Clinical Challenges in Colorectal Surgery: Let’s Talk Ostomies!

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 21 August 2023

⏱️ 34 minutes

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Summary

Have you ever struggled choosing which type of stoma to mature in an anatomically or medically challenging patient? What about wrestled with the associated postoperative complications? Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss ostomy creation and management of stoma complications.

Hosts:
- Susan Galandiuk MD, University of Louisville, Louisville, Kentucky, @DCREdInChief
- Vladimir Bolshinsky MD, Peninsula Health, Victoria, Australia, @bolshinskyv
- Sandy Kavalukas MD, University of Louisville, Louisville, Kentucky, @sandykava
- Hillary Simon DO, University of Louisville, Louisville, Kentucky, @HillaryLSimon

Producer:
- Manasa Sunkara MS3, University of Louisville, Louisville, Kentucky, @manasasunkara12

Learning objectives:
- Review pre-operative stoma marking and ostomy education.
- Understand “bail-out” ostomy creation options in medically and anatomically challenging patients.
- Discuss common postoperative ostomy complications and management.
- Review common peristomal skin pathology and treatment options.

Video References:
- Colwell, Janice C. A.P.R.N., C.W.O.C.N.1; Williams, Toyia M.S.N., R.N.2. Management of the Patient With a Prolapsed Ileostomy. Diseases of the Colon & Rectum 65(12):p e1073, December 2022. | DOI: 10.1097/DCR.0000000000002605 https://www.youtube.com/watch?v=Wx83CpRLkqk
Non-operative management of stoma prolapse/reduction

- Colwell, Janice C. A.P.R.N.. Management of the Patient With a Retracted Loop Ileostomy Located in a Crease. Diseases of the Colon & Rectum 65(3):p e182-e183, March 2022. | DOI: 10.1097/DCR.0000000000002367 https://www.youtube.com/watch?v=mc6o7nG1fsQ
Management of a retracted stoma, in a crease, with peristomal skin breakdown

- Watanabe, Kazuhiro M.D., Ph.D.; Kohyama, Atsushi M.D., Ph.D.; Suzuki, Hideyuki M.D., Ph.D.; Kajiwara, Taiki M.D., Ph.D.; Karasawa, Hideaki M.D., Ph.D.; Ohnuma, Shinobu M.D., Ph.D.; Kamei, Takashi M.D., Ph.D.; Unno, Michiaki M.D., Ph.D.. Slug Method: A Technique for Stoma Prolapse Reduction Using High Osmolality of the 50% Glucose Solution. Diseases of the Colon & Rectum 63(12):p e565, December 2020. | DOI: 10.1097/DCR.0000000000001798 https://cdn-links.lww.com/permalink/dcr/b/dcr_1_1_2020_09_01_watanabe_20-00282_sdc1.mp4
Osmotic reduction

Other References:
- Baker ML, Williams RN, Nightingale J.. Causes and management of a high-output stoma. Colorectal Dis. 2011;13(2):191–197. doi: 10.1111/j.1463-1318.2009.02107.x.
- Behrenbruch, C., Carr, G., Johnston, M. and Woods, R. (2019), Three-point stapled fixation technique to manage ileostomy spout retraction. ANZ Journal of Surgery, 89: 423-424. doi: 10.1111/ans.15006
- O’Brien, Stephen J. M.B. B.Ch., B.A.O.; Ellis, C. Tyler M.D., M.S.C.R.. The Management of Peristomal Pyoderma Gangrenosum in IBD. Diseases of the Colon & Rectum 63(7):p 881-884, July 2020. | DOI: 10.1097/DCR.0000000000001701
- Paquette IM, Solan P, Rafferty JF, Ferguson MA, Davis BR.. Readmission for dehydration or renal failure after ileostomy creation. Dis Colon Rectum. 2013;56(8):974–979. doi: 10.1097/DCR.0b013e31828d02ba
- Steele S, Hull Tracy, Hyman N, Maykel J, Read T, and Whitlow C. The ASCRS Textbook of Colon and Rectal Surgery. 4th Edition. Volume II. Springer, Switzerland AG, 2022.

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

If you liked this episode, check out other recent Colorectal Surgery Episodes here: https://behindtheknife.org/podcast-category/colorectal/

Transcript

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0:00.0	Behind the Night, the Surgery Podcast, relevant and engaging content designed to help you dominate the day.
0:14.0	Hello, behind-the-night listeners! We are happy to present our first clinical challenges
0:28.5	in colon and rectal surgery episode, discussing the decision-making and challenges surrounding
0:33.8	ostomy creation and management. We are one of two colorectal surgery teams working with behind-the-night
0:40.7	this year, and we'll be sharing the stage with the team from Leahy. Before we begin, we'd like to
0:46.9	briefly introduce our team, starting with our most senior surgeon, Dr. Susan Glandyak.
0:52.0	I've been as the University of Louisville for a really long time, an editor of DCR since 2017.
0:58.0	The advantage is having been around for a long time is having worked with some really great people,
1:02.6	and also having learned from seeing some very bad things done.
1:06.5	Next, our colorectal surgery colleague from Melbourne, Australia, Dr. Vlad Bolshinsky.
1:12.7	The discrepancy of my name and accent always breeds confusion. I grew up in Australia and completed
1:18.8	my surgical residency in Melbourne. I commenced post-philoship training in 2015, and this journey
1:24.0	took me to the United States, where I completed a clinical colorectal fellowship and then an
1:28.5	associate at the Cleveland Clinic. Subsequently, I became involved in the DCR Journal, and as the DCR
1:35.4	Journal Club convener, I was fortunate to get to know Dr. Glandyak through the journal, and now I
1:40.5	am very grateful to participate in these recordings with the excellent faculty from the University of Louisville.
1:47.3	Next, Dr. Sanding Kevlogus. Hello, everyone. I'm a mid-to-early career attending
1:53.3	about to start my four-year on faculty at the University of Louisville. I have certainly gone
1:58.7	through some hard knocks of being my own attending, and so hopefully I haven't done the dumb things
2:04.1	that Dr. Glandyak has seen. I'm happy to join them behind the night team this year.
2:16.8	And lastly, I'm Dr. Hillary Simon. I did my general surgery training at Allegheny General in
2:22.1	Pittsburgh, and I'm finishing my colorectal surgery fellowship at the University of Louisville,
	...

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