Page 14 - Tina van Loon
P. 14

Chapter 1

              the  time  of  operation  and  suture  the  mucosa  to  the  skin;  no complications  have
              occurred  from  this”  has  significantly  increased  the  outcomes  for,  but  also  the
              number  of  patients  with  ileostomies.   This  has  also  led  to  the  way  in  how  we
              fashion our protruding stomas up until this day.

              Surgeons were inventive in creating stomas; however, they were of little help in
              developing  ways  to  manage  the  stomal  output  and  stoma  care.  The  first  stoma
              patients were pioneers, there were no appliances available and no one to turn to
              for guidance or when problems were encountered. This changed when dr. Rupert
              Turnbull recruited one of his former ileostomy patient as “enterostomal therapist”
              in 1958.  Together they have developed reliable pouching systems and established
              stoma  support  systems  and  formal  training  programs.  It  is  clear  that  especially
              those  experts  by  experience  are  essential  in  their  expertise,  management  and
              guidance for new stoma patients.

              According  to  the  Dutch  stoma  care  nurses  society,  there  are  about  32,000
              permanent  ostomy  carriers  in  the  Netherlands  (0.2%  of  the  population)  and
              approximately 7000 ostomies (temporary and permanent) are being placed each
              year  (0.04%  of  the  population).  Due  to  increasing  life  expectancy,  aging  of  the
              population  and  active  screening  programs  for  colorectal  malignancies,  both  the
              overall  number  of  ostomy  carriers  as  well  as  the  proportion  of  elderly  ostomy
              carriers, is expected to rise even further in future years. Ostomies are being placed
              in  35%  of  the  older  colorectal  surgery  patients.   Decision‐making  regarding
              colorectal surgery is challenging, especially in the elderly. It is therefore important
              to  have  insight  in  the  potential  physical  and  mental  impact,  as  well  as  care
              dependency and postoperative morbidity due to an ostomy in our patients. This
              information can be useful in preoperative patient counseling as well as in shared
              decision‐making. Collecting such information was the primary goal of this thesis.

   9   10   11   12   13   14   15   16   17   18   19