIGN DISEASE 6. INFLAMMATORY BOWELDISEASE CROHNS AND ULCERATIVE COLITIS PERIANAL CROHNS DISEASE DIVERSION AFTER SURGERY FOR IBD RESTORATIVE PROCTOCOLECTOMY 7. Total proctocolectomy with endileostomy Surgical treatment for ulcerative colitis 8. MOBILITY ISSUES WHEELCHAIR-BOUND PATIENTS PATIENTS WHO CANNOT PERFORM ACTIVITIES OFDAILY LIVING 9. CONTINENCE ISSUES DUE TO A PHYSICAL IMPAIRMENT FECAL INCONTINENCE WHICH IS REFRACTORY TOOTHER MEDICAL AND SURGICAL INTERVENTIONS 10. OSTOMY CONSTRUCTION YOU NEED A PIECE OF BOWEL AND A HOLE BOWEL IS TETHERED BY ITS BLOOD SUPPLY THE HOLE CAN BE DIFFICULT TO CREATE 11. OSTOMY CONSTRUCTION VARIES WITH COLOSTOMIES VERSUS ILEOSTOMIES MAY HAVE DIFFERING CHALLENGES BASED ONFUNCTION TEMPORARY VERSUS PERMANENT EMERGENT VERSUS ELECTIVE 12. CHALLENGING PATIENTS OBESE CACHECTIC PREVIOUS SURGERIES/SCARS PREVIOUS OSTOMIES ORCONCURRENT OSTOMY 13. OBESITY INCREASINGLY COMMON ISSUE IN SURGERY 14. WHAT IT MEANS IN OSTOMYCONSTRUCTION CHALLENGES! 15. GENDER DIFFERENCES IN OBESITY MEN HAVE THIN ABDOMINAL WALLS BUT CAN HAVE VERY THICK, STIFF MESENTERY PRESENTS ITS OWN SET OF CHALLENGES WOMEN HAVE THICK ABDOMINAL WALLS A LOT OF SUBCUTANEOUS FAT LIES BETWEEN THE ABDOMINAL WALL AND THE SKIN 16. DIAGRAM OF OSTOMYCONSTRUCTION COLOSTOMY 17. AGAIN, OBESE PATIENTS ARE ACHALLENGE 18. EXTREMELY THIN PATIENTSCAN PRESENT A CHALLENGE,TOO! NEED TO WATCH OUT FOR BONY PROMINENCES! 19. PREVIOUS SURGERY YOU DECIDE WHATS TOUGH ABOUT THIS 20. Previous surgery Or this 21. STOMA COMPLICATIONS PROLAPSE SKIN ISSUES PARASTOMAL HERNIA 22. prolapse 23. Skin issues Vexing problem, worse with poorly-positioned stomas 24. Parastomal hernias Very common problem 25. SUMMARY STOMA FORMATION CAN BE A CHALLENGE 26. SUMMARY FIRST SURGERY IS THE TIME TO GET IT RIGHT 27. SUMMARY WOUND-OSTOMY SPECIALISTS ARE CRITICAL TOSUCCESSFUL PLACEMENT AND CARE OF OSTOMIES 28. SUMMARY BAD OSTOMIES EXACT A TERRIBLE TOLL ONPATIENTS 29. SUMMARY TEAM APPROACH IS ALWAYS BEST ENTEROSTOMAL THERAPIST COLORECTAL SURGEON PATIENT STAFF AND VISITING NURSES PHARMACIST/HOME HEALTH SUPPLY SPECIALIST FAMILY/FRIENDS 30. QUESTIONS