Indications for and complications of intestinal stomas in the children and adults at a tertiary care hospital in a resource-limited setting: a Tanzanian experience
Abstract Background An intestinal stoma, though a life-saving procedure on the care of many gastrointestinal conditions, carries significant number of complications. This study describes the common indications, complications, and management of stomas and identifies the factors that are associated wi...
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| Format: | Article |
| Language: | English |
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BMC
2019-08-01
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| Series: | BMC Gastroenterology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12876-019-1070-5 |
| _version_ | 1818189084149940224 |
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| author | Alicia Massenga Alfred Chibwae Aloyce A. Nuri Merchades Bugimbi Yasin K. Munisi Ramadhani Mfinanga Phillipo L. Chalya |
| author_facet | Alicia Massenga Alfred Chibwae Aloyce A. Nuri Merchades Bugimbi Yasin K. Munisi Ramadhani Mfinanga Phillipo L. Chalya |
| author_sort | Alicia Massenga |
| collection | DOAJ |
| description | Abstract Background An intestinal stoma, though a life-saving procedure on the care of many gastrointestinal conditions, carries significant number of complications. This study describes the common indications, complications, and management of stomas and identifies the factors that are associated with these complications in a tertiary care hospital in Tanzania. Methods A cross-sectional study of patients with intestinal stomas was conducted at Bugando Medical Centre (BMC) between July 2016 and June 2017. Ethical approval to conduct the study was obtained from relevant authority before the commencement of the study. Results A total of 167 patients (M: F = 1.2:1) were enrolled in the study. The mean age at diagnosis was 0.6 ± 1.4 years for children and mean age for adults was 36.7 ± 15.8 years. Anorectal malformation (110, 89.4%) was the most common indication for intestinal stoma formation in children, while bowel perforation (14, 31.8%) was the main indications in adults. The sigmoid colon (137, 82.0%) was the most common anatomical site for stoma formation followed by the ileum (18, 10.8%). Stoma prolapse (18, 41.9%) was the most frequent complication of a stoma, whereas, surgical site infection (9, 34.6%) was the most frequent complication after stoma closure. Thirty five (26.7.%) of the children developed stomal complications, while only 8 (22.2%) of the adults developed complications. The level of training of operating surgeon and timing of surgery were the main predictors of stoma-related complications (p < 0.034 and 0.013), whereas the level of training of the operating surgeon and the type of stoma closure were significantly associated with the complications related to stoma closure (p < 0.001). Conclusion The intestinal stomas performed at BMC are associated with various complications, which in turn, become a burden to the patients. The insights observed in the current study may apply to other tertiary hospitals in Tanzania and Africa at large. We suggest that the keystones for improvement and control in the formation and complications of intestinal stomas are the following; colostomy formation should rarely be done in transverse colon, the procedure should be carried out by senior doctors (specialist) or junior doctors under close and direct supervision of the specialists, using proper meticulous techniques, and the need to determine and/or improve techniques for early detection of complications. |
| first_indexed | 2024-12-11T23:37:11Z |
| format | Article |
| id | doaj.art-b81afec2df3342b7a25aa172163665f0 |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-11T23:37:11Z |
| publishDate | 2019-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-b81afec2df3342b7a25aa172163665f02022-12-22T00:45:50ZengBMCBMC Gastroenterology1471-230X2019-08-0119111010.1186/s12876-019-1070-5Indications for and complications of intestinal stomas in the children and adults at a tertiary care hospital in a resource-limited setting: a Tanzanian experienceAlicia Massenga0Alfred Chibwae1Aloyce A. Nuri2Merchades Bugimbi3Yasin K. Munisi4Ramadhani Mfinanga5Phillipo L. Chalya6Department of Surgery, Bugando Medical CentreDepartment of Surgery, Bugando Medical CentreDepartment of Surgery, Bugando Medical CentreDepartment of Surgery, Bugando Medical CentreDepartment of Surgery, Bugando Medical CentreDepartment of Surgery, Bugando Medical CentreDepartment of Surgery, Bugando Medical CentreAbstract Background An intestinal stoma, though a life-saving procedure on the care of many gastrointestinal conditions, carries significant number of complications. This study describes the common indications, complications, and management of stomas and identifies the factors that are associated with these complications in a tertiary care hospital in Tanzania. Methods A cross-sectional study of patients with intestinal stomas was conducted at Bugando Medical Centre (BMC) between July 2016 and June 2017. Ethical approval to conduct the study was obtained from relevant authority before the commencement of the study. Results A total of 167 patients (M: F = 1.2:1) were enrolled in the study. The mean age at diagnosis was 0.6 ± 1.4 years for children and mean age for adults was 36.7 ± 15.8 years. Anorectal malformation (110, 89.4%) was the most common indication for intestinal stoma formation in children, while bowel perforation (14, 31.8%) was the main indications in adults. The sigmoid colon (137, 82.0%) was the most common anatomical site for stoma formation followed by the ileum (18, 10.8%). Stoma prolapse (18, 41.9%) was the most frequent complication of a stoma, whereas, surgical site infection (9, 34.6%) was the most frequent complication after stoma closure. Thirty five (26.7.%) of the children developed stomal complications, while only 8 (22.2%) of the adults developed complications. The level of training of operating surgeon and timing of surgery were the main predictors of stoma-related complications (p < 0.034 and 0.013), whereas the level of training of the operating surgeon and the type of stoma closure were significantly associated with the complications related to stoma closure (p < 0.001). Conclusion The intestinal stomas performed at BMC are associated with various complications, which in turn, become a burden to the patients. The insights observed in the current study may apply to other tertiary hospitals in Tanzania and Africa at large. We suggest that the keystones for improvement and control in the formation and complications of intestinal stomas are the following; colostomy formation should rarely be done in transverse colon, the procedure should be carried out by senior doctors (specialist) or junior doctors under close and direct supervision of the specialists, using proper meticulous techniques, and the need to determine and/or improve techniques for early detection of complications.http://link.springer.com/article/10.1186/s12876-019-1070-5Intestinal stomasIndicationsComplicationsManagementTanzania |
| spellingShingle | Alicia Massenga Alfred Chibwae Aloyce A. Nuri Merchades Bugimbi Yasin K. Munisi Ramadhani Mfinanga Phillipo L. Chalya Indications for and complications of intestinal stomas in the children and adults at a tertiary care hospital in a resource-limited setting: a Tanzanian experience BMC Gastroenterology Intestinal stomas Indications Complications Management Tanzania |
| title | Indications for and complications of intestinal stomas in the children and adults at a tertiary care hospital in a resource-limited setting: a Tanzanian experience |
| title_full | Indications for and complications of intestinal stomas in the children and adults at a tertiary care hospital in a resource-limited setting: a Tanzanian experience |
| title_fullStr | Indications for and complications of intestinal stomas in the children and adults at a tertiary care hospital in a resource-limited setting: a Tanzanian experience |
| title_full_unstemmed | Indications for and complications of intestinal stomas in the children and adults at a tertiary care hospital in a resource-limited setting: a Tanzanian experience |
| title_short | Indications for and complications of intestinal stomas in the children and adults at a tertiary care hospital in a resource-limited setting: a Tanzanian experience |
| title_sort | indications for and complications of intestinal stomas in the children and adults at a tertiary care hospital in a resource limited setting a tanzanian experience |
| topic | Intestinal stomas Indications Complications Management Tanzania |
| url | http://link.springer.com/article/10.1186/s12876-019-1070-5 |
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