Complications
Treatment options included medication, enemas and manual evacuation.
In a multi-centre, non-randomised trial, 99 of 112 patients reported 384 device-related adverse events; 51 (46%) of patients required revision operation; 37% had their devices explanted; 7 of these 51 patients had successful reimplantation.[65]
Often minimal sequelae but meticulous wound care with cleaning is required. Encourage regular sitz baths (a type of bath where only the hips and buttocks are submerged). Avoid constipation by avoiding opiate analgesia and giving regular laxatives.
Infection may require removal of the device, antibiotic therapy, and consideration of alternative treatment strategies.
Local skin irritation and excoriation is particularly likely if left untreated. Advice on continence pads and skin care products can help to minimise this risk.
Social stigmatisation is common, resulting in exclusion, anxiety, and depression. Empathy, support, and advice should be offered, with referral to mental health services if psychological issues persist.
If symptoms recur, endoanal ultrasound may be indicated to exclude a recurrent disruption. Subsequent repair may be indicated. Otherwise biofeedback may sustain normal function.
Many complications are related to technical issues in construction of the stoma along with patient-related factors (e.g., weight) but can be controlled with appropriate stoma appliances (e.g., convex appliances for stoma retraction stoma belts for parastomal hernia control). Using prosthetic mesh to reinforce the stoma when it is initially formed may reduce the risk of parastomal hernia at 6 to 24 months compared with no mesh reinforcement.
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Some stomas may require surgical refashioning. After anterograde irrigation surgery, appendicostomy stenosis occurs in over 36% of patients and may require surgical revision.[85]
Device failure may occur for several reasons. Simple adjustment of the electrode configuration, and the amplitude and frequency of the electrical impulses may resolve the problem. Dislodgement or fracture of the leads requires replacement.
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