Overcoming challenges: life with an ostomy

Background

Studies have demonstrated decreased health-related quality of life in patients with stomas.

Methods

Using US Department of Veterans Affairs electronic medical records, veterans with stomas were surveyed using the City of Hope Quality of Life-Ostomy questionnaire. Focus groups were conducted segregated by type of stoma (ileostomy vs colostomy) and quality-of-life score (high vs low). Qualitative analysis was performed on the basis of the City of Hope Quality of Life for Ostomates format of health-related quality of life (physical, psychological, social, and spiritual). The findings of the colostomy focus groups are reported.

Results

Two new domains emerged: colostomy specific and health care specific. The most common domains discussed were colostomy specific, psychological, and social. The most frequently discussed colostomy-specific theme was effective and ineffective solutions to colostomy care. Family and spousal relationships were the main theme from the psychological category. The predominant social issue was sexual relationships.

Conclusions

Awareness of patients' social, psychological, and medical status allows surgeons to identify those likely to have problems and devote resources to those veterans.     

Minimally invasive surgery for colorectal cancer: quality of life, body image, cosmesis, and functional results

Background  The aims of this cross-sectional study were to assess the long-term quality of life, the body image, and the cosmetic and functional results in patients who had laparoscopic-assisted for colorectal cancer. Methods  Forty-two patients were enrolled in this study: 21 consecutive patients who had undergone laparoscopic-assisted colonic resection and 21 patients who had open colonic resection, selected according to stage, gender, age, cancer site, and type of resection. The patients answered four questionnaires about their quality of life, body image, functional, and cosmetic results. Nonparametric tests were used for statistical analysis. Results  Postoperative hospital stay was shorter in patients who had laparoscopic-assisted resection. The cosmetic score was significantly better in the laparoscopic-assisted group than in the open group (p < 0.01). In spite of similar overall body image score, patients who had a laparoscopic-assisted resection reported a significantly better satisfaction with their own body (p = 0.05). Quality-of-life and functional results were similar in both groups. Conclusions  The cosmetic results and the consequent satisfaction with the body were significantly better after laparoscopic assisted resection compared to equivalent open procedure. These effects seemed to be temporary but they could help patients to accept the burden of surgery.     

Partial longitudinal resection of the anorectum and sphincter for very low rectal adenocarcinoma: a surgical approach to avoid permanent colostomy

Aim Abdominoperineal resection has been the standard procedure for low rectal cancer. The present study details a new technique, partial longitudinal resection of the anorectum and sphincter, and assesses the oncological and functional outcomes. Method Between January 2004 and April 2008, 12 patients underwent partial longitudinal resection of the anorectum and sphincter for low rectal cancer. All patients underwent a diverting ileostomy and received biofeedback training before stoma closure. Functional results were assessed by vector manometry, Wexner constipation score and Wexner incontinence score. The quality of life (QoL) was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ‐C30). Results There was no postoperative mortality and a R0 curative resection was confirmed in every case. Morbidity included anastomotic leakage in three patients, one of whom underwent reoperation, and stenosis in 11, which was successfully managed with dilatation. The patient who underwent reoperation was not included in the functional analysis. The 11 successful patients received biofeedback training for 1–4 months, and underwent ileostomy closure 6–12 months after surgery. No patient had severe faecal incontinence after stoma closure. The EORTC QLQ‐C30 global health status and QoL scores at 12 months after stoma closure were 50.4 ± 24.3, similar to preoperation scores of 52.3 ± 25.6 (P = 0.927), and not significantly different to scores for the healthy control population of 63.4 ± 23.5 (P = 0.539). No patients developed local recurrence during the median observation period (35.5 months). One patient had distant metastases at 24 months, and underwent resection of the left liver. Conclusion Curability and acceptable anal function can be obtained by partial longitudinal resection of the anorectum and sphincter in patients with very low rectal cancers. This technique is recommended as an alternative to abdominoperineal resection in patients with external sphincter muscle invasion or tumours located below the dentate line.     

Post hoc patient satisfaction with the choice of valve prosthesis for aortic valve replacement: results of a single-centre survey

Open in a separate window OBJECTIVESOur goal was to examine post hoc patient satisfaction and the decision-making process of choosing a prosthesis for aortic valve replacement (AVR).METHODSWe surveyed 113 patients who were operated on for AVR at 60–70 years of age, including 74 patients with a mechanical valve (MECH) and 39 with a bioprosthesis (BIO). The study focused on quality of life and the decision pathway in relation to prosthesis choice and valve-related complications. Decisional conflict was defined as the post hoc uncertainty perceived by patients regarding their choice of prosthesis.RESULTSThe survey was performed at a median of 5.2 (3.2–8.1) years after the AVR. Patients with a biological valve were older (BIO: 68.4 years [66.2–69.4] vs MECH: 63.9 [61.9–66.7]; P < 0.001). Global post hoc satisfaction with prosthesis choice was high in both groups (MECH: 95.9%; BIO: 100%), and 85.1% (MECH) and 92.3% (BIO) of them would repeat their choice. Conflict about their decision was equal (MECH: 30.3%; BIO: 32.6%) for different reasons: MECH patients experienced more anticoagulation-related inconvenience (25.9% vs 0%), fear of bleeding (31.1% vs 0%) and prosthesis noise (26.2% vs 0%), whereas more BIO patients feared prosthesis failure (39.7% vs 17.4%) or reoperation (43.5% vs 18.1%). Active involvement in the decision (odds ratio 0.37, 95% confidence interval 0.16–0.85; P = 0.029) and adequate information about the prosthesis (odds ratio 0.34, 95% confidence interval 0.14–0.86; P = 0.020) decreased the risk of conflict about the decision.CONCLUSIONSAlthough 30% of the responders showed a decisional conflict related to prosthesis-specific interferences, global patient satisfaction with the prosthesis choice for AVR is excellent. Increasing the patient’s involvement in the prosthesis choice through shared accountability and improved information is recommended to decrease the choice-related uncertainty.     

Early results of a new mechanical tri-leaflet heart valve prosthesis - Tricusp: an animal study

Objective --A new tri-leaflet mechanical heart valve made of titanium was inserted in the mitral position to evaluate early results. Methods and results --Five sheep were followed between 3 and 6 months (mean 4.7 months) and performed very well clinically during the follow-up period. In three of five animals a minor para-valvular leakage without hemodynamic importance was observed. The invasive pressure measurements at the end of follow-up revealed only minor transvalvular pressure differences between 1 and 4 &#114 mmHg (mean 2.4 &#114 mmHg). Similar results were obtained by echo-Doppler technique. Histological examination of the tissue around the valve showed no signs of foreign body reaction or chronic inflammatory reaction. Conclusion --This new tri-leaflet heart valve has shown an excellent hemodynamic performance and good tissue compatibility, and therefore may be an alternative to other currently used valve prostheses.     

Midline intravaginal slingplasty for treatment of urinary stress incontinence: results of an independent audit up to 2 years after surgery

Recently, the midline intravaginal slingplasty (anterior IVS) directed at reinforcing the pubourethral ligament was introduced for treatment of urinary stress incontinence. An independent telephone interview to evaluate urinary symptoms and surgery-related changes in quality of life was performed between 12 and 32 months after surgery. Of 52 women initially enrolled, 3 were lost during follow-up. None of the patients experienced infection, rejection or erosion of the tape. The procedure failed in 7 patients whereas in 42 patients cure of stress incontinence was achieved. This was not only verified by clinical examination at initial follow-up but also confirmed by the patients at the time of the interview. Although about two-thirds of the patients reported urge incontinence and/or voiding difficulties during their interview, the validation of the surgery was rather high and only in a minority did urinary complaints translate into reduced quality of life.Funding: This study was partially funded by a generous grant from Tyco Healthcare Netherlands to MIJ     

Long-term follow-up after vaginal sacrospinous fixation: patient satisfaction,anatomical results and quality of life

The objective of this study is to evaluate long-term anatomical results, symptoms of descent, and quality of life after vaginal sacrospinous fixation (SSF) through postoperative follow up study from one institution. Ninety nine women (mean 66 years) underwent vaginal SSF for vault prolapse at our institution. We contacted all patients 2-15 years after surgery for examination (POP-Q, survey). Sixteen out of 55 (29%) patients, who completed follow-up, presented with cystocele, three patients with rectocele, and four patients had a recurrent vault prolapse. As for quality of life, 42/55 (76%) patients reported lower urinary tract symptoms, but only 9/55 (16%) felt a sensation of prolapse. Ten out of 24 patients, who were still sexually active, reported symptoms of sexual dysfunction. There was no correlation between length of follow-up and anatomical or functional results. Vaginal sacrospinous fixation resulted in excellent vault suspension but 29% of the patients developed cystocele formation. Only 16% of patients reported symptoms of descent.     

Glycaemic control,treatment satisfaction and quality of life in type 2 diabetes patients in Greece: The PANORAMA study Greek results

AIM: To provide an update on glycaemic control inEuropean patients with type 2 diabetes mellitus(T2DM). We present the Greek population data of the study. METHODS: An observational multicenter, cross-sectional study evaluating glycaemic control and a range of other clinical and biological measures as well as quality of life(Qo L) and treatment satisfaction in 375 patients with T2 DM enrolled by 25 primary care sites from Greece. RESULTS: The mean age of the patients was 63.5 years and the male/female ratio 48.9%/51.1%. 79.7% of the patients exerted none or light physical activity, 82.4% were overweight or obese and 32.9% did not meet Hb A1 c target of less than 7.0%(53 mmol/mol). Patients reported high satisfaction to continue with treatment, high satisfaction with administered treatment and increased willingness to recommend treatment to others(mean Diabetes Treatment Satisfaction Questionnaire score 29.1 ± 5.6). However, 80% of the patients reported that their Qo L would be better without diabetes. Finally, the most challenging parameter reported was the lack of freedom to eat and drink. CONCLUSION: This analysis of the Greek Panorama study results showed that a considerable percentage of T2 DM patients in Greece do not achieve glycaemic target levels, despite the favourably reported patient satisfaction from administered therapy. Additionally, the majority of primary care T2 DM patients in Greece depict the negative effect of the disease in their Qo L.     

Current state of medical‐advice‐seeking behaviour for symptoms of colorectal cancer: determinants of failure and delay in medical consultation

Aim There are few data on the factors associated with healthcare‐seeking behaviour for symptoms of colorectal cancer. This study describes the determinants of failure and delay in seeking medical advice for rectal bleeding and change in bowel habit. Method In total, 1592 persons (56–88 years) were randomly selected from the Hunter Community Study and mailed a questionnaire. Results In all, 18% (60/332) of respondents experiencing rectal bleeding and 20% (39/195) reporting change in bowel habit had never consulted a doctor. The rate of delay (> 1 month) for each symptom was 18% and 37%. The reasons for delay included the assumption that the symptoms were not serious or that they were benign. Triggers for seeking medical advice varied. Healthcare‐seeking behaviour for rectal bleeding had not significantly improved compared with a previous community‐based study. Conclusion The seriousness of symptoms, importance of early detection and prompt medical consultation must be articulated in health messages to at‐risk persons.     

Compression strapping: the development of a novel compression technique to enhance compression therapy and healing for 'hard-to-heal' leg ulcers

Non healing wounds of the lower limb continue to be a significant issue for both practitioners and patients. Failure of gold-standard management demands a creative response. This article describes the development of a novel and intuitive strapping technique overlying the compression bandage that appears to have an influence in healing complex lower limb ulcers. A retrospective audit of 17 patients with 25 ulcers allows further analysis and discussion. The strapping technique uses cohesive inelastic compression bandaging; narrow strips of bandages are layered in a fan distribution over the ulcer and oedema. This approach seems to offer an intuitive response to these complex wounds, allowing management to be tailored to the site of the ulcer and oedema. Tolerance for this less bulky compression therapy regime is excellent, thereby aiding healing and reducing all costs associated with non healing leg ulcers.     

Body image,cosmesis, quality of life,and functional outcome of hand-assisted laparoscopic versus open restorative proctocolectomy: long-term results of a randomized trial

Background This study aimed to compare quality of life (QOL), functional outcome, body image, and cosmesis after hand-assisted laparoscopic (LRP) versus open restorative proctocolectomy (ORP). The potential long-term advantages of LRP over ORP remain to be determined. The most likely advantage of LRP is the superior cosmetic result. It is, however, unclear whether the size and location of incisions affect body image and QOL. Methods In a previously conducted randomized trial comparing LRP with ORP, 60 patients were prospectively evaluated. The primary end points were body image and cosmesis. The secondary end points were morbidity, QOL, and functional outcome. A body image questionnaire was used to evaluate body image and cosmesis. The Short Form-36 Health Survey and the Gastrointestinal Quality of Life Inventory were used to assess QOL. Body image and QOL also were assessed preoperatively. Results A total of 53 patients completed the QOL and functional outcome questionnaires. There were no differences in functional outcome, morbidity, or QOL between LRP and ORP. At a median of 2.7 years after surgery, 46 patients returned the questionnaires regarding body image, cosmesis, and morbidity. The body image and cosmesis scores of female patients were significantly higher in the LRP group than in the ORP group (body image, 17.4 vs 14.9; cosmesis, 19.1 vs 13.0, respectively). The female patients in the ORP group had significantly lower body image scores than the male patients (14.9 vs 18.3). Conclusions This study is the first to show that ORP has a negative impact on body image and cosmesis as compared with LRP. Functional outcome, QOL, and morbidity are similar for the two approaches. The advantages of a long-lasting improved body image and cosmesis for this relatively young patient population may compensate for the longer operating times and higher costs, particularly for women.     

Erectile dysfunction, premature ejaculation and hypogonadism and men’s quality of life: an Asian perspective

A large percentage of men are still sexually active as they age. Hence, sexual problems potentially impair men’s quality of life even in later years. Erectile dysfunction, premature ejaculation and hypogonadism are among the common sexual health problems faced by men. Published data from Asian countries demonstrate that erectile dysfunction is associated with poor quality of life in the mental and vitality domains, with increased physical co-morbidity, such as diabetes, heart diseases, prostate hyperplasia, and hyperlipidemia, and with psychological ill-health e.g. depression. A great proportion of men are also bothered by their erectile dysfunction. Although the data on premature ejaculation and hypogonadism in Asian countries are limited, there is evidence to suggest that premature ejaculation is associated with perceived low general health status, increased depression, increased anxiety, and poor mental health and vitality scores. The data also suggests that hypogonadism is associated with a number of domains in quality of life scores and depression. In conclusion, in Asian countries, erectile dysfunction, premature ejaculation and hypogonadism should be actively identified and treated to improve men’s quality of life.     

Health-related quality of life, surgical and aesthetic outcomes following microvascular free flap reconstructions: an 8-year institutional review

INTRODUCTION

Microvascular free flap reconstruction has revolutionised the reconstruction of complex defects of traumatic, oncological, congenital and infectious aetiologies. Complications of microvascular free flap procedures impact negatively on patient post-operative course and outcome.

METHODS

We performed a retrospective analysis of 102 consecutive patients undergoing 108 free flap procedures at a tertiary referral centre over an 8-year period. Logistic regression analysis was used to identify factors pRedictive of free flap complications. Health-related quality of life (HRQoL) and aesthetic outcomes were assessed using the Short Form 36 questionnaire and a satisfaction visual analogue scale respectively.

RESULTS

In total, 108 free tissue transfers were performed; 23% were fasciocutaneous free flaps, 69% musculocutaneous and 8% osteoseptocutaneous. The overall flap success rate was 92.6%. Over a third of patients (34.3%) had flap-related complications ranging from minor wound dehiscence to total flap loss. ASA (American Society of Anesthesiologists) grade ≥2 (OR: 16.9, 95% CI: 15.3–18.1, p<0.009), history of smoking (OR: 6.1, 95% CI: 5.5–7.2, p<0.049), body mass index ≥25kg/ m² (OR: 21.3, 95% CI: 20.8–22.1, p<0.003), low albumin (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.2–3.9, p<0.003) and peripheral vascular disease (OR: 6.9, 95% CI: 5.9–7.5, p<0.036) were identified as factors independently predictive of free flap complications.

CONCLUSIONS

Patients undergoing uncomplicated free flap surgery and those reporting superior post-operative flap aesthesis have higher HRQoL scores. Microvascular free tissue transfer has revolutionised our approach to the reconstruction of complex defects, providing a safe, reliable procedure to restore functionality and quality of life for patients.     

The prognosis for pain, disability, activities of daily living and quality of life after an acute osteoporotic vertebral body fracture: its relation to fracture level, type of fracture and grade of fracture deformation

The level of the acute osteoporotic vertebral fracture, fracture type and grade of fracture deformation were determined in 107 consecutive patients and related to pain, disability, activities of daily living (ADL) and quality of life (QoL) after 3 weeks, 3, 6 and 12 months. Two-thirds of the fractured patients were women and with a similar average age, around 75 years, as the men. Fifty-eight of the acute fractures were located in the thoracic spine and 49 in the lumbar spine and predominantly at the Th12 and L1 levels. Sixty-nine percent of the fractures were wedge, 19% concave and 12% crush fractures. There were 22 mildly, 50 moderately and 35 severely deformed vertebrae. The grade of fracture deformation was not related to gender, age or fracture location. Severely deformed vertebrae predominantly (92%) occurred among the crush fracture type. One year after the fracture, irrespective of fracture level, fracture type or grade of fracture deformation, 4/5 still had pronounced pain and deteriorated QoL. Initial severe fracture deformation by far was the worst prognostic factor for severe lasting pain and disability, and deterioration of ADL and QoL. Factors like fracture level, lumbar fractures tended to improve steadily while thoracic deteriorated, type of fracture, the wedge and concave resulting in less pain and better QoL than the crush fracture type and gender influenced to a lesser extent the outcomes during the year after the acute fracture.     

A safety and quality of life analysis of intravaginal slingplasty in female stress incontinence: a prospective,open label,multicenter, and observational study

This prospective, open label, multicenter, and observational study was performed to determine the efficacy, safety, and the impact of this procedure on the current quality of life (QOL). One hundred three women underwent the intravaginal slingplasty (IVS) procedure. The postoperative evaluation consisted of clinical examination, Incontinence Quality of Life (I-QOL) questionnaire, 3-day consecutive frequency volume chart, free flowmetry, and measurement of post void residual. At 12 months, 83 patients have completed follow-up and are included in this analysis. Patient assessment of continence revealed 89.2% (74/83) cure rate. During follow-up period, one patient (1.2%) has presented with vaginal erosion of the sling material. The I-QOL showed significant improvement in total and three subscale scores at 12 months of follow-up period. This study demonstrated that the IVS procedure provides a safe and effective means for the treatment of female stress incontinence and improvement of QOL.