Page 14 - Tina van Loon
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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
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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”
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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
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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.
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